BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 769
S
AUTHOR: Alquist
B
AMENDED: August 16, 2010
HEARING DATE: August 25, 2010
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CONSULTANT:
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Orr/
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PURSUANT TO S.R. 29.10
SUBJECT
Federal funding: supplemental appropriations: pandemic
influenza
SUMMARY
This bill provides that federal funding received pursuant
to the federal Supplemental Appropriations Act, 2009 for
pandemic flu preparedness and response, shall be subject to
appropriation by the Legislature for allocation by the
California Department of Public Health (CDPH) pursuant to
the 2008-09 federally approved collaborative state-local
plan, which effectively allocates funds in a 70/30
local/state split.
CHANGES TO EXISTING LAW
Existing law:
Establishes local health departments to protect and
preserve the public health. Provides for the allocation of
state aid to local health departments according to a
specified formula for prescribed purposes, including
communicable disease control activities and community and
public health surveillance activities.
Continued---
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Requires that federal funding received by the state for
bioterrorism preparedness and emergency response be subject
to appropriation in the annual Budget Act or other statute,
commencing with the 2003-04 fiscal year, and pursuant to
the federally approved collaborative state-local plan.
These provisions become inoperative as of September 1,
2010.
Established a basic allotment of one hundred thousand
dollars ($100,000) to the administrative bodies of each
local health jurisdiction (LHJ), subject to the
availability of funds appropriated in the annual Budget Act
or another act, for the 2003-04 fiscal year and subsequent
fiscal years. Requires that the balance, if any, of the
annual appropriation be allotted on a per capita basis in
proportion to the population of each eligible LHJ. These
provisions become inoperative as of September 1, 2010 and
are repealed as of January 1, 2011.
This bill:
Requires that federal funding received pursuant to the 2009
Supplemental Appropriations Act for pandemic influenza, for
purposes of state and local public health and emergency
response infrastructure, be subject to appropriation by the
Legislature in the annual Budget Act or other statute. This
applies to federal funding provided by the Public Health
Emergency Preparedness Cooperative Agreement and the Public
Health Emergency Response Cooperative Agreement for state
and LHJs.
Requires that the proportion of funds allocated to support
LHJ activities shall be at least the proportion stipulated
in the 2008-09 federally approved state applications for
the Public Health Emergency Preparedness Cooperative
Agreement unless stipulated otherwise by federal law or
guidance. Makes an exception if the department, in
consultation with the California Conference of Local Health
Officers (CCLHO) and the County Health Executives
Association of California (CHEAC), submits an application
that specifies a different funding allocation.
Allows CDPH to establish a minimum allocation of less than
one hundred thousand dollars ($100,000) to LHJs, if the
department consults with CCLHO and CHEAC.
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Declares the bill provisions inoperative on September 1,
2012, thereby extending the sunset date two years.
Makes findings and declarations regarding public health
infrastructure and the need to ensure that federal funds
for public health emergency response to a pandemic
influenza outbreak are distributed appropriately to LHJs.
Declares the bill an urgency measure in order to ensure an
adequate and timely response to the H1N1 virus and other
public health threats.
FISCAL IMPACT
The Assembly Appropriations Committee estimates unknown
future distributions of federal funding, in the 70 percent-
30percent sharing ratio.
BACKGROUND AND DISCUSSION
The author asserts that this bill establishes a standard
that local health departments (LHDs) receive at least 70
percent of any public health emergency preparedness funds
released to the state by the federal government. This
formula, called the 70/30 split, has been used by the state
since September 11, 2001 to allocate federal public health
emergency preparedness funds to the local health
jurisdictions. Over $500 million have been allocated to
California for public health emergency preparedness since
that time. These funds have been critical to the
modernization and enhancement of public health
infrastructure at the local level. Because of a lack of
both state and local funding, the author claims federal
dollars have been the only significant funds available to
improve the core public health capabilities of disease
identification, control and prevention. This bill also
extends the sunset on provisions that give CDPH the
authority to continue to allocate federal emergency
preparedness funds.
As a result of the H1N1 outbreak that began during the
spring of 2009, additional federal funding was supplied to
the states to respond to this public health threat.
Approximately $120 million has been provided to California
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for this purpose. The first three phases of this money have
been allocated to the locals on a 70/30 split. Several
billion dollars are still available at the federal level
for future pandemic flu outbreaks. This bill will insure
future federal allocations to California will be directed
to local levels based on the same 70/30 split.
Pandemic influenza
Influenza A (H1N1) virus is a subtype of influenza A and
the most common cause of flu in humans. In 2006, H1N1
caused approximately half of all human flu. In 2009, the
World Health Organization (WHO) declared that a new strain
of swine-origin was responsible for a global flu pandemic.
The WHO declared an alert level phase 6, indicating
widespread human infection. That was the first time it
raised the alert level that high in 40 years. The H1N1
isolated in American patients has been found to be a
genetic mixture of four strains: including avian, swine,
and human genetic characteristics.
Funding for public health emergency preparedness and
response
Congress authorized funding for the Public Health Emergency
Preparedness (PHEP) cooperative agreement to support
preparedness nationwide in state, local, tribal, and
territorial public health departments in 2002, shortly
after the events of September 11, 2001, and subsequent
anthrax attacks. The PHEP cooperative agreement provides
funding to enable public health departments to have the
capacity and capability to effectively respond to the
public health consequences of not only terrorist threats,
but also infectious disease outbreaks, natural disasters,
and biological, chemical, nuclear, and radiological
emergencies.
Congress appropriated funding in June 2009 through the 2009
Supplemental Appropriations Act for the "Public Health and
Social Services Emergency Fund" to prepare for and respond
to an influenza pandemic. This funding provided the
Department of Health and Human Services (HHS), the Centers
for Disease Control and Prevention (CDC), and other federal
and state agencies with resources to respond to ongoing and
emerging outbreaks of novel H1N1 influenza in the United
States. To date, CDC is administering $1.35 billion through
the Public Health Emergency Response (PHER) grant to
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upgrade state and local pandemic influenza preparedness and
response capacity.
Funding was distributed in phases. Phase I funding of $260
million was awarded beginning July 31, 2009. An additional
$248 million in PHER Phase II funding was released
nationwide beginning August 21, 2009, and another $846
million in PHER Phase III funding was awarded nationwide
for implementation of the 2009 H1N1 influenza mass
vaccination campaign, which began in October of 2009.
A total of $49.7 million in PHER Phase IV funding has been
awarded to 15 states and localities, including California,
to complete their H1N1 vaccination programs, specifically
targeting high-risk populations, minority and hard-to-reach
populations, and underserved and vulnerable populations
that may have been unable to access vaccination services
previously. Phase IV funds have been allocated using a
base-plus-population formula, with 100 percent of the funds
available beginning March 18, 2010.
Prior legislation
SB 678 (Ortiz), Chapter 35, Statutes of 2004, allocated
$18 million in federal funding for implementing
bioterrorism and smallpox preparedness measures to DPH and
LHJ.
SB 406 (Ortiz), Chapter 393, Statutes of 2002, established
requirements with respect to allocation of federal
emergency funding and the state-local plan similar to SB
769.
Arguments in support
The County of San Diego believes this bill establishes
procedures for the distribution of the federal funding
received by the state for the purpose of responding to a
pandemic influenza outbreak, and authorizes CDPH to
establish a minimum allocation of $100,000 to LHJs as
specified. Receipt of supplemental funding could help
support the maintenance of San Diego County's current
public health workforce and could improve the quality of
the county's response to a local influenza pandemic in
terms of surveillance, laboratory capacity, and technology.
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PRIOR ACTIONS
Senate Health: 11-0
Senate Floor: 36-0
Assembly Health: 18-0
Assembly Appropriations: 17-0
Assembly Floor: 77-0
Senate Floor: 26-1
Assembly Floor: 76-0
COMMENTS
1. Recent amendments. When this bill was heard in the
Senate Health Committee on April 22, 2009, it did the
following:
a. Required federal funding received pursuant to the
Recovery Act, for purposes of
chronic disease prevention and wellness, to be subject
to appropriation by the
Legislature commencing with the 2009-10 fiscal year.
b. Provided that its provisions apply when federal funding
is allocated and expended for
disease control and prevention activities by LHJs and
specifies that funds appropriated
for those purposes cannot be used to supplant funding
for existing levels of service.
c. Required allocations to be made by the Department of
Public Health (DPH) to the
administrative bodies of qualifying local health
jurisdictions and requires funds to be
used for activities to improve and enhance
evidence-based clinical and community-
based prevention and wellness strategies authorized by
the federal Public Health
Services Act that deliver specific measurable health
outcomes that address chronic
disease rates.
The Assembly amendments:
a. Specify that the provisions of the bill apply to federal
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funding provided by the Public
Health Emergency Preparedness Cooperative Agreement
and the Public Health
Emergency Response Cooperative Agreement for state and
local health jurisdictions
(LHJ).
b. Require that the proportion of funds allocated to
support LHJ activities shall be at
least the proportion stipulated in the 2008-09
federally approved state applications for
the Public Health Emergency Preparedness Cooperative
Agreement unless stipulated
otherwise by federal law or guidance with specified
exceptions.
c. Allow the department to establish a minimum allocation
of less than one hundred
thousand dollars ($100,000) to LHJs, as specified.
d. Sunset the bill as of January 1, 2013.
e. Declare the bill an urgency measure.
POSITIONS
Support: Health Officers Association of California
(Sponsor)
California State Association of Counties
County Health Executives Association of California
County of San Diego
Regional Council of Rural Counties
Santa Clara County Board of Supervisors
Urban Counties Caucus
Oppose: None received
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