The annual state budget process, which began in January, comes into focus later this week when the Governor releases the May Revision of his proposed 2015-16 budget. Health and community advocates are urging the Governor and the Legislature to include funding for critical health programs in upcoming budget negotiations. These investments continue the Affordable Care Act’s momentum by removing barriers to coverage, ensuring those covered in Medi-Cal get access to care along with important benefits, and extending coverage to the remaining uninsured.

The deadline for the Legislature to pass and the Governor to sign a budget is June 15. The Governor’s May Revision sets the stage for a short month of negotiations, shaped by information about how much of a surplus is available given the state revenues that came in during April tax time, and constitutional formulas that limit the use of these funds.

Recent Budget Subcommittee Hearings: Since introducing the budget in January, the legislature’s budget subcommittees have reviewed the Governor’s proposed budget along with budget requests from advocates. In recent days, the Senate and Assembly Budget Subcommittees on Health and Human Services completed their reviews of the Governor’s proposed budget, along with a range of urgent and needed health investments that were not included in the Governor’s proposed budget, from expanding coverage without regard to immigration status to limiting estate recovery in Medi-Cal to restoring Medi-Cal benefits. The subcommittees left most of these items open for further discussions pending the May Revision. Many consumer and community organizations including Health Access California were on hand to strongly support these critical investments.

Immigrant Health Care. Although the Affordable Care Act made health coverage possible for millions of Californians, it excludes undocumented immigrants currently living and working in any state. If and when the President’s executive order on immigration is upheld in court, those newly eligible for deferred action will have access to Medi-Cal. Advocates are proposing to expand that access to all Californians income eligible for Medi-Cal, without regard for immigration status, as proposed in SB 4 (Lara). The cost would be a small fraction of last year’s proposal, amounting to only 2 more cents for every dollar spent on Medi-Cal, but would make a world of difference for not just immigrant families, but for our health system and society.

Estate Recovery. Advocates are also seeking that California limit Medi-Cal estate recovery to costs associated with long term care services and supports, consistent with minimum federal requirements. Last year, the Governor vetoed a bill to limit Medi-Cal estate recovery, arguing the policy change should be considered in the budget instead. Health Access will continue to vigorously advocate for this policy change so that older low-income Californians don’t have to make a trade-off between seeking health care coverage and keeping their family home.

Restore Medi-Cal Benefits Eliminated in the 2009-10 Budget. Major cuts were made during the budget crisis that have yet to be restored, including Medi-Cal rates and benefits, and consumer advocates including Health Access request undoing those cuts. In this part week, the budget subcommittees heard a proposal to restore non-federally mandated yet critical Medi-Cal benefits that were eliminated for budgetary, not policy reasons, in response to the state fiscal crisis. They include, among other things: acupuncture, audiology, chiropractic, podiatry, speech therapy, and full restoration of adult dental coverage. Partial restoration of adult dental was done in the 2013-14 budget, which gives Medi-Cal beneficiaries access to preventative care, restorations, and full dentures. However, important services such as gum treatment and partial dentures or implants are still not covered in Medi-Cal. According to a recent study published in Health Affairs, California emergency departments experienced a spike in visits for dental issues after comprehensive dental benefits for adults were cut from Medi-Cal. The study further found that the lack of adult dental benefits shifts dental care needs to costly emergency departments where dental issues are not adequately addressed.

Medi-Cal Provider Rates. Many providers and consumer groups have sought to rescind the 10 percent Medi-Cal provider rate cut, which will encourage more providers to participate in Medi-Cal and help increase access for Medi-Cal beneficiaries. In fact, California’s Medi-Cal provider reimbursement rates are among the lowest in the nation, making access to doctors, specialists, and beneficiaries harder for some of the 12 million Californians with Medi-Cal coverage.

What’s Next: The Governor is expected to release his May Revision of the budget later this week. The budget subcommittees will then hold hearings to review the May Revision the following week (May 18-22), and the Budget Conference Committee will convene at the end of the month to hash out differences between actions taken by the two houses. A final budget must be passed by June 15th. Stay tuned for updates!

by Steve Smith, California Labor Federation

Among the big political news this week was the release of the Legislative Peer Review Group’s report on the California high-speed rail project. The report recommends that the state freezes the project “at this time” until further assessment is done on its long-term feasibility. Problem is, the report was completed with minimal consultation with the California High-Speed Rail Authority, and ignored many of the details on feasibility included in the Authority’s recent business plan.

Opponents seized on the erroneous report to further their campaign to derail the project. While it might make good politics for some conservatives to oppose a signature program of the Obama White House, it certainly doesn’t make for good policy. Halting the high-speed rail project at this critical stage would jeopardize the entire project. It would put billions in federal funding at risk, and sap the state of an important engine to create desperately needed jobs.

The debate on high-speed rail – like so many other issues these days — has become overly politicized and isn’t on the merits. A group of conservative Republicans wants to put the issue back on the ballot, even though voters have already approved $9 billion in state bonds for high-speed rail. Even the peer review group, which is balanced and supports the concept of high-speed rail, got many pertinent facts wrong in its report.

With respect to the project, it’s time we got back to basics. Many countries around the world, including China, are showing that high-speed rail is an important component to the future of transportation. It’s clean, environmentally friendly, efficient, convenient and affordable. It alleviates traffic and air congestion while giving passengers an important option to meet their travel needs. In California, the project also offers an enormous opportunity to give our struggling economy a boost, especially in areas hard hit by the recession like the Central Valley. Over the life of the project, as many as 750,000 jobs would be created.

The project is supported by Republicans, Democrats and Independents. On its merits, it makes perfect sense. And the California High-Speed Rail Authority (HSRA), after early missteps, now has its act together and has delivered a detailed and transparent plan to bring the project to fruition. Gov. Brown has infused the HSRA board with seasoned experts, like Dan Richard and Mike Rossi, who bring years of experience in transportation planning and finance.

California Labor Federation Executive Secretary Treasurer Art Pulaski:

With California facing a jobs crisis and an urgency to upgrade our failing transportation infrastructure, further delay in breaking ground on high-speed rail is neither prudent nor responsible. Any project that’s the size and scope of high-speed rail is bound to encounter difficulties along the way. But rather than working to implement the vision of high-speed rail, the peer review panel suggests derailing the project at a critical stage, which is not a viable solution for California. Under new leadership, the California High-Speed Rail Authority is headed in the right direction. The Authority’s business plan addresses the myriad issues facing high-speed rail in a thoughtful and thorough way.

The main hurdle for high-speed rail right now isn’t the project’s feasibility. It’s that the project has been enveloped in politics as usual. That’s why it’s critical that the legislature take all evidence into account, listen to the experts and carefully analyze the Authority’s business plan, which answers many of the questions raised by the peer review group.

One such expert is the new CEO of the California High-Speed Rail Authority Roelof van Ark:

It is unfortunate that the Peer Review Committee has delivered a report to the Legislature that is deeply flawed in its understanding of the Authority’s program and the experience around the world in successfully developing high speed rail.   As someone involved in many of the successful high speed rail programs internationally, I can say that the recommendations of this Committee simply do not reflect a real world view of what it takes to bring such projects to fruition.

That’s not to say that ongoing issues, including long-term funding of the project, shouldn’t be addressed. But bowing to political hype to scuttle the project instead of carefully considering issues and finding solutions to work through them, would be a huge mistake.

The California labor movement supports high-speed rail because it holds more promise to transform our state’s economy, protect our environment and create a better quality of life for our families than any public works project in generations.

California was built by visionaries. It’s a proud tradition and important part of our heritage that we, as Californians, collectively embrace. Despite the challenges facing our state, it isn’t the time to shrink from the vision of high-speed rail. The bullet train can and must be built.

Pulaski:

In the short term, the project will create thousands of desperately needed jobs to help lift our state out of economic morass. In the long term, high-speed rail will deliver a world-class, environmentally friendly transportation system that will transform our state. An investment in high-speed rail is an investment in our state’s future. The Legislature must grant voter-approved bonds so that work can begin on the project this year.