Focus on Reform, Opioids Sets the Tone as Members and Allies Gather for Lobby Day

Lobby Day is the ideal opportunity for CANP members and allies to show strength in numbers, and there’s still time for you to bolster the turnout. CANP Lobby Day 18 takes place May 1 in Sacramento. Online registration closes April 24.

Those in attendance will get the latest information on legislation under consideration that impacts the nurse practitioner profession, then head to the Capitol for face-to-face meetings with legislators and their staff members.

The program will also feature the presentation of CANP’s NP Advocate of the Year award to Senator Jeff Stone (R-Temecula). Senator Stone is being honored in gratitude for his commitment and willingness to work with CANP on legislation that secures an NP's role in providing medically assisted therapy to those struggling with opioid addiction.

CANP’s legislative advocacy team, in conjunction with the Association’s Health Policy and Practice Committee, has reviewed the dozens of health care-related bills introduced this year, and has adopted a support position on the following measures:

• Assembly Bill 2517 (Wood), which would establish the Advisory Panel on Health Care Delivery Systems and Universal Coverage in the California Health and Human Services Agency and would require the advisory panel to develop a plan to achieve universal coverage and a unified publicly financed health care system.
• Assembly Bill 2682 (Burke), which would authorize a nurse-midwife to practice in a variety of settings without supervision by a physician and surgeon subject to certain situations requiring consultation or co-management with, or referral or transfer to, a physician and surgeon.
• Assembly Bill 2965 (Arambula), which would extend eligibility for full-scope Medi-Cal benefits to individuals of all ages who are otherwise eligible for those benefits but for their immigration status.
• Senate Bill 974 (Lara), which essentially replicates AB 2965 regarding Medi-Cal eligibility.

Among the new health care-related bills, two common themes have emerged: health care reform in the wake of debate over a single-payer model, and solutions to the opioid crisis.

Health Care Reform

The single-payer question continues to dominate the headlines following last year’s introduction of Senate Bill 562 (Lara). That measure remains dormant after being shelved by Assembly Speaker Anthony Rendon, primarily over concerns regarding lack of specifics and a potential cost of more than $400 billion – more than twice the amount of the entire state budget. Earlier this year, CANP announced it had joined the Coalition to Protect Access to Care, a group of health care providers formed to protect access to health care and maintain stability in California’s health care delivery system. Opposition to SB 562 is a chief position of the coalition.

In holding that bill, Rendon established the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage, formed specifically to examine universal health care.  The Committee held six hearings to delve into the issue, and the Assembly subsequently commissioned a report by the University of California, San Francisco, which summarizes the Select Committee’s findings and potential options.

Acknowledging the legal, technical and political challenges of single-payer, the report concluded that such a system would take years to develop. However, the report found that “something close” to universal coverage is attainable in the nearer term via utilization of Medicare, Medi-Cal, employer-sponsored insurance and the individual market as the primary channels to obtain coverage. The report recommended that short-term changes to increase coverage make sense given the uncertainty and timeline surrounding single payer, especially if the short-term changes are made in a way to facilitate a future transition to single-payer.

Consequently, the Assembly introduced a package of 14 health care reform bills, ranging from Medi-Cal expansion for undocumented immigrants and the establishment of a public option, to cost-sharing limitations, increased access to care and streamlined enrollment. Most of these bills are authored by the Select Committee co-chairs – Jim Wood (D-Healdsburg) and Joaquin Arambula (D-Fresno).

Addressing Opioids

A package of 25 bills was introduced by lawmakers this year to address the opioid crisis.  The proposals address a number of issues, including the CURES database, prescription limits, medication-assisted treatment, prescription labeling and opioid consultation.

Of particular interest are two of the prescription limitation bills: Assembly Bill 1998 by Assemblymember Freddie Rodriguez and Assembly Bill 2741 by Assemblymember Autumn Burke.  As initially drafted, AB 1998 would have prohibited health care practitioners from prescribing more than a three-day opioid prescription unless he or she determines that the patient needs a larger prescription for chronic pain. The bill was amended on April 11 to remove the prescription limitation and instead require the adoption of safe prescribing protocols.

AB 2741 would limit opioid prescription for minors to five days, with some exceptions.

Also on the Radar

Other noteworthy bills introduced this year include:

• Senate Bill 1109 (Bates), which would require prescribers to take continuing education courses regarding opioid addiction. It would also require additional warning labeling on Schedule II prescription containers regarding the risks of opioid addiction.
• Assembly Bill 1963 (Waldron), which would require the state to increase Medi-Cal provider reimbursement rates for medication-assisted treatments, like buprenorphine/naloxone treatment.
• Assembly Bill 2789 (Wood), which would require prescribers and pharmacies to electronically transmit and receive (“e-prescribe”) all prescriptions in California, except under certain circumstances.

Many of these bills are being heard in policy committees in April. All bills must clear policy committees by April 27. This year’s House of Origin deadline – the date by which all bills must pass out of the full house in which they were introduced – is June 1.