BILL ANALYSIS Ó
AB 2424
Page 1
ASSEMBLY THIRD READING
AB
2424 (Gomez)
As Amended May 31, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |14-2 |Wood, Maienschein, |Olsen, Patterson |
| | |Bonilla, Burke, | |
| | |Campos, Chiu, | |
| | |Dababneh, Gomez, | |
| | | | |
| | | | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Rodriguez, Santiago, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |14-6 |Gonzalez, Bloom, |Bigelow, Chang, |
| | |Bonilla, Bonta, |Gallagher, Jones, |
| | |Calderon, Daly, |Obernolte, Wagner |
| | |Eggman, Eduardo | |
| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Quirk, Santiago, | |
| | |Weber, Wood | |
AB 2424
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| | | | |
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SUMMARY: Creates a Community-based Health Improvement and
Innovation (CHII) Fund for certain purposes, including funding
for health inequity and disparities in the rates and outcomes of
priority chronic health conditions. Specifies funds are
available to reduce health inequity; prevent the onset of
priority chronic health conditions, as defined; strengthen local
and regional collaborations; and evaluate effectiveness and
cost-effectiveness of community-based prevention strategies for
priority chronic health conditions. Specifies funds can be used
for activities as described. Specifies policy, systems, and
environmental change approaches. Specifies a target level of
annual statewide investment from the fund that must be
established as a set dollar amount per capita, and allocates
funds to the California Department of Public Health (DPH).
Specifies funds shall supplement and not supplant existing
funding for community-based prevention activities of priority
chronic health conditions, and that participating hospitals and
health plan partners must identify monetary or in-kind
contributions to local projects. Creates an advisory committee
to offer expert input and guidance to DPH on the development,
implementation, and evaluation of the fund. Requires
implementation contingent on a budget appropriation.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)DPH would incur one-time costs for staffing, information
technology, and contracts, likely in the low millions of
dollars. Ongoing costs would depend on the total allocation
and the number of grants and contracts to be managed.
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2)This bill does not specify a funding source or amount, but it
is safe to assume a program of the scale envisioned would cost
in the tens of millions of dollars General Fund (GF) per
three-year cycle, in absence of another fund source. Based on
the minimum $250,000 allocated to each local health
jurisdiction, which would make up 50% of the funding, as well
as the ambitious nature and comprehensiveness of the program,
staff estimates cost pressure of $30.5 million GF at a
minimum. Assuming a program of this size, $2.8 million would
be allocated to communications and media, $1.5 million to
evaluation, up to $1.8 million for DPH administration and
oversight, $15.3 to local health jurisdictions to implement
community-based health improvement activities, and $9.1
million for competitive grants.
3)A related stakeholder proposal request for a $380 million GF
appropriation for a CHII Fund was discussed in the Assembly
Budget Subcommittee 1 on April 11, 2016. This represents
nearly a $10 per capita investment, which would support one
cycle of a three-year grant program.
4)Research indicates funding evidence-based, community-based
chronic disease prevention activities can have a high return
on investment in terms of health care cost savings. A return
on investment (ROI) analysis is beyond the scope of this
estimate, but as this bill focuses on the most costly and
preventable conditions, including obesity, heart disease, and
diabetes, and assuming the activities were evidence-based and
well-implemented, it is reasonable they could lead to
improvements in population health and a corresponding a
reduction in health care cost growth statewide, and for the
state as a large payer. In addition, the bill's focus on
health equity priority populations is likely to have a
significant overlap with the Medi-Cal population, increasing
the chances of a positive ROI for the state. Finally, the
bill's emphasis on funding systems and policy changes means
health-promoting changes adopted pursuant to this program may
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have a lasting impact. For example, the tobacco control
program led to changes in public acceptance of tobacco use,
which in turn resulted in policies that are unlikely to be
reversed, such as tobacco-free workplaces.
COMMENTS: The author states that with this bill and with proper
management, innovative investment strategies, and equitable
distribution and implementation plans, the CHII Fund would help
the state achieve greater health equity and advance the "Triple
Aim" of health improvement: 1) better care; 2) better health;
and, 3) lower costs. According to the author, a $10 per capita
investment over three years (for prevention of disease which
accounts for 80% of health care costs) is actually fairly modest
for a statewide program with these goals. For comparison,
Massachusetts has invested a $60 million one-time in a similar
fund, which is similar in scale based on their population. The
state spends over $450 per capita from the General Fund just on
Medi-Cal every year - and much more when accounting for
California Public Employees' Retirement System employees and
retirees, as well as correctional health. According to the
author, DPH received a grant from the Centers for Disease
Control and Prevention (CDC) for $3.8 million to promote healthy
behaviors and reduce diabetes.
As part of the Patient Protection and Affordable Care Act of
2010, the Prevention and Public Health Investment Fund
(Prevention Fund) was created to provide communities around the
country with more than $15 billion over the next 10 years to
invest in effective, proven prevention efforts, like childhood
obesity and tobacco cessation. The Prevention Fund, in recent
years, has suffered legislative reduction and elimination of
major programs.
In 2012, the Assembly and Senate Committees on Health conducted
a joint hearing with the goal of highlighting the health
benefits and cost savings associated with investing in
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community-wide health promotion and disease prevention. The
hearing also highlighted prevention activities currently
underway at the time across the state to implement successful
strategies aimed at reducing health care costs and promoting
health and wellness.
In 2014, the Assembly Committee on Health held an Information
Hearing, entitled Supporting Public Health in California: The
Critical Role of the State and Local Departments in Disease
Surveillance and Control. The background included some
information of the following:
1)Department of Public Health. The mission of DPH is to
optimize the health and well-being of Californians, primarily
through population-based programs, strategies, and
initiatives. DPH is broadly organized into the Center for
Chronic Disease Prevention and Health Promotion, the Center
for Environmental Health, the Center for Family Health, the
Center for Health Care Quality, and the Center for Infectious
Diseases. California created the Health in All Policies Task
Force in 2010. The Task Force was charged with identifying
priority programs, policies, and strategies to improve the
health of Californians.
2)Local Health Departments. There are 61 local health
jurisdictions in California representing the 58 counties and
three cities: Berkeley, Long Beach, and Pasadena. Public
health officers have broad far-reaching authority and
responsibility under the law. For example, public health
officers have the authority to order testing for individuals
or communities, quarantine individuals or groups, and close
beaches, restaurants, and other facilities for public safety.
Public health officers receive reports from health providers
and laboratories concerning the incidence of more than 80
statutorily reportable diseases including HIV/AIDs,
tuberculosis, and syphilis. County health departments must
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submit monthly, quarterly, or annual public health and program
reports to state agencies including DPH and the Emergency
Medical Services Authority. County public health programs
vary substantially in their administrative structures, scope,
funding levels, staffing, and specific services and programs
offered.
3)Public Health Spending in California. The Governor's fiscal
year (FY) 2014-15 Budget provides $3 billion for the support
of DPH programs and services, a decrease of 11.4% from the
previous year. Of the amount approved, 23% ($683.3 million)
is for state operations and 77% ($2.3 billion) is for local
assistance.
4)Health Equity. According to the CDC, health equity is
achieved when every person has the opportunity to "attain his
or her full health potential" and no one is "disadvantaged
from achieving this potential because of social position or
other socially determined circumstances." Health inequities
are reflected in differences in length of life; quality of
life; rates of disease, disability, and death; severity of
disease; and, access to treatment. Established in 2012, DPH's
Office of Health Equity (OHE) aims to reduce health and mental
health disparities in vulnerable communities. The OHE is
required to consult with community-based organizations and
local governmental agencies to ensure that community
perspectives and input are included in policies, strategic
plans, recommendations, and implementation activities
5)Targeted federally funded programs. The largest prevention
program DPH administers is the Nutrition Education and Obesity
Prevention program, which provides health education
interventions to recipients of Supplemental Nutrition
Assistance Program benefits. In federal FY 2014, the CDC
provided about $303 million to entities in California,
including health departments, universities, and other public
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and private agencies. Of this total, about $62 million of
this funding statewide was allocated to different entities for
chronic disease and prevention activities.
Analysis Prepared by:
Kristene Mapile/ HEALTH / (916) 319-2097 FN:
0003240