California Health Care Workers To Get Bonuses Of Up To $1,500 Through Newsom’s Budget Deal

CA legislature OK's Newsom bonuses for health care workers | The Sacramento  Bee

Source: The Sacramento Bee, by Cathie Anderson

Taxypayer-funded retention bonuses are indeed coming to California’s frontline health care workers after Gov. Gavin Newsom and legislative leaders reached a budget deal Monday setting aside money to thank medical professionals who have worked through the COVID-19 pandemic.

Full-time workers stand to get the biggest potential payments, up to $1,500: up to $1,000 from the state of California and up to $500 in a match from their employers, according to the text of Assembly Bill 184.

Part-time workers will get as much as $1,250, a maximum of $750 of which comes from the state and $500 from their employers.

Physicians will receive up to $1,000 from the state. Managers and supervisors are ineligible for the payouts.

The bonuses will go not only to workers at general acute-care hospitals, government-operated hospitals, skilled nursing facilities and physician practice groups but also to employees at acute psychiatric hospitals, many nonprofit clinics, hospital outpatient clinics, and at any heath facility owned or operated by the state of California or any state department.

“The Legislature finds and declares that stability in the California health care workforce will further its efforts to manage the COVID-19 pandemic and address other public health issues that face Californians,” legislators wrote in laying out their rationale for the bonuses. “Providing California health care workers in 24-hour-care facilities with retention payments … will advance California’s effort to promote stability and retention in California’s health care workforce.”

Legislators noted that the size of the individual payments could drop, depending on how many people take part in the bonus program. They have set aside $1.3 billion for the purpose, and they also provided instructions for a dispute process if physicians or workers feel they have been shortchanged, first requiring them to appeal to their employers before seeking assistance from state agencies or the courts.

Any employer that willfully withholds bonuses is liable to the employees for the unpaid amount and interest, and they may have to pay the employees’ legal fees.

Anthony Cava, a spokesperson for the Department of Health Care Services, said the agency is still working out the operation details of this effort. He could not answer questions about when the money would be distributed.

Full-time employees must have worked at least 400 hours in person and part-time workers at least 100 hours at a facility over a 91-day period in 2022. The state department will determine that employment window after the legislation is enacted.

Employers must pay out funds within 60 days of receiving them and cannot use the funds to cover or replace other payments owed to employees or physicians.

Employers and physician organizations have to report names, addresses and other information for those receiving the payments. The measures are intended to ensure that neither employees nor doctors receive more than one retention bonus, even though they may work at more than one eligible facility.

Dialysis Reform Will Be On The California Ballot Yet Again. Does It Stand A Chance?

California 2020 vote-by-mail bill approved by Legislature | The Sacramento  Bee

Source: The Sacramento Bee, by Owen Tucker-Smith

Once again, California’s largest healthcare workers union is campaigning for dialysis reform — but they face powerful opponents.

It’s deja-vu for the California political scene, where such a battle transpires repeatedly. This time around, SEIU-United Healthcare Workers West is advocating for a ballot initiative that would require a physician assistant, physician or nurse practitioner to monitor patient dialysis treatments.

The union pushed similar policies in 2018 and 2020, but both measures failed by significant margins. On Monday, Secretary of State Shirley Weber said that the 2022 measure had collected over 685,534 valid signatures, making it eligible for the November ballot.

“There’s just so much improvement that can be made, and there’s plenty of resources in the industry to make those improvements,” SEIU-UHW research director David Miller told the Bee. “That’s the tension: there’s enormous profitability, then you meet folks of enormous need, and you realize that some of that money should be diverted to patient care.”

Historically, these measures have faced opposition from organizations like the California Medical Association and giants in the dialysis industry. Now, a coalition that includes the state’s Dialysis Council, the California Taxpayer Protection Committee, the California Chamber of Commerce and many medical societies and associations are organizing to shut down the initiative.

Dialysis reform naysayers hold that forcing clinics to hire more physicians would cost too much. A fiscal report from the state estimates that the measure could raise health care costs for state and local governments “by low tens of millions of dollars annually.” The policy, according to the report, would boost clinics’ costs by by “several hundred thousand dollars” annually.

There are an estimated 80,000 dialysis patients in California. The industry says that the rising costs would end up shutting down clinics. Miller refuted this theory, and said the massive campaign against the proposition has generated misconceptions.

“Most of the misconceptions are generated by the spending against the measure, rather than a thoughtful debate about the policy itself,” he added.

In 2018, the union spearheaded Proposition 8, which would have increased staffing and worker pay by capping revenues clinics could keep. At the time, SEIU-UHW ran a campaign on emotional stories of clinic mistreatment, and on the message that clinic workers were underpaid and overworked.

But Prop 8 failed. It was the priciest proposition on the ballot, and while the union got their hands on $18 million to support it, the campaign was outspent six-to-one by the state’s dialysis industry.

Then came Proposition 23, two years later in 2020. The measure required one physician to be present during treatment; it also would force clinics to report infection data to California — not just to the federal government. Prop 23 failed too, and only 36% of voters approved of the idea.

Now, the union is back for a third time, fighting an uphill battle against an industry that has time and time again proved to be a political powerhouse in the Golden State. In December of 2020, the LA Times reported that the national dialysis industry had poured $233 million into California campaigns in four years. According to Politico, $2.2 million has already been spent against this year’s initiative, and the coalition in opposition has released searing press releases recently.

Some have questioned the aggressive approach of the union, which has funneled significant funds into the effort with little success. In the fall, Politico called the phenomenon “the electoral version of groundhog day,” and suggested that union leaders weren’t necessarily looking for a win on election day — rather, they were looking to weaken the dialysis industry, dollar by dollar.

Regardless of the union’s intentions, the industry has snapped into the defense during each stage of the game. On Monday, the coalition didn’t hesitate to respond to Weber’s announcement with their own take.

“This November 2022 initiative shakedown is just a continuation of UHW’s broader corporate union organizing campaign against health care providers,” the coalition wrote. “Since 2012, SEIU-UHW has wasted $82 million of its members’ dues money on 60 ballot initiatives across the country either directly or through its 501c4. In California alone, UHW has filed 23 state and local initiatives at a cost of $58 million or about $600 per member in wasted dues money.”

One critique of the union, according to Miller, is that the initiative is identical to 2020’s. But it’s not — 2022’s effort expanded the supervision clause to include nurse practitioners and physician assistants. The union also heard criticism about a lack of available providers in rural clinics, Miller said, so this time around the advocates are allowing for a telehealth option.

“We moved toward the critics, both in the industry and outside the industry,” Miller said. “We actually feel better and even more confident that our solutions are closer to being right… that’s how it differs from the last attempt.”

The Protect the Lives of Dialysis Patients Act joins four ballot propositions that Weber had previously named eligible for a spot on the November ballot. The three initiatives and one referendum tackle the sports betting industry, arts funding in schools, flavored tobacco sales and single-use plastics.

Other initiatives are close to making the cut. Initiatives must have their signatures qualified by June 30 to hold their place on the ballot.

California To Become First State Offering Health Care To All Undocumented Residents

California Poised to Extend Health Care to All Undocumented Immigrants -  The New York TimesSource: The Sacramento Bee, by Mathew Miranda

California will become the first state to remove immigration status as a barrier to health care, making all low-income undocumented residents eligible for state-subsidized insurance regardless of age.

Gov. Gavin Newsom late Sunday announced a budget deal he struck with the Legislature included a new Medi-Cal expansion that would cover more undocumented adults.

The program’s launch, starting no later than Jan. 1, 2024, is expected to provide full coverage for approximately 700,000 undocumented residents ages 26-49 and lead to the largest drop in the rate of uninsured Californians in a decade.

“This historic investment speaks to California’s commitment to health care as a human right,” said Sen. María Elena Durazo, D-Los Angeles.

The state already allows many undocumented residents to join Medi-Cal. In 2015, California began allowing undocumented children to join Medi-Cal. Four years later, eligibility broadened to those younger than 26. And in May, the state started covering people aged 50 and over.

The Medi-Cal expansion is expected to cost $2.6 billion annually.

Californians generally are eligible for Medi-Cal coverage based on their income. The income cap for a family of four this year is $36,156.

California also opens Medi-Cal eligibility to people with certain medical conditions. It’s available to people who are pregnant, blind, disabled, under age 21, living in a nursing home or are a recently settled refugee.

Opening up Medi-Cal to all undocumented Californians has been a goal for health and immigration advocates for years. “This budget investment reflects California’s values of inclusion and fairness and should be a model for the rest of the nation,” said Sarah Dar, director of Health and Public Benefits Policy at the California Immigrant Policy Center. “All Californians, regardless of their age or where they were born, should have access to basic necessities like food and fair, steady wages.”

Undocumented residents remain the largest group of uninsured in California, according to a recent analysis from the the Center for Labor Research and Education at the University of California, Berkeley.

A disparity and “historic wrong” that will be fixed with the expansion, said Assemblyman Miguel Santiago, D-Los Angeles.

“This is a game changer,” said Santiago. “It’s one of the most important pieces of legislation that’s gonna go through this house because the ability to give health care means the ability to live life without pain.”

California Lawmakers Met Their Budget Deadline. Here’s What’s Left To Negotiate In The $300 Billion Spending Plan.

California budget: Big surplus, big differences - CalMatters

Source: Cap Radio, by Nicole Nixon

California state lawmakers approved a $300 billion budget this week, but several key sticking points remain between Governor Gavin Newsom and lawmakers, which could drag out negotiations on a final spending plan.

Under California law, the Legislature must approve a budget by June 15 or forfeit their pay and per diem until they do. The governor must sign the spending plan by June 30, in time for the state’s new fiscal year to begin on July 1.

Often, many budget details are worked out and approved in the weeks following those constitutional deadlines, which are referred to as “budget trailer bills.”

That appears to be the case once again this year, as top lawmakers and Newsom continue to negotiate over exactly how to spend a historic $98 billion surplus.

The budget approved by the Legislature Monday includes a record amount of money for public schools and higher education, as well as a total of $37.8 billion for budgetary reserves — nearly double the amount in savings before the pandemic in 2019.

It also includes $40 billion for infrastructure projects and funding to make Medi-Cal available for every low-income undocumented resident.

Despite the budget’s monstrous size, there are still many details for lawmakers and the governor to work out.

Republican Assembly member Vince Fong (R—Bakersfield) said the approved budget “fails to adequately address critical and core crises facing our state from the devastating drought to catastrophic wildfires, to a potentially crippling power shortage.”

Fong, who is the top Republican on the Assembly Budget Committee, criticized Democrats for passing an incomplete spending plan to meet their deadline and planning to fill in the gaps later. The practice has become the norm in state budget-making over the past decade, though Republicans say it lacks transparency.

Other unresolved issues include rebates to address skyrocketing gas prices and inflation, as well as reimbursement rate increases for state-sponsored child care providers and disability insurance, which received a temporary boost during the pandemic. Lawmakers want to increase those rates, but the Newsom administration is reportedly hesitant.

“It’s not a big surprise that when there’s a lot of money on the table, there might be more points of contention,” said Chris Hoene, executive director of the California Budget and Policy Center. “There’s often more contention about how to spend money during the good times because you’re expanding programs or you’re creating new programs or you’re doing one-time things.”

Another sticking point between top lawmakers and Newsom is the size and eligibility for a tax relief package aimed at helping Californians cope with inflation and record-high gas prices.

In March, Newsom proposed sending $400 per vehicle — up to $800 — to car owners to offset the rising cost of fuel. Leaders in the Assembly and state Senate have insisted on targeting tax relief to lower-income residents, who spend a higher percentage of their income on necessities like housing and transportation and are hit harder by inflation. Senate pro Tem Toni Atkins (D-San Diego) and Speaker Anthony Rendon (D-Lakewood) unveiled their own plan to send $200 per person, with an additional $200 per dependent, for individuals earning up to $125,000 or families with incomes up to $250,000.

But three months later, neither side appears to have budged. In a statement after the Legislature’s budget was passed, Newsom’s office said the governor “would like to see more immediate, direct relief to help millions more families with rising gas, groceries and rent prices” and noting Newsom’s plan would spend $3.5 billion more on tax relief.

Meanwhile, Republicans continue to call on Newsom and Democrats who control the legislature to suspend the state’s gas tax, which is set to increase from 51 cents per gallon to 54 on July 1.

“At a time when we have the highest gas prices not only in the nation, but in U.S. history, we need real solutions that will ease the burden on families, not increase the load,” Assembly member Suzette Valladares (R-Santa Clarita) said at a press conference Wednesday. “My colleagues and I are here … to remind Governor Newsom that it has been nearly 100 days since he promised he would bring Californians relief from the highest gas prices in the nation.”

Valladares told stories of constituents who had to sleep in their cars or skip university classes because they couldn’t afford fuel.

Republican state lawmakers argue suspending the gas tax would provide near-immediate relief to those most impacted by high gas prices.

Democrats have refused to cut the gas tax, citing the funding it provides for infrastructure projects. They also say there’s no way to guarantee oil companies and gas stations would not keep prices high and pocket the difference. A bipartisan bill attempts to address that issue by requiring fuel stations to pass on their savings and by backfilling lost revenue from the state’s burgeoning general fund.

Hoene said as an organization focused on improving life for the state’s lower- and middle-class residents, the California Budget Center prefers the Legislature’s approach of targeting relief based on income. He also thinks the state should deliver the fund through the Franchise Tax Board, which doled out millions of Golden State Stimulus checks last year.

“The best way to get aid into the hands of people who need it most is to base it on their income level,” Hoene said, “and deliver them a check — electronically or in other forms — which is exactly what we did two times over the past year, very successfully in the state.”

Popular State Worker Health Insurance Plan Projected To Go Up In Price 17% Next Year

Popular state worker health insurance plan projected to go up in price 17% next  year

Source: The Sacramento Bee, by Wes Venteicher

Premiums are projected to grow an average of about 7% for CalPERS health insurance policyholders next year, with two popular PPOs spiking by more than 14%, according to preliminary prices posted online Tuesday by the retirement system.

The California Public Employees’ Retirement System provides health insurance for about 1.5 million people, including roughly 750,000 state and local public employees and retirees and about 770,000 dependents.

The system introduced changes two years ago that boosted PPO premiums while lowering costs for two expensive plans with the richest benefits. The changes are aimed at preserving the top-tier plans and stabilizing prices over the long term.

The plans that will go up in price are the PERS Gold and PERS Platinum PPOs. Together they cover about 278,000 people.

PERS Gold, covering about 124,000, is projected to increase in price by 17.8%, reaching $766 per month for an individual starting Jan. 1, according to preliminary figures.

PERS Platinum, covering about 153,000, is projected to go up 14.5%, to $1,084 per month next year, according to the figures.

The most popular plan by far that CalPERS offers is a Kaiser Permanente HMO that covers about 556,000 people. The Kaiser HMO is slated to go up about 6% next year, reaching about $853 per month.

The preliminary rates posted online are subject to further negotiation, and could change slightly before they are approved by the CalPERS Board of Administration next month. California pays about $650 per month toward individual state workers’ plans, and offers an additional $260 health insurance stipend to members of SEIU Local 1000.

Two years ago, the CalPERS board approved a new rate-setting methodology on the recommendation of its health insurance experts, who said the system needed to make changes to save three of its best plans.

Those plans — Anthem Traditional HMO, Blue Shield Access+ and a plan formerly known as PERS Care — attract people who spend the most on medical treatment. Insurers kept raising their premiums to cover large bills, driving healthy people away and prompting more price hikes.

That pattern, known as a “death spiral,” would have made the plans unsustainable, experts told the board two years ago.

So the board adopted a structure that, in oversimplified terms, essentially shifts money from plans with lower health risk to those with higher risk. As a result, the prices for the Anthem and Blue Shield plans are projected to go down by nearly 7% each next year, in a second year of price drops.

Plans formerly known as PERS Select, PERS Choice and PERS Care were combined into two plans, the Gold and Platinum plans, which under the new methodology are supposed to level off in price starting in 2024.

CalPERS also offers Medicare Advantage policies and Medicare supplemental plans for those who qualify.

Included in the offerings are Medicare supplement plans called PERS Gold and PERS Platinum that cover about 150,000 seniors. The Gold plan premiums are going up 4% and the Platinum premiums are going up about 10%.

Other popular Medicare plans will go up by a couple percentage points or be reduced. A Kaiser Permanente Senior Advantage policy covering about 111,000 seniors will drop in price by about 6.4%.

Open enrollment, during which policyholders may switch plans, will run from Sept. 19 to Oct. 14.

Can California Keep Offering Cheap Health Care? Here’s What State Network’s New CEO Says

Can California keep offering cheap health care? Here's what state network's  new CEO says | Nation |

Source: The Sacramento Bee, by Cathie Anderson

Jessica Altman took over in March as chief executive officer of Covered California, and even as she was settling into a new home in Sacramento she also was making the rounds with congressional leaders to drive home just how much Californians want access to health insurance.

The greatest barrier to getting it is all too often the cost, Altman said in her first interview with The Sacramento Bee, and nothing underscored that more than the record enrollment Covered California saw last year when new federal assistance in the American Rescue Plan slashed premiums for California enrollees by an average of 20%.

Enrollment in plans offered on California’s state-based marketplace surged to 1.8 million, according to Covered California records, an increase of more than 150,000 people.

Altman said she has to keep sharing the story that the financial help put in place under the American Rescue Plan is having an astounding impact for all Americans who rely on state and federal marketplaces to provide them with a lifeline when they or their family members are unexpectedly struck by illness and to get the preventative care that is so crucial to staying in good health. The federal subsidies were approved for only 2022 policies.

“Health care is core,” she said, “and being healthy is core to our ability to live happy and healthy lives and pursue the things that we want to pursue. It is also, within our society, a great equalizer if it’s used effectively and equitably in supporting people across our nation and in California.”

In other words, Altman said, Covered California’s work is not done when a consumer pays a premium.

“Our role as a marketplace does not end simply when people get covered,” she said. “It goes to what happens next. Is that health insurance providing the access that people need. Do they have the providers that they need? Are the providers providing high quality care that is actually delivering them better health outcomes? So this next phase of responsibility (is) not just access to coverage but access to quality, equitable care.”

A native Californian, Altman was the insurance commissioner for the state of Pennsylvania before she took the top job at Covered California. Altman takes the reins from Peter V. Lee, the founding leader of the marketplace since 2012.

She offered a glimpse into her key priorities during a question-and-answer session with The Bee. We asked what her three key priorities were as she started her tenure.

The top priority is always going to be consumer-centric? How can Covered California, better serve customers that we have today, better reach the customers that we can have tomorrow, and better serve them in navigating our health care system, that can be all too complex.

One example: How can we better assist Californians as they transition between types of coverage — whether that’s from Medi-Cal to private insurers, from COBRA to a Covered California insurer, or between plans within Covered California or other types of transitions.

What are the outreach tools and the infrastructure that we have to identify these people at the time when they need us and to help them through those processes?


Equity is built into our mission. It is something Covered California has always done. Are the providers providing high quality care that is actually delivering better health outcomes for all enrollees?

This next phase of responsibility is not just about access to coverage but access to quality, equitable care.

There are many things that we are doing through the equity lens, for example, our outreach to community-based organizations, our efforts to be embedded in different communities across California to provide customer service, our push to be known and understood across languages and across cultures, and our work to make sure that the providers that are in the network of the health plans that we contract with are diverse are culturally competent and are meeting the health care needs of all of our population.


Our job doesn’t stop with coverage. It goes to quality.

Over the next coming years, we will be monitoring our health plans’ performance for six key measures of quality. We will have our health plans putting financial accountability on the table (paying penalties) if they do not meet the goals of those quality measures.

We are talking about things like: How many children that they cover are getting immunizations? How many adults are getting colorectal screenings that save lives at the appropriate age? How are they doing in monitoring blood sugar levels and hypertension among their population and improving it? These are the things that we know are the drivers of morbidity and mortality.

We will, by the way, be collecting and reviewing those measures not just holistically but also stratified by demographic factors like race and ethnicity to really make sure we are understanding any disparities.

Our equity work and our quality work are both the same and much more than one another. So what I mean by that is, health care quality is equity. Delivering on health care quality will help us deliver equitable outcomes.


I come from a family who has worked in health care and is steeped in health care. My father’s father was a primary care physician who I remember well, doing house calls even into his 80s with his black leather doctor’s bag and his stethoscope. My mother’s father was an obstetrician-gynecologist who provided women’s health services in a very different era.

And both my parents have worked in health care and had long careers in health care.

The issues hit close to home for me both because of watching my family members and loved ones give their lives and commitment to improving the health care of others and also (because) I have seen too many people I love experiencing health challenges. I have always been driven to public service, I have never worked anywhere other than in public service.

California Wants to Slash Insulin Prices by Becoming a Drugmaker. Can it Succeed?

California aims to slash insulin prices and challenge Big Pharma. Can it  succeed? - Los Angeles Times

Source: California Healthline, by Angela Hart

California is diving into the prescription drug business, attempting to achieve what no other state has done: produce its own brand of generic insulin and sell it at below-market prices to people with diabetes like Sabrina Caudillo.

Caudillo said she feels like a “prisoner” to the three major pharmaceutical companies that control the price of insulin, which ranges from $300 to $400 per vial without insurance. The price Caudillo paid in 2017, when she was diagnosed, is etched into her memory: $274.

“I remember crying my eyes out at CVS and realizing it’s going to be like this for the rest of my life,” said Caudillo, 24, a college student who lives in La Puente, in Southern California. She now has insurance that covers the entire cost of the lifesaving drug but still has trouble affording her insulin supplies and paying the monthly premium for her plan.

“This disease is really expensive, and I’m barely making it every month,” Caudillo said.

Gov. Gavin Newsom’s administration said roughly 4 million Californians have been diagnosed with diabetes, a disease that can destroy organs, steal eyesight, and lead to amputations if it’s not controlled. One in 4 people who have diabetes and rely on insulin cannot afford it, forcing many to ration or forgo the drug, the administration added.

Newsom is asking state lawmakers to pump $100 million into an ambitious initiative to launch California’s generic drug label, CalRx, and begin producing insulin in the next few years, said Alex Stack, a Newsom spokesperson. The state is also working to identify other generic drugs it could bring to market, targeting those that are expensive or in short supply.

To start, the goal is to dramatically slash insulin prices and make it available to “millions of Californians” via pharmacies, retail stores, and mail order, said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency.

But state health officials are still negotiating a contract with a drug manufacturer to make and distribute insulin and have not answered key questions such as how cheaply insulin could be produced and what patients would pay. To be successful, California — and the company it partners with — must navigate a complicated pharmaceutical distribution system that relies not only on drug manufacturers but also middleman companies that work hand in hand with health insurers. Those companies, known as pharmacy benefit managers, negotiate with manufacturers on behalf of insurers for rebates and discounts on drugs — but insurers don’t always pass those savings on to consumers.

“Insulin has long epitomized the market failures that plague the pharmaceutical industry, which have resulted in keeping insulin prices high,” Vishaal Pegany, assistant secretary of the Health and Human Services Agency, told lawmakers in May. He argued that high prices “have directly harmed Californians.”

Newsom said in early May that disrupting monopolistic drug prices requires state intervention and that California can pull it off because the state — with 40 million residents — “has market power.”

But the nonpartisan Legislative Analyst’s Office questioned whether California can produce its own drugs and achieve lower insulin prices. Luke Koushmaro, a senior fiscal and policy analyst with the office, warned at a legislative hearing in May that the effort could be hampered by “considerable uncertainties” — a sentiment echoed by some Democratic lawmakers.

The Newsom administration thinks state-made insulin could cut some insurers’ spending on the drug as much as 70% — savings it hopes would trickle down to consumers. But “there is no guarantee” that the administration’s predictions of dramatic savings or wide distribution of insulin will materialize, state Assembly member Blanca Rubio (D-Baldwin Park) said at the hearing. “Who is going to write the prescriptions for this magic insulin?” she asked. “Hope is not a strategy. I’m not hearing any strategies as to how this is going to become available.”

The price of insulin has soared in recent years. A 2021 U.S. Senate investigation found that the price of a long-acting insulin pen made by Novo Nordisk jumped 52% from 2014 to 2019 and that the price of a rapid-acting pen from Sanofi shot up about 70%. The investigation implicated drug manufacturers and pharmacy benefit managers in the increases, saying they perpetuated artificially high insulin prices.

“Insulin manufacturers lit the fuse on skyrocketing prices by matching each other’s price increases step for step rather than competing to lower them, while PBMs, acting as middlemen for insurers, fanned the flames to take a bigger cut of the secret rebates and hidden fees they negotiate,” U.S. Sen. Ron Wyden (D-Ore.) said when the report was released.

Contacted by KHN for comment, the trade associations that represent brand-name drugmakers, pharmacy benefit managers, and California health insurers blamed one another for the increase in prices.

Under Newsom’s plan, generic forms of insulin — known as “biosimilars” because they are made with living cells and mimic brand-name drugs on the market — would be widely available to insured and uninsured Californians.

If Newsom’s $100 million initiative is approved by lawmakers this summer, the state would use that money to contract with an established drugmaker to begin supplying CalRx insulin while the state constructs its own manufacturing facility, also in partnership with a drugmaker.

The administration is currently negotiating with drug companies that can produce a reliable supply of insulin under a no-bid contract, but no partnership has been formalized. The insulin would be branded with images associated with the state, such as the “California Golden Bear.” And, Pegany said, the packaging could boast that the lower-priced insulin was brought to patients by state government.

“There’s a short list of people who would even compete for this,” Ghaly told KHN in May. “We’re going to put together competition and get a partner we think is going to deliver not just the soonest, but something that we think is sustainable.”

On the short list is Civica Rx, a nonprofit drugmaker based in Utah. Civica announced independently in March that it was preparing to produce biosimilar insulin — exactly what California is seeking. The FDA last year approved the first biosimilar, interchangeable insulin product, and Civica plans to make three types of generic insulin to compete with the brand-name versions made by Eli Lilly and Co., Sanofi, and Novo Nordisk.

Allan Coukell, Civica’s senior vice president of public policy, told KHN that the drugmaker has had discussions with the Newsom administration and is in talks with other states.

Civica aims to market insulin for close to the cost of making it, rather than charging markups and making profits, he said. Coukell said the company plans to bring biosimilar insulin to the market for roughly $30 per vial and $55 for a box of five pen cartridges.

Coukell acknowledged that Civica may have to work with pharmacy benefit managers, which also help health insurers determine which drugs they will cover, to distribute the medicine but doesn’t expect that to cause a big price increase. “Our goal is to make these insulins available to any American who needs them,” Coukell said. “Our goal is to have market impact, not market share.”

The state has had discussions with other companies, including celebrity investor Mark Cuban’s for-profit drug company, the Mark Cuban Cost Plus Drug Company. It is building its own manufacturing plant, like Civica, but for now sells drugs online to anyone at wholesale cost plus a 15% markup. Founder Dr. Alex Oshmyansky said that the company’s talks with California fizzled out early on but that he’d be open to future discussions. Cuban is the chief investor in the company, Oshmyansky said.

“America is the wealthiest country in the history of human civilization, so for our citizens to not be able to afford medications, including insulin, due to market manipulations is terrible,” Oshmyansky said.

For people with diabetes like Caudillo, relief can’t come fast enough. She stockpiles insulin in case she can no longer afford health insurance and donates extra to other people in need.

“I know how expensive it is when you aren’t covered, and if you don’t pay that money, you’re going to be in the hospital fighting for your life,” she said. “Your body goes into decay, and your organs slowly shut down. It’s very painful. No diabetic should have to go through that.”

Here’s How Many People Are Quitting Their Jobs in California

Why the 'Great Resignation' may not last very longSource: The Center Square, by Samuel Stebbins

In what has been dubbed the Great Resignation, Americans have been quitting their jobs in record numbers in recent months – a trend that shows no signs of slowing. According to the Bureau of Labor Statistics, over 4.5 million Americans quit their job in March 2022, the most ever recorded in a single month, and up from 4.4 million quits in February.

Explanations for the high quit rates vary. A recent survey from Pew Research Center found that low pay, limited opportunities for advancement, and a lack of flexibility are among the most common reasons.

Whatever the explanation, the consequences are clear. Record-high quits are exacerbating a labor shortage in the United States and creating an existential crisis for many small businesses, and quit rates vary considerably among states.

According to the Job Openings and Labor Turnover Survey report from the Bureau of Labor Statistics, 486,000 people in California quit their jobs in March, the most recent month of available data – a 46.8% increase from one year earlier.

The total number of monthly quits in the state accounts for 2.8% of the total workforce, slightly lower than the 3.0% share of workers nationwide who quit their jobs in March.


Though there are some notable exceptions, states with lower unemployment rates often have higher quit rates. Since quits do not include workers who retired, each of the 4.5 million Americans who quit in March will presumably take another job. A stronger job market, therefore, may incentivize workers to look for better opportunities, while workers in states with weaker job markers may be deterred. The March jobless rate in California stood at 4.9%, compared to the national unemployment rate of 3.6%.

Mask Rules Are Suddenly Back In California As Coronavirus Hits Danger Zone

Palisades Charter High School students ride the Metro E line train on April 21.

Source: Los Angeles Times, by Rong-Gong Lin II and Christian Martinez

Suddenly, California officials are moving toward new indoor mask rules as coronavirus cases enter the danger zone in many parts of the state.

The virus has been spreading rapidly across California after a spring of big declines. That is setting up an anxious summer in which officials are now talking about a return to mask wearing to prevent wider spread.

So far, the biggest concerns have been in Northern California. But Los Angeles County officials say mask mandates are possible by the end of the month if conditions continue to deteriorate.

Why are masks back on the agenda?

The U.S. Centers for Disease Control and Prevention recommends universal indoor masking when a county enters the high COVID-19 community level, the worst in a three-tier system.

Entering the high COVID-19 community level means that new weekly rates of hospitalizations, or hospital capacity, are being affected by coronavirus-positive patients to such an extent that the hospital systems may grow strained.

The CDC on Thursday placed 13 California counties in the high COVID-19 community level. It’s the first time since mid-March that any county in the state was in that level.

Nearly 1 in 6 Californians live in a county with a high COVID-19 community level. The affected counties are Santa Clara, Sonoma, Solano, Marin and Napa in the San Francisco Bay Area; Sacramento, Placer, Yolo, El Dorado in the Sacramento Valley area; and Monterey, Mendocino, San Benito and Del Norte elsewhere in Northern California.

What actions are being taken?

Alameda County issued a new mask mandate for most indoor public settings effective Friday, becoming the first California county to do so.

The county, home to Oakland, is the Bay Area’s second-most populous. Its mandate is the first issued in California since the winter Omicron surge faded

The order does not apply to K-12 school settings through the end of the school year, nor does it apply to Berkeley, which is in Alameda County but has its own public health department. Berkeley’s school system, however, has already implemented an indoor mask mandate.

“Rising COVID cases in Alameda County are now leading to more people being hospitalized, and today’s action reflects the seriousness of the moment,” county health officer Dr. Nicholas Moss said in a statement.

“We cannot ignore the data, and we can’t predict when this wave may end. Putting our masks back on gives us the best opportunity to limit the impact of a prolonged wave on our communities.”

Alameda County has one of California’s highest coronavirus transmission rates, reporting about 354 cases a week for every 100,000 residents for the past week. That figure has climbed 20% from mid-May. A rate of 100 cases a week or more for every 100,000 residents is considered high.

What are the details?

The Alameda County order will require masks to be worn at indoor businesses and workplaces, including offices, stores, theaters and conference centers, as well as restaurants and bars when not eating or drinking; on public transportation, including taxis and app-hailed rides; and at Oakland International Airport. Businesses and venue operators are required to post signage at all entrance points to communicate the mask requirement and “make reasonable efforts to ensure compliance in their setting,” the health order said.

The county won’t require masking in schools through the few remaining days in the school year. Masks need not be worn while working alone in a closed office or room, while swimming or showering at a gym or while obtaining a medical or cosmetic service involving the head or face for which mask removal is needed to perform the service.

Alameda County also is allowing masks to be optional for performers at indoor live events, such as the theater, opera, symphony, religious choirs and professional sports; at religious gatherings when necessary to perform rituals; and at indoor gyms and yoga studios by people who are “actively engaged in periods of heavy exertion,” are swimming or diving, or when engaged in sports where masks create a risk to health, like wrestling and judo.

Masks will be required in other youth settings, including child care, summer school and youth programs. Children younger than 2 must not mask because of the risk of suffocation.

What about other places?

The Berkeley school system has already issued a mask order for indoor K-12 classroom settings, as well as indoor graduations.

Other educational institutions in California have done the same, including UCLA and Cal Poly San Luis Obispo. Sacramento schools also announced new mask measures this week.

Where does Los Angeles County stand?

L.A. County could be poised to see a new universal indoor mask mandate lat`er this month if the upward trends continue.

“Our weekly case rate and the rate of increase in hospital admissions are of concern,” L.A. County Public Health Director Barbara Ferrer said Thursday. “If we continue on the current trajectory … we’re likely to move into the CDC high [COVID-19] community level within a few weeks towards the end of June, indicating increased stress on the healthcare system.”

According to CDC data issued Thursday, L.A. County observed 5.3 new weekly coronavirus-positive hospitalizations for every 100,000 residents, an 18% increase from the previous week’s rate of 4.5. A rate of 10 or more would place L.A. County in a high COVID-19 community level.

Elsewhere in Southern California, Ventura County had a new weekly coronavirus-positive hospitalization rate of 7.6; Santa Barbara County, 6.3; Orange County, 5.3; San Diego County, 4.9; and Riverside and San Bernardino counties, 2.9.

What are experts saying?

There is still not a clear sense of how bad the summer COVID-19 wave will be in California. Hospitalizations and deaths are still relatively modest.

Some observers say there’s no sign that California is nearing a peak, as the latest variant’s exceptional contagiousness is thought to be approaching that of measles. State modeling suggests, however, that the spread of COVID-19 is likely still increasing in Southern California, the San Joaquin Valley and Greater Sacramento.

Even if hospitals don’t become burdened, there’s concern that climbing rates of transmission could keep people at home for a week or more, ruining plans for graduations, weddings and vacations and making it difficult for businesses to maintain adequate staffing.

Of all the COVID-19 restrictions that have been issued over the years, a mask order is among the least onerous to the public, said UC San Francisco epidemiologist and infectious-diseases expert Dr. George Rutherford.

“If you’re going to try and stay in front of this and try and restrict the damage that’s going on, this strikes me as a fairly low-level ask, to have people wear a mask,” Rutherford said.

“We’re not talking about lockdowns, we’re not talking about mandatory vaccination, we’re not talking about mandatory testing programs. We’re just talking about wearing masks, which are highly effective, especially if both people are wearing masks. And it’s something we’re used to doing,” Rutherford said.

Politics and Pandemic Fatigue Doom California’s Covid Vaccine Mandates

Richard Pan speaks at a news conference.

Source: Kaiser Health News, by Rachel Bluth

In January, progressive California Democrats vowed to adopt the toughest covid vaccine requirements in the country. Their proposals would have required most Californians to get the shots to go to school or work — without allowing exemptions to get out of them.

Months later, the lawmakers pulled their bills before the first votes.

One major vaccine proposal survives, but faces an uphill battle. It would allow children ages 12 to 17 to get a covid-19 vaccine without parental permission. At least 10 other states permit some minors to do this.

Democrats blamed the failure of their vaccine mandates on the changing nature and perception of the pandemic. They said the measures became unnecessary as case rates declined earlier this year and the public became less focused on the pandemic. Besides, they argued, the state isn’t vaccinating enough children, so requiring the shots for attendance would shut too many kids out of school.

Political pressure from business and public safety groups and from moderate Democrats — along with vocal opposition from anti-vaccine activists — also contributed.

Now, even as case rates start to balloon again, the window of opportunity to adopt covid vaccine mandates may have closed, said Hemi Tewarson, executive director of the National Academy for State Health Policy. “Given the concerns around mandates and all the pushback states have received on this, they’re hesitant to really move forward,” Tewarson said. “Federal mandates have stalled in the courts. And legislation is just not being enacted.”

Other states have also largely failed to adopt covid vaccine requirements this year. Washington, D.C., was the only jurisdiction to pass legislation to add the covid vaccine to the list of required immunizations for K-12 students once the shots have received full federal authorization for kids of those ages. A public school mandate adopted by Louisiana in December 2021 was rescinded in May.

The most popular vaccine legislation has been to ban covid vaccine mandates of any kind, which at least 19 states did, according to the National Academy for State Health Policy.

In California, the landscape has shifted radically in just a few months. In January, a group of progressive Democrats unveiled eight bills to require vaccinations, combat misinformation, and improve vaccine data. Two were sweeping mandates that would have required employees of most indoor businesses to get shots and added covid vaccines to the list of immunizations required for schools.

“It’s important that we continue to push for vaccine mandates the most aggressively we possibly can,” state Assembly member Buffy Wicks (D-Oakland) told KHN in early 2022. She was the author of the workplace mandate bill.

But the legislation imploded almost immediately.

In March, Wicks’ worker vaccine mandate proposal died. It was strongly opposed by firefighter and police unions, whose membership would have been subject to the requirement.

“I don’t think the anti-vaxxers carry much weight in Sacramento with my colleagues,” Wicks said. “They’re a pretty insignificant part of the equation.” The public safety unions “are the ones that carry the weight and influence in Sacramento,” she said.

California Professional Firefighters and other public safety groups argued in written opposition to the bill that mandates would interfere with their ability to negotiate employment requirements with their employers. “To summarily remove these bargained policies with a blanket mandate sets a dangerous and demoralizing precedent,” wrote the group, which represents 30,000 firefighters.

Schools were also supposed to be subject to a strict vaccine mandate.

In October 2021, Democratic Gov. Gavin Newsom announced that California would become the first state to require shots for schoolchildren starting in July 2022. That deadline has since been pushed back to at least July 2023.

And Newsom’s order came with a loophole that will allow parents to opt their kids out by claiming a “personal belief” exemption.

In January, when California routinely topped 100,000 new cases a day, lawmakers introduced legislation to prohibit personal belief exemptions for covid vaccines — those are not allowed for any other required childhood vaccines.

Again, they soon backed off, saying the vaccination rate among kids was so low that shots shouldn’t be required until they’re broadly available in pediatrician offices.

About 60% of eligible Californians are fully vaccinated and have received a booster shot, while only 35% of kids ages 5 to 11 have received their first two doses, according to the California Department of Public Health. Boosters were approved for children in mid-May.

Instead of implementing mandates, the state should focus on educating and reaching out to parents, said Assembly member Akilah Weber (D-San Diego), an OB-GYN who was among the legislators who introduced the package of vaccine bills. “It’s hard to make that argument that right now we need to be mandating when you have a good number of people who feel like we are past the pandemic,” she said.

Lawmakers could resurrect the mandate bills, she said, if hospitals and health care workers become overwhelmed again.

Cases are rising statewide. The rate of positive covid tests has been as high as 7% in recent days, its highest level since February — and likely an undercount because of the people who are testing at home and not reporting results.

Weber’s suggestion to better engage parents helps explain why the legislation failed, said Robin Swanson, a Democratic political consultant based in Sacramento. State and local officials never clearly communicated with the public about vaccinating kids, she said, and didn’t effectively reach out to vulnerable populations from the outset. “You can’t build a mandate on top of distrust,” Swanson said.

Outreach and public information are critical, said Dr. John Swartzberg, a clinical professor emeritus of infectious diseases and vaccines at the University of California-Berkeley School of Public Health. But if those were paired with a mandate, he said, the state could vaccinate and protect many more children. “In businesses that mandate vaccines, it works pretty well,” Swartzberg said. “And in schools, in particular, it works very well.”

Pro-vaccine activists who vowed to have a greater presence in the California Capitol this year also thought mandates would dramatically boost vaccination rates. But as reality set in, they shifted their focus to boosting funding for vaccination and pushing surviving bills across the finish line.

“Yes, we do need vaccine requirements, and, yes, they do work,” said Crystal Strait, who leads the pro-vaccination organization ProtectUS. But she acknowledged that the situation had changed since January and said her group had to change with it: “We can’t be as simplistic as just a vaccine requirement.”

Newsom’s latest state budget proposal includes $230 million for vaccine outreach and $135 million for vaccine distribution and administration.

Strait’s group plans to combat vaccine misinformation among the public and wary lawmakers, including those within the Democratic ranks. “You have people saying they’re pro-science and pro-public health, but when push comes to shove, they’re not there yet,” Strait said of hesitant legislators.

Generally, vaccine mandates are popular with the public. According to a March survey from the Public Policy Institute of California, 57% of Californians favored requiring people to provide proof of vaccination to go to large outdoor gatherings or enter some indoor venues like bars and restaurants.

But Rose Kapolczynski, a Democratic strategist who worked on the pro-vaccine lobbying push with Strait, likened vaccine beliefs to climate change: Voters say they care, but other, more tangible issues, such as gas prices and reproductive rights, become more urgent to them.

“If things were as bad now as they were in January and February, there would be more concern and action,” said Catherine Flores-Martin, executive director of the pro-vaccine California Immunization Coalition.

“I’m disappointed that people are not taking the long view.”

Last Updated 06/29/2022

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