California Lawmakers to Newsom: Give All Immigrants Health Coverage

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SACRAMENTO — California Democratic lawmakers so far have failed to convince Gov. Gavin Newsom that the state can afford to spend an estimated $2.6 billion a year to expand its Medicaid program to all unauthorized immigrants.

Now, they’re trying a new strategy.

Rather than working independently, a fiercely liberal state senator from Los Angeles and a moderate Assembly member from the Central Valley are joining forces to pressure Newsom to make California the first state in the nation to cover every income-eligible resident regardless of immigration status. Unauthorized immigrants up to age 26 can already qualify for Medi-Cal, the state’s Medicaid program for low-income residents.

Emboldened by the win of Democratic President-elect Joe Biden and spurred by the urgency of the coronavirus pandemic, state Sen. María Elena Durazo (D-Los Angeles) and Assembly member Joaquin Arambula (D-Fresno) plan to introduce a two-bill package on Monday that would cover unauthorized senior immigrants first, and eventually the remainder of California’s undocumented immigrant population.

“It’s a national issue. Look at how all the national Democratic candidates raised their hands in front of the world to support covering undocumented immigrants in health insurance,” Durazo told California Healthline. “We want a clear commitment to finally do this, not just lip service.”

Newsom has long touted his goal of achieving universal health coverage in California and made campaign promises to work toward a single-payer health care system. But after nearly two years in office, Newsom’s ambitious health care agenda has been sidetracked by deadly wildfires and a widening homelessness crisis — as well as the COVID-19 pandemic — and he has not managed to dramatically expand coverage.

California currently covers about 200,000 unauthorized immigrant children and young adults, according to the state Department of Health Care Services. The state budgeted about $375 million to cover young adults ages 19 through 25 this fiscal year, but does not track spending for undocumented immigrant children, according to the state Department of Finance.

Opening the low-income health program to all eligible undocumented immigrants would expand coverage to at least 915,000 low-income residents and cost an additional $2.6 billion annually, according to a projection this year by the nonpartisan state Legislative Analyst’s Office. There are an estimated 1.5 million undocumented immigrant Californians who are uninsured, estimates show, but not all of them would qualify.

Public support for expanding coverage to unauthorized immigrants has risen over the past few years, according to the Public Policy Institute of California. But expending scarce taxpayer resources on such an effort is politically risky, said Doug Herman, a Los Angeles-based national Democratic strategist.

“Gavin’s got bigger priorities right now and he has been wounded, so he has to be very cautious about what he does,” Herman said. “Look at the French Laundry and [Employment Development Department] scandals. The homelessness crisis is raging and the prison outbreak happened on his watch. This doesn’t rise to that level.”

Newsom communications director Jesse Melgar said no one from his office was available for comment.

Since Newsom took office, Durazo and Arambula have authored separate bills to expand Medi-Cal to more undocumented immigrants. Durazo has gotten close after negotiating with Newsom — only for the first-term Democratic governor to back out, citing costs.

Such proposals have received widespread legislative support among Democratic lawmakers, who hold supermajority power in both houses of the state legislature.

A worsening economic outlook and long-term budget pressures could once again derail their efforts. Because the federal government prohibits states from using federal Medicaid dollars to cover undocumented immigrants — except for emergency services — California would have to pick up most of the price tag, which could top $3 billion annually to cover everyone, including children and adults, according to the Legislative Analyst’s Office.

Newsom will be forced to weigh an onslaught of budget demands while managing, and paying for, the ongoing COVID-19 emergency.

“That gives Newsom the ability to delay or oppose anything that doesn’t fit his agenda,” Herman said.

But some lawmakers, immigration rights activists and health care advocates argue the COVID pandemic has made their campaign more urgent as Latino and Black residents get sick and die at disproportionate rates.

Politicians cannot ignore that the pandemic has exposed a broken health care system that has left millions of taxpaying Californians without health coverage because their immigration status renders them ineligible, said Sarah Dar, director of health and public benefits for the California Immigrant Policy Center, which is already lobbying the governor to support the Medi-Cal expansion.

“Now we have a full picture of what this crisis is, and the blatant disparities faced by our essential workers, so there’s no excuse,” she said. “Immigrant communities and farmworkers in the food and agricultural sector, like meatpacking plants, have literally been hotbeds for the spread of disease.”

Dar acknowledged financial pressures ahead for the state, and said advocates will be pushing for ways to generate money to pay for the expansion, possibly including tax increases.

There could be some hope for a one-time cash infusion. Fiscal estimates show California could reap a $26 billion surplus next year, largely from personal income tax receipts from high-income earners who have not suffered devastating economic losses during the pandemic, according to state fiscal analysts. Durazo and Arambula are eyeing that revenue for the Medi-Cal expansion.

“He has routinely stated his vision, but we’d like Gov. Newsom to deliver on health care for all during his governorship,” Arambula said. “I’m not going to sit and wait.”

Durazo said she would introduce a bill Monday to expand Medi-Cal to unauthorized immigrant Californians age 65 and older. She put a similar bill on hold in 2019, in exchange for a commitment from Newsom to include the proposal in this year’s state budget.

Newsom included the proposal in the first version of his state budget in January, but then withdrew it, citing soaring unemployment, business closures and an economy decimated by the pandemic.

Durazo and other backers decided to craft a new approach: Alongside Durazo’s bill to cover older adults, Arambula plans to introduce companion legislation to cover all undocumented immigrant adults.

The lawmakers are using the two bills as a negotiating tactic. Arambula and advocates said they hope to win coverage for undocumented immigrants 65 and older next year, while developing a plan with Newsom to expand coverage to the entire population at some point during his governorship.

Durazo said both bills are equally important and are intentionally being used to pressure the governor into action next year.

“This is our way to finally have a real conversation about what it’ll take to get everyone covered, given we’ll have federal partners with the Biden-Harris administration,” said Orville Thomas, director of government affairs for the California Immigrant Policy Center.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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California Law Banning Toxic Chemicals in Cosmetics Will Transform Industry

A toxic chemical ban signed into law in California will change the composition of cosmetics, shampoos, hair straighteners and other personal care products used by consumers across the country, industry officials and activists say.

The ban, signed by Gov. Gavin Newsom at the end of September, covers 24 chemicals, including mercury, formaldehyde and several types of per- and polyfluoroalkyl substances, known as PFAS. All the chemicals are carcinogenic or otherwise toxic — and advocates argue they have no place in beauty products.

When the law takes effect in 2025, it will mark the first major action to remove toxic substances from beauty products in almost a century. Federal regulation of cosmetics has not been updated meaningfully since 1938, and only 11 ingredients in personal care products are regulated by the Food and Drug Administration. By contrast, the European Union bans more than 1,600 cosmetic substances and ingredients from cosmetics.

The California law, passed by wide margins in both houses of the legislature, “is a milestone for cosmetic safety in the United States,” said Emily Rusch, executive director of the California Public Interest Research Group, which was heavily involved in shaping the bill.

The Personal Care Products Council, which represents big companies like Amway and Chanel, was hesitant but eventually supported the bill and worked directly with legislators on its final form. The industry’s buy-in will help give the California law national repercussions.

“If you’re doing business in the United States, you’re doing business in California,” said Mike Thompson, senior vice president for government affairs at the council. “I would assume that this would really, in many ways, set up a new standard.”

Breast Cancer Prevention Partners, another activist group, advocated strongly for the measure because many of the banned chemicals have been linked to breast cancer, said Janet Nudelman, the group’s director of program and policy.

For salon workers like Kristi Ramsburg, the bill could offer the peace of mind that comes from knowing her workplace is freer of toxics. Over the 20 years she’s worked as a hairdresser in Wilmington, North Carolina, Ramsburg has done hundreds of straightening jobs on her clients’ naturally frizzy hair. Performing the procedure known as a Brazilian Blowout three to four times a week exposed her to harsh and dangerous/toxic products including formaldehyde and phthalates.

She experienced “sore throats, dizziness. My vision changed, definitely,” she said. “You’d be almost crying at first.”

Studies dating to the early 1900s show that inhaling even small quantities of formaldehyde can lead to pneumonia or swelling of the liver. It’s been classified as a carcinogen, according to the FDA.

Ramsburg believes her exposure severely damaged her health. Over six years, she had surgeries to remove her gallbladder, ovaries and appendix. After her liver swelled dangerously, she suspected, based on medical consults and studies she read, that the formaldehyde she had been breathing for decades was to blame.

“I was just inundated with toxins constantly. I literally almost died,” she said.

Horror stories like Ramsburg’s are what motivated legislators, as well as the cosmetic industry, to support the California law.

Federal legislation that would have given the FDA more power to control or recall products containing the 11 federally regulated ingredients failed to gain traction in either chamber in recent sessions, despite the support of celebrities like Kourtney Kardashian.

Advocates say the inadequacies in federal regulation have been apparent for years. Current law does not require cosmetics to be reviewed and approved by the FDA before being sold to consumers. And the agency can take post-marketing action only if a cosmetic’s ingredients were found to be tampered with or its labeling is wrong or misleading.

The FDA couldn’t even intervene when asbestos was found in cosmetics sold at the youth-oriented Claire’s and Justice stores. In a 2019 letter, then-FDA Commissioner Scott Gottlieb wrote that his hands were tied because “there are currently no legal requirements for any cosmetic manufacturer marketing products to American consumers to test their products for safety.” No action was taken.

FDA scientists moved to ban formaldehyde from hair straighteners as early as 2016, according to internal agency emails, but weren’t successful. A 2019 study by government investigators found that using hair straighteners was linked with a higher risk of breast cancer, which rose with increased use. The study also found that using permanent hair dye was linked with an increased breast cancer risk.

After the federal legislation stalled, advocates changed their focus to California. The Golden State’s liberal leanings made it a likely place to pass a bill, while its status as the world’s fifth-largest economy meant any new law would have national impact. That has previously been the case, as when California set its own limits on car emissions or demanded nutrition labels for restaurant menus.

“It plays that pivotal role nationwide and has such a large economy, and so much of the cosmetic industry has a huge base here,” said Rusch, of the California Public Interest Research Group. “This type of landmark legislation has the effect essentially of setting a national standard. That was our intent.”

The Personal Care Products Council was open to the ban since the chemicals on the list — after some pruning during negotiations on the bill — include only those already prohibited in the European Union.

“You don’t want a patchwork of rules, either around the country or around the world. You want consistency,” Thompson said. “A lot of our companies may be already there, because they’re designing products for the European Union. … It’s just simpler for them to put out one product versus two.”

In recent years, growing consumer demand for transparency in beauty products has led to the development of a “clean cosmetics industry” whose products make up about 13% of high-end sales, double the percentage four years ago, according to the market research company NPD Group.

Drug and department stores have also increasingly moved toward “clean” products. CVS in 2019 removed parabens, phthalates and chemicals that contain or can give off formaldehyde from its store-brand products.

Advocates argue that the state law will force all companies to provide transparency and consistency about what, exactly, is in the products consumers put on their hair and faces.

“In order to ensure and give assurance to the public that the worst of the worst stuff is out of cosmetics, we felt we really needed to standardize and to put that into statute,” Rusch said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Amid COVID Chaos, California Legislators Fight for Major Health Care Bills

California lawmakers are barreling toward an end-of-month deadline to pass or kill bills amid the biggest public health crisis the state has faced in a century.

Yet even in a year consumed by sickness, they’re considering significant — sometimes controversial — health policy measures that aren’t directly related to COVID-19.

Much of this legislation predates the pandemic, having lacked the support to win approval in previous years. Now, the bills are making significant progress because they underwent rigorous vetting in the past. That puts them steps ahead in a year with little time for deliberation or debate.

They include bills to ban the sale of flavored tobacco products, such as menthol cigarettes and vaping liquids; allow California to develop its own brand of generic drugs; enhance the state attorney general’s power to reject hospital mergers; and allow nurse practitioners to practice independently.

“Some of these bills, which have pretty far-reaching effects, may just sweep through because [lawmakers are] trying to get out of here by the end of August,” said Garry South, a Democratic political strategist.

The California legislature has had a bizarre year. Lawmakers left town abruptly in March to comply with lockdown orders and then again in July when some Assembly members tested positive for COVID-19, cutting the legislative session short.

The reduced time means most policy committees scheduled fewer hearings in the last weeks of the session to debate bills. Because of COVID-19 restrictions, most witnesses are giving testimony over the phone and in video conferences, lawmakers are unable to have informal meetings in the hallways, and advocates have less opportunity to lobby officials.

Lawmakers face an Aug. 31 deadline to send bills to Gov. Gavin Newsom, who has until the end of September to sign or veto them.

Given the shortened time frame for voting and deliberation, legislative leaders repeatedly asked committee chairs and members of their houses to reduce their legislative load, focusing on the most pressing challenges, like COVID-19 and wildfires. Despite those directives, most officials acknowledge a need to address more than those issues this year.

“We have the capacity to do many different things, and there are many things we must tend to in this state,” Newsom said at a press conference in late July. “I look forward to signing many bills that the legislature sends down.”

Passage is not guaranteed in the last three chaotic weeks of the legislative session, but the following major health care bills have made it through one house of the legislature and are working their way through committees in the second chamber.

  • SB-977 would give the attorney general new authority to regulate and potentially deny mergers between large for-profit hospitals, private equity firms and physicians’ groups. Attorney General Xavier Becerra has been working on this legislation for years in the face of strong opposition from hospitals.
  • SB-793 is an enormously controversial bill that would go beyond the recent federal ban on flavors in vape cartridges, which excludes menthol and tobacco flavors. This measure would ban the sale of most flavored tobacco products statewide, including menthol cigarettes, an idea that has died and been resurrected in many forms in both the Senate and Assembly.
  • AB-890 represents another long-standing Capitol feud, with the powerful doctor lobby opposing. The measure would allow nurse practitioners — nurses with advanced degrees and training — to practice medicine in some cases without oversight from a physician.
  • SB-852 would establish a state office that would contract with drug manufacturers to produce or distribute low-cost generic drugs in California. Newsom floated the idea in January.

It’s not an accident that such weighty bills are the ones left standing after legislators were asked to slash their portfolio of bills this year, said Sen. Richard Pan (D-Sacramento), who chairs the Senate Health Committee.

When Pan culled the bills his committee would consider, he eliminated measures with unresolved questions, he said, because administration officials dealing with the pandemic were less available to testify as witnesses and lawmakers were unable to work closely with one another in the Capitol.

“Is this something that needs to be done this year?” Pan said he asked himself.

That means many of the bills moving through his committee and other policy committees are largely the ones that have been scrutinized in previous years, Pan said.

“We spent a lot of time working through those issues and trying to get those all resolved for the committee,” Pan added.

But South warned that even legislation that has been heard in the past deserves the full debate and deliberation that would take place in a typical year.

“I don’t think the process is set up this year to be passing major legislation that affects major sections of society without adequate input from stakeholders and the general public,” he said.

Some lawmakers are keeping other measures alive by using the pandemic to sharpen pitches for their pre-COVID bills, with the refrain “Now more than ever.” Sure, the bill was important when it was introduced in February, they argue, but “now more than ever” it really has to pass.

“You’ve got legislators not used to having so many of their bills threatened,” said Rob Stutzman, a Republican political consultant. “It’s not surprising they’d be trying to adapt their proposals to the narrowed purview of this session, which is obviously COVID-related.”

Sen. Jerry Hill (D-San Mateo), author of the tobacco flavor bill, is employing this tactic.

“I know we’ve all had to reassess our priorities,” Hill said at an Assembly committee hearing. “Yet emerging evidence about smoking and COVID-19 suggests smoking can put people at greater risk.”

Another example of the “Now more than ever” trend is SB-855, a “mental health parity” bill that would strengthen requirements for private health insurance to cover medically necessary treatment for mental illnesses.

“Even before COVID, mental health and addiction were major crises in this country,” but the pandemic is making the crises worse, the bill’s author, Sen. Scott Wiener (D-San Francisco), said at a press conference last week. “People who were stable with their mental health are now losing stability.”

That’s not to say using COVID-19 as justification to pass a bill is just a gimmick; some problems really have gotten worse since the start of the pandemic, said Larry Levitt, executive vice president of health policy at KFF. (KHN, which produces California Healthline, is an editorially independent program of the Kaiser Family Foundation.)

“Mental health is a perfect example of the pandemic exacerbating problems that were already there,” he said.

Wiener’s measure has survived the Senate and several committees, but other lawmakers haven’t seen the same success.

Assembly member Adrin Nazarian (D-Van Nuys) lobbied hard for AB-2203, which would have capped out-of-pocket payments for insulin. Nazarian pointed to a study from the Centers for Disease Control and Prevention that showed 40% of people who died of COVID-19 had diabetes.

His bill sailed through the Assembly but wasn’t given a hearing in the Senate. He said he followed directions from leadership to reduce the number of bills he was carrying, paring them down from about 25 to fewer than 10.

“Without a pandemic, this was a straightforward bill that would protect consumers and curb health care costs,” Nazarian said. “I’m extremely upset and frustrated about this.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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