Blog: Three For Thought
Kris Calvin, AAP-CA CEO

For questions or comments on Three For Thought, contact Kris at kcalvin@aap.net. You are invited to post or share these updates. Thanks for your interest in AAP-CA advocacy and activities!

Update #22, March 5, 2010

1. State Budget Update: Healthy Families Program and First Five Funds Again in Jeopardy

Last year AAP-CA and member pediatricians worked successfully to protect state funds for both the Healthy Families Program and First Five from being swept into the black hole of state deficit reduction. It is, however, unfortunately “déjà vu all over again”. Both Healthy Families and First Five are slotted for severe cuts or even potential elimination in the Governor’s 2010-2011 budget proposal.

Those of us engaged in children’s health care would undoubtedly need a moment to stand in wonder at what mechanism and combination of factors continues to threaten programs that year after year are proven to provide more in benefits to Californians than they cost, both through direct services and through access to federal funds. But there is no rest for the weary, no good deed goes unpunished, and just about every cliché one can think of for fighting against repeated irrational actions applies here, as it is time for our action yet again.

We need to remind policymakers that Healthy Families, currently serving nearly a million children in California, provides care that would otherwise occur in more costly settings used by the uninsured like emergency rooms, and which draws down $2 for every state dollar we spend on the program, yielding not only healthier kids, but also a healthier California economy. Similarly, we need to make our case again, that First Five program funds serve children 0-5 in a myriad of ways that yield the benefits of early prevention and intervention at a fraction of what later services would cost.

YOUR ACTION MATTERS:
Please email, fax or call your state legislators and let them know the critical importance of investing in children’s health in this budget by opposing cuts to the Healthy Families Program and raids on First Five funds. Two things are critical in your communication: (1) Identify yourself as a constituent; and (2) Clearly state how cuts to Healthy Families and First Five will affect your patients, the children and youth of your legislator’s district.

To identify your legislator and get their contact information, go to www.leginfo.ca.gov

2. Medicaid Provider Rate Cut Injunction Reaffirmed – Cuts Prohibited!

Great news, the 9th Circuit Court reaffirmed an earlier decision that California may not implement 5% budget cuts to Medi-Cal providers’ reimbursement for budgetary reasons without proper analysis regarding implications for access.

The following is an excerpt from the March 3, 2010 9th Circuit decision:

“We have now handed down multiple decisions instructing the State on Section 30(A)’s procedural requirements... We trust that the State now understands that... payments for services must be consistent with efficiency, economy, and quality of care, and sufficient to ensure access,’ …it must: 1) ‘rely on responsible cost studies, its own or others’, that provide reliable data as a basis for its rate setting,’ … and 2) study the impact of contemplated rate change(s) on the statutory factors prior to setting rates, or in a manner that allows those studies to have a meaningful impact on rates before they are finalized.”

Finally, some good news in a tough time for budgets and health care!

3. Register Now for AAP-CA Legislative Day, April 27th, 2010!

AAP-CA is holding our Annual Legislative Day in Sacramento in conjunction with the California Medical Association Legislative Day on April 27, 2010 at the Sheraton Grand.

We will meet beginning at 9am with CMA, who always has a great line-up of speakers.  Following that, AAP-CA leaders and staff will offer an 11am AAP-CA legislative training, focused on bills and budget items of particular interest to pediatrics.

We rejoin CMA for their lunchtime speaker, and then head to the Capitol from 1-4pm for meetings with your legislators to advocate for children and the viability of pediatric practices.

Please join me!  This is a wonderful opportunity to engage actively in advocacy with colleagues and District officers and staff in order to make a real difference for your patients and your practice. Registration is free. You can register now at https://www.aap-ca.org/event/leg_day/register . If you have questions, please contact office@aap-ca.org

Update #21, January 7, 2010

1.  Healthy Families Update:  AAP-CA and Coalition Partners Secure Hundreds of Millions in Federal Dollars Via AB 1422

AAP-CA was a leader in the successful enactment of AB 1422 last year.  Supported by participating health plans, AB 1422 will draw down federal funds that more than offset a fee paid by those plans, and in so doing close a $300 million gap in Healthy Families funding.

These funds were in jeopardy when the federal government issued an initial opinion that the way the fee was structured, i.e., on some, not all California managed care plans, might not meet federal requirements to access matching funds.

A rapid and forceful response by AAP-CA, coalition partners, and ultimately the Governor and his staff resulted in agreement by the federal government to delay a final decision on the issue for at least 18 months.  During this time, AB 1422 will operate as planned, and the funds will allow pediatricians to continue to serve the Healthy Families population.

Thanks to all of you who sent letters and made calls in support of AB 1422.  We will keep you posted as other advocacy opportunities arise in support of Healthy Families.  Unfortunately, with the Governor’s budget set for release in the next few days in the context of a $20 billion state deficit, such advocacy will likely be needed.

2. AAP-CA Makes Progress in Protection of California Children’s Services (CCS)

The state’s “1115 Medicaid waiver,” granted by the federal government and primarily related to hospital financing, expires August 31st.  In preparation for a renewal that broadens the scope of the waiver to include possible redesign of the California Children’s Services Program (CCS), the state solicited input from AAP-CA and others.

The state has been responsive to concerns raised by AAP-CA that any changes to CCS must build on the current strengths of the program.  In particular, we have communicated that it is imperative that the state’s current cost-cutting environment not generate harmful policy decisions, including a much-discussed elimination of county CCS program and roll-in of all CCS children into Medi-Cal managed care for all their services.  In short, AAP-CA is urging the state to recognize that children in CCS and their families must not be asked to pay the price of California’s budget crisis by losing services that matter most to them.

The first draft of the state concept paper for the waiver, issued in October 2009, focused on the need to incorporate the core concepts of organized delivery systems into the care received by children less than 21 years of age with special health care needs (i.e., CCS-eligible children), without mention of the critical positive elements of the CCS program that must be retained.  In contrast, the December 2009 concept paper section on CCS leads with the following:  “California will work with stakeholders to develop and test approaches to enhance the delivery of care to children with special health care needs, specifically oriented towards pediatric care.  The approaches will be designed to preserve the strengths of the current CCS program, such as the access to qualified sub-specialists and tertiary care to treat conditions that require specialized care.”

This important shift in framing lays the groundwork for continued AAP-CA advocacy to protect the core elements of the CCS program, while working with the state to seek improvements that support provider and enrollees in a more user-friendly, efficient system of care.

YOUR ACTION MATTERS:  Please let government leaders know of your personal support for the CCS program, and that any changes must build on the program’s strengths.  You can communicate your concerns to the Governor at Phone:  916-445-2841, Fax:  916-558-3160 (new number) or through his website via email at http://gov.ca.gov/interact#email, to DHCS Director David Maxwell-Jolly at Phone:  916-440-7400, Fax:  916-440-7404, or email at david.maxwell-jolly@dhcs.ca.gov, and to your legislator-- find their website and contact info at www.leginfo.ca.gov.

3. Save the Date:  AAP-CA Legislative Day, April 27th, 2010!

AAP-CA is holding our Annual Legislative Day in Sacramento in conjunction with the California Medical Association Legislative Day on April 27, 2010 at the Sheraton Grand.

We will meet beginning at 9am with CMA, who always has a great line-up of speakers.  Following that, I will offer an 11am AAP-CA legislative training, focused on bills and budget items of particular interest to pediatrics.

We rejoin CMA for their lunchtime speaker, and then head to the Capitol from 1-4pm for meetings with your legislators to advocate for children and the viability of pediatric practices.

Please join us!  This is a wonderful opportunity to engage actively in advocacy with colleagues and District officers and staff in order to make a real difference for your patients and your practice.

To receive details and updates on the AAP-CA Legislative Day, email office@aap-ca.org.

Update #20 December 7, 2009

1. H1N1 Influenza Vaccine - Exemption to State Thimerosal Law Extended Through September 2010

A request by AAP-CA and others to extend the initial exemption to the California Mercury Free Vaccine Act for the H1N1 influenza vaccine originally scheduled to expire on November 30, 2009, has been granted by the California Health and Human Services Agency in consultation with Governor Schwarzenegger. This exemption allows preservative-containing monovalent H1N1 influenza vaccine to be administered to children younger than 3 years old and pregnant women for the period of October 12, 2009 - September 30, 2010. The exemption was granted to ensure that pregnant women and young children, who are at high-risk for H1N1 flu complications, can receive protection from H1N1 flu vaccine when preservative-free vaccine is limited or unavailable. The exemption covers the H1N1 vaccine only. There is no exemption currently for remaining supplies of seasonal (trivalent) influenza vaccine.

2. Healthy Families Funds Again in Jeopardy, as Federal Government Finds Fault With AB 1422 Provisions for Fee on Managed Care Plans

With strong support from AAP-CA and individual actions from many of you, the Legislature passed and the Governor signed AB 1422, one of the bills critical to filling the nearly $600 million funding gap in Healthy Families that had led to waiting lists and threats of disenrollment.

AB 1422 contains a fee on managed care organizations that contract with Medi-Cal. The revenue, nearly $100 million, is intended as the state match for increased federal Medicaid funding. However, the federal Centers for Medicare and Medicaid Services (CMS) has issued a preliminary opinion that the tax structure in AB 1422 is not consistent with applicable CMS regulations, because the fee is limited to only those managed care organizations that serve Medi-Cal, rather than all managed care plans.

The AAP-CA has urged the federal government to reconsider, in light of the ongoing state budget crisis here and the need to provide services through Healthy Families for those struggling in the current economic climate.

There is no immediate impact on the Healthy Families Program, as the decision is still under review. However, the possibility of our facing, once again, severe reductions in services under Healthy Families as a result of a budget shortfall is real. We will keep you posted on ways you can help if further advocacy at the federal or state level is required.

3. AAP-CA Foundation Children’s Health Systems, Inc. Moves Forward with Development of Residency Training Regarding Communication About Vaccine Safety to Patients and Families—Your Help is Needed

The non-profit foundation set up  by the AAP-CA, Children’s Health Systems, Inc., has received a 2-year, $370,000 grant from the CDC to develop curricula to train residents regarding how best to communicate to parents and adult patients about vaccine safety. The Foundation is working on this project in partnership with Stanford University, UC San Diego, the California Academy of Family Physicians, and expert pediatrician consultants based at UC Davis and Children’s Hospital Los Angeles.

We are in the process of seeking residency program sites around the country at which to conduct focus groups to gather input for development of the curricula, and to pre-and post-test the new curricula once completed. If you are affiliated with a residency program or have close ties with colleagues who are and have an interest in becoming one of the focus groups or test sites for this important project, please let me know.

Time commitment from the program is minimal for the focus group (permitting me to come there and conduct a focus group with residents). Those who are able to provide a test site would have greater involvement, and will be the first to view and test the new materials, helping to shape resident education on vaccine safety issues for years to come. If you are able to help us identify appropriate residency training sites, please contact me as soon as possible at kcalvin@aap.net.

Update #19, November 17, 2009

1. AAP-CA Endorses Pediatrician Richard Pan, MD For Assembly. Go To panforassembly.com Now and Help Send Richard Pan to Sacramento to Help Children and Pediatricians!

Richard Pan, MD, FAAP, Vice-Chair of AAP-CA, has launched his run for the 5th District Assembly seat in Sacramento.

Actions in Sacramento affect all of California. Richard Pan brings a unique commitment and understanding of the needs of children and pediatricians. AAP-CA has therefore taken the unprecedented action of endorsing his candidacy and urging you to help!

If elected, Dr. Pan would be the first pediatrician to hold a seat in the California Legislature. But financial reporting deadlines are fast approaching, and Richard needs pediatricians’ direct financial support to meet the goals that will enable him to be successful in this bid.

Although you cannot vote outside your own Assembly District, you may give support in name or in financial contributions to any candidate across the state who you feel would stand up for your values when in office.

YOUR ACTION MATTERS
Please go to www.panforassembly.com, learn more about Richard’s candidacy and go to “Donate” to help him make a healthier California for children and pediatricians!!

2. Trio of AAP-CA Supported Bills Enacted to Fill Healthy Families Funding Gap, Yet Money May Still be at Risk

With strong support from AAP-CA and individual actions from many of you, the Legislature passed and the Governor signed three bills designed to fill the nearly $600 million funding  gap in Healthy Families this year that led to waiting lists and threats of disenrollment.

AB 1422 contains a fee on managed care organizations that contract with Medi-Cal.  This revenue will be used as the state match for increased federal Medicaid funding.  Similarly, AB 1383 and AB 188 together enact a fee on hospitals to generate additional federal matching funds. While most of the money in these last two bills goes to support struggling children’s hospitals, a portion of these fees is intended to go to children’s coverage through Healthy Families. In both cases, the associations representing the affected entities (health plans and hospitals) support the bills, since they will ultimately bring more in federal dollars to the plans and hospitals than the fees they would pay.

While hard-fought enactment of these bills is cause for celebration, there may remain legal and other hurdles to secure the targeted federal funds in AB 1422. Furthermore, the children’s access portion of AB 1383 and AB 188 may be vulnerable to hijack by the state to fill the General Fund deficit, rather than for use as intended for kids’ health. AAP-CA is monitoring this closely, and will keep you posted if there are ways you can help ensure that full implementation of these important bills becomes a reality.

3. H1N1 Vaccine Distribution Across California Inequitable, Many Medica Homes in Short Supply. AAP-CA Urges State to Help!

AAP-CA has worked with the California Immunization Branch for months, providing input to try to ensure that an appropriate provider registration and distribution system would be in place for the H1N1 vaccine. However, shortages and delays in supply of the vaccine, while occurring nationwide, are revealing terrible inadequacies in the final system in California.  These include variation among cities and counties in H1N1 vaccine supply; urgent care centers, worksites and public health clinics receiving vaccine prior to pediatric offices; and a nonresponsive ordering system that does not permit pediatricians to know the status of their orders.

We know that when a practice receives 50 doses instead of the hundreds or thousands it ordered, it is a recipe for disaster. Does the practice give those doses to highest-risk patients, but ask them to keep it a secret so that the many other parents desperate to get the vaccine for their children do not inundate their office with angry calls and pleas, or even leave the  practice believing we did not sufficiently value their children relative to someone else’s?  

AAP-CA realizes this is not all under the state’s control, but a haphazard and inequitable distribution system has made the problem much worse than it should be. Thus, in addition to numerous meetings, a public letter has been sent this week to the Governor and State Public Health Director Mark Horton, MD, FAAP, MD to ask their continued help in solving this crisis.

We will continue to work aggressively to do all we can to see that H1N1 vaccine is prioritized for delivery to the pediatric medical home, and to those children that need it most.

This weekend is the AAP-CA’s highly successful annual CME meeting in Vegas, Nov 19-22. We have 600 pediatricians attending.  It is not too late for you to join us! You can register now or on site at Caesars. Please message me know when you get there (kcalvin@aap.net), and we can talk politics and more. Go to http://www.aap-ca.org/meetings/index.html#vegas

Update 18#, October 23, 2009

1. Urgent: Ask Your Assemblyperson to Vote Aye on AAP-CA Supported Hospital Fee Bill AB 188

AB 188 (Jones) is a technical clean-up bill to authorize the state budget appropriation required to implement AAP-CA supported AB 1383. Assemblymembers will vote on AB 188 as early as Monday, October 26, 2009. AAP-CA strongly supported rec

AAP-CA strongly supported recently-enacted AB 1383 (Jones). Co-sponsored by The Children’s Hospital Association and the California Hospital Association, AB 1383 will levy a fee on California hospitals in order to access $2 billion annually in federal funds for increased hospital Medi-Cal reimbursement. It will also generate over $300 million annually intended for children’s health coverage.

AB 188 takes the needed actions to begin this funding process. 50% of the state’s 6 million-plus Medi-Cal enrollees are children, and the currently under-reimbursed costs of their inpatient care falls largely on these hospitals.

YOUR ACTION MATTERS:
Please call, fax, or email your Assemblymember NOW to urge them to vote AYE on AB 188, critical legislation for children’s health!

To identify your Assemblymember go to
http://www.leginfo.ca.gov/yourleg.html

Your message can be brief. The important thing is to let your Assemblymember know that as a front-line provider in the care for children, you urge him or her to vote AYE on AB 188 to access significant federal funds to support children’s hospitals in the important work they do, and to support children’s access to care.

2. You Can Give H1N1 Vaccine Containing Preservatives to Children Under Three Years of Age Through Nov 30, 2009: AAP-CA Request for Exemption to Law Granted

Since 2006, California law has stated that vaccines containing specific levels of mercury cannot be administered to pregnant women and young children, except under certain circumstances. Due to delayed supplies of thimerosol-free H1N1 vaccines this year, AAP-CA and others have successfully urged the state to grant an exemption to the law. Specifically, the Secretary of the California Health and Human Services Agency has granted an exemption to this restriction for Influenza A (H1N1) 2009 Monovalent Vaccine in children younger than 3 years of age and pregnant women from October 12, 2009 – November 30, 2009. The need for a further extension of the exemption will be assessed.

YOUR ACTION MATTERS:
This exemption is in place through November 30, 2009. Please keep me posted if you do NOT expect to receive sufficient supplies of preservative-free H1N1 vaccine for your “under-3 years” patients for the period after November 30,2009.

3. AAP-CA Joined All Specialties at CMA House Last Weekend: Poison Control Funding, Sugar Tax and Medical Home Featured in Policy Debates

AAP-CA Delegation Chair, Stuart Cohen, MD and Delegate Damodara Rajesekhar, MD joined AAP-CA SGA Co-Chair Shannon Udovic-Constant, other pediatricians and physicians of all specialties last weekend to develop policy recommendations for the CMA Board. Numerous important resolutions were enacted to help guide CMA in its policies and actions, including the following priority resolutions for the AAP-CA:

Resolution 716a-09

California Poison Control System Funding

Resolved: That CMA declare that the California Poison Control System is a public health necessity deserving secure funding and that CMA undertake all efforts to achieve this goal

Resolution 721a-09

Sugar Sweetened Food/Beverage Education and Taxation

Resolved: That physicians should educate their patients about the health risks associated with the consumption of food and beverages containing high amounts of processed simple sugars or refined sugars such as high fructose corn syrup; and be it further

Resolved: That CMA support increased taxes on sodas and other relevant sugar sweetened beverages, with the revenues to be utilized for public health education efforts such as those conducted by the CMA Foundation and for other health purposes; and be it further

Resolved: That CMA encourage public health education campaigns on obesity prevention and treatment

Resolution 219-09

Medical Home Advocacy

Resolved: That CMA support the definition of “patient centered medical home” in state law that is based on the “Joint Principles of the Patient Centered Medical Home”; and be it further

Resolved: That only a licensed physician should lead any medical home model.

Update #17, October 13, 2009

1. Deadline Passes: Gov signs drunk driving bill, vetoes child care nutrition, hospital bill fate unknown

n the end, the Governor felt enough work had been done by the Legislature on a water package that he stepped back from his mass veto threat, and instead weighed each of the 700-plus bills on his desk on individual merit. No report yet on how he acted on AB 1383, the Children’s Hospital bill to increase Medi-Cal reimbursement to hospitals through a hospital fee. It must have been among the last that he acted upon.

Meanwhile, we know the Governor did sign AAP-CA supported AB 91 (Feuer), to implement mandatory ignition lock devices for specified drunk driving offenses through a pilot in the Counties of Alameda, Los Angeles, Sacramento, and Tulare. Thanks to AAP-CA member Jim Crawford, MD for providing in-person testimony to the Legislature on this important bill.

The Governor vetoed AAP-CA supported AB 627 (Brownley), which would have set higher nutrition standards in day care settings in California. The Governor noted his regret at vetoing this bill, but said that in a time of so many education cuts he could not sanction a new program. More on bill status to come, including a special notice when we hear on AB 1383…

2. CA Ballot Initiative Filed to Require Guardian Notification prior to Abortion by Minor, With Physicians Held Liable for Lack of Compliance

Despite three prior defeats at the ballot box, yet another initiative had been filed that would require notification of a parent or guardian prior to a minor obtaining an abortion in California. Further, the physician, once made aware of the desired abortion by the minor, would be required to fill the role of making the notification (by phone or certified mail) to the parent or guardian. The physician would be personally liable in a civil suit if due diligence in making the notification was not demonstrated.

The AAP-CA strongly supports communication between the parent or guardian and the minor in this decision (which the evidence shows happens in the vast majority of such cases without legislative inference), and supports the right of each individual pediatrician to their own position on abortion as a moral and ethical question. At the same time, the AAP-CA’s position is that these types of initiatives to force communication are potentially harmful to the health of minors (who may seek illegal or late abortions under such circumstances) and inappropriately make physicians the agents of the state, violating the patient-physician trust relationship.

As such, the AAP-CA has joined with the California Medical Association, the American College of Obstetricians and Gynecologists and public health organizations in successfully defeating such initiatives in the past.

The initiative, with the proposed title by those who submitted it of the “Parental Notification, Child and Teen Safety, and Stop Predators Act”, can be viewed at
http://ag.ca.gov/cms_attachments/initiatives/pdfs/i850_09-0053_amdt_1s.pdf.

3. Work continues on AAP-CA Vegas Nov 19-21nd CME meeting: Deadline for discounted rooms at Caesars is November 4th

Deadline for discounted rooms at Caesars Palace Resort for the AAP-CA’s Annual CME meeting in Vegas Nov 19-21st ends November 4th.

Speaker topics include timely and practical information for your practice on diagnosis and treatment in the areas of asthma, dermatology, orthopedics, and teen gynecology.

Please email me at kcalvin@aap.net if you are attending the Vegas meeting and would like to get together for an informal discussion of advocacy for pediatricians.

To learn more and to register, go to http://www.aap-ca.org/meetings/index.html#vegas

Addendum #17, October 11, 2009

Governor Signs AB 1383: Increases Medi-Cal Reimbursement to Hospitals!!!!!!

Late-breaking news: Governor signs AB 1383 to establish a hospital fee that enables California to access $2 billion annually in federal funds to increase Medi-Cal reimbursement to hospitals!!!

This bill was strongly supported by the AAP-CA, and sponsored by the California Children's Hospitals and the California Hospital Association.

Below is the signing message the Governor sent along with his signature on the bill. It relays his remaining concerns, and in it he emphasizes the need, agreed to by the author and sponsors, for additional legislation to implement the bill's full intent.

Based on my understanding of the substantive concerns of the Administration, as well as the political dynamics that were in play in Sacramento, I am convinced that advocacy from individual pediatricians and residents made a difference in the Governor's final decision to sign this bill.

THANK YOU TO ALL WHO ACTED ON BEHALF OF CHILDREN, PEDIATRICIANS AND THE VIABILITY OF OUR CHILDREN'S HOSPITALS.

Kris

To the Members of the California State Assembly:

I am signing Assembly Bill 1383.

While I was supportive of many types of provider fees in my 2007 health care reform proposal and even offered this very same solution several months ago to help address our budget shortfall, I would point out that this bill lacks key features that must be addressed in order for this bill’s provisions to be implemented.

• This bill does not contain an urgency clause. Therefore, it will not go into effect until January 1, 2010. Any expectation that this bill can be implemented earlier is not feasible.
• There is no appropriation in this bill. Therefore, the significant departmental workload associated with implementing this bill has not been funded. No steps will be taken to implement this bill unless and until a subsequent appropriation is passed by the Legislature. The Department may, at its discretion, engage with the federal Centers for Medicare and Medicaid Services about the funding proposal as a means to seek preliminary feedback and ascertain whether further statutory changes are needed.
• The bill contains no authority for the funds to be distributed to hospitals, or to provide funding for children’s health coverage. There will be additional legislation needed for this authority as well.

The Department’s ability to implement this bill will have to rely on actions that have yet to be taken up by the Legislature. I look forward to the expedient passage of subsequent legislation to address the appropriation and funding issues related with this bill.

Sincerely,
Arnold Schwarzenegger

Update #16 October 8, 2009

1. Deadline Sunday Midnight: Support Children’s Hospital Bill AB 1383

AAP-CA strongly supports AB 1383 (Jones), which passed the Legislature last week and is on the Governor’s desk awaiting action, co-sponsored by The Children’s Hospital Association and the California Hospital Association, AB 1383 would levy a fee on California hospitals in order to access $2 billion annually in federal funds for increased hospital Medi-Cal reimbursement. It would also generate over $300 million annually   intended for children’s health coverage.

The hospital fee would sunset in 2013, and would only go into affect if the federal government approves the proposal and makes available the increased federal funding.  50% of the state’s 6 million-plus Medi-Cal enrollees are children, and the currently under-reimbursed costs of their inpatient care falls largely on these hospitals.

YOUR ACTION MATTERS:
The Governor has only until midnight Sunday, October 11th, to make a decision on AB 1383. Please call, fax or email the Governor NOW to urge him to sign this critical legislation for children’s health! You can reach the Governor at:
Phone: 916-445-2841 Fax: 916-558-3160 (new number) or through his website via email at http://gov.ca.gov/interact#email

Your message can be brief. The important thing is to let the Governor know that from your position as a front-line provider in the care for children, you urge him to sign AB 1383 as a priority, consistent with his commitment to children and children’s health access in California.

2. AAP-CA Foundation Receives $350,000 Grant for Resident Education on Vaccine Safety Communication to Parents

The AAP-CA Foundation, a 501©3 committed to undertaking projects that support the mission of the AAP-CA, was recently awarded a two-year federal stimulus funds grant of $350,000 through the Centers for Disease Control. Partnering with Stanford University and the University of California at San Diego, as well as the California Academy of Family Physicians and immunization experts Bill Mason, MD, FAAP, Richard Pan, MD, FAAP and Dean Blumberg, MD, FAAP, the AAP-CA Foundation will identify current gaps in residency education regarding vaccine safety and parental support, and develop pilot materials to address those gaps. Mark Sawyer, MD, FAAP will act as the Principal Investigator on the project, and I will serve as Project Director.

We are very excited to begin this important work, as we know the stresses you face on a daily basis as issues of vaccine safety continue to be foremost concern on parents’ minds. We hope this project will help us to support the next generation of pediatricians as they face these challenges, by giving them effective tools to educate parents quickly in the practice setting.

YOUR ACTION MATTERS:
We would appreciate any suggestions or input you have as to key issues being raised now by parents in your practices relative to vaccine safety issues, and any tips that have worked for you in supporting families to make sound, evidence-based decisions. on vaccines. We can incorporate your ideas into our discussions and development of materials for residents, giving them the benefit of your on-the-ground experience. Please contact me directly at kcalvin@aap.net.

3. Pediatrician Richard Pan, MD  Files for  Sacramento Assembly Seat for June 2010: If Successful, Pan Would be  First Pediatrician Seated  in California Legislature

Richard Pan, MD, FAAP, current Vice-Chair of AAP-CA, joins fellow Democrats Lawrence Miles and James Shelby, and Republicans Craig DeLuz and Andrew Pugno in seeking the 5th District Assembly seat in Sacramento.

Assemblymember Roger Niello (Republican) is in his third and final term due to term limits. The District primary will be held in June 2010. If elected, Dr. Pan would be the first pediatrician to hold a seat in the California Legislature.  

The AAP-CA does not endorse candidates.  We encourage you to seek information on all candidates in any races of interest to you, including this one, and to make an independent decision as to your choice. Note that while you can not vote outside your own District, you may support in name or with financial contributions any candidates across the state who you feel would stand up for your values when in office.

A good resource for candidate information is www.smartvoters.com run by the nonpartisan League of Women Voters. Note, however, that it does not have 2010 races up yet. 

P.S. Next month is the AAP-CA’s annual CME meeting in Vegas, Nov 19-22. I hope you will join me at Caesars’ and we can talk politics and more! Go to http://www.aap-ca.org/meetings/index.html#vegas

Update #15 September 23, 2009

1. Governor signs AAP-CA Supported to FUND Healthy Families: 700,000 kids will have health insurance through the program despite earlier budget cuts!

With strong advocacy by the AAP-CA, individual pediatricians and others, AB 1422 cleared the 2/3 vote hurdle in the state Assembly and Senate and was signed yesterday by the Governor. Combined with a voluntary First Five contribution of $81.4 million, this bill will provide health insurance coverage through Healthy Families that otherwise would have been lost to draconian budget cuts earlier this year.

There is great reason to celebrate this success, and I want to personally thank all of you who contacted your legislator or the Governor to remind them that children’s health access must be a priority for California.

At the signing ceremony the Governor stated  “One of my goals as been to ensure all children, so it was very tough for me to make those cuts”, followed by a response from Senate Leader Senator Steinberg that, “The Governor says it was his goal to cover every child in California…I say, we still have time – let’s do it!”

The next three years are projected to again yield significant state budget deficits unless structural changes are made in the way we secure revenue and make expenditures: $8 billion next year, followed by $15 billion shortfalls each of the following two years. AB 1422 is a critically important measure, but still only a temporary fix, as the tax provision expires in 2 years.

YOUR ACTION MATTERS:
Please call the Governor to thank him for his important action in signing AB 1422, and to urge him to work with Legislative leaders so that a long-term solution to covering all California children can be found. This is a goal we know he shares with the AAP-CA!
You can reach the Governor at:
Phone: 916-445-2841 Fax: 916-558-3160 (new number) or through his website via email at http://gov.ca.gov/interact#email

If you have not done so already, please also take the time to thank your Legislator if they voted for AB 1422. If you have a Legislator who voted against AB 1422, send a brief, respectful  (not angry) note letting them know your disappointment in their action, and your hope that they will stand up for children when the next opportunity arises. To identify your legislator and get their contact information, go to www.leginfo.ca.gov

For the vote record on AB 1422 in the Assembly, go to:
http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_1401-1450/ab_1422_vote_20090903_0332PM_asm_floor.htm

For the vote record in the Senate, go to:
http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_1401-1450/ab_1422_vote_20090902_0402PM_sen_floor.html

2. CMA welcomes new CEO Alfred Gilchrist

Alfred D. Gilchrist, the CEO of the Colorado Medical Society and former longtime director of state and federal governmental advocacy for the Texas Medical Association, has been named the new chief executive officer of the California Medical Association. Mr. Gilchrist will take over as CMA CEO on November 16, 2009 replacing former state Senator Joe Dunn. Mr. Dunn is leaving his CMA post to have more time with his family, who live in Orange County. While at the Colorado Medical Society Mr. Gilchrist “broke new ground in reforming managed care contracting practices, physician profiling and rating systems, and transparency and disclosure to Colorado’s health plan merger and acquisitions statute, as well as significant expansions and reforms in Medicaid”.

JOIN THE CMA:

If you are not already a CMA member, please consider joining. Having a strong state medical society that advocates for physicians on those issues that pertain to all of medicine frees the AAP-CA to focus on pediatric-specific areas of particular significance to you and your patients. While we do not move in lockstep with CMA, on the vast majority of issues the AAP-CA and thj CMA work very closely together. In the rare instances where there is a difference of opinion, having   significant numbers of pediatricians as CMA members strengthens our voice within the organization and our ability to work with CMA to engage its resources on your behalf.

To find out more about CMA and how to join, go to www.cmanet.org.

3. Please join me at the AAP-CA November CME meeting in Las Vegas to support AAP-CA advocacy efforts

As noted in the last Three for Thought, and worth repeating, AAP-CA hosts only one joint CME meeting each year of all four of the AAP-CA regional chapters. In its 31st year, this meeting provides   critical support for AAP-CA advocacy efforts; without the revenue it produces, our ability to speak in Sacramento on your behalf is severely compromised.

The meeting is held in Las Vegas at Caesars Palace, with attendance generally running at 600 or more pediatricians from around the country and around the world, and an always stellar array of speakers.  I could hope to   persuade you to consider attending on the acknowledged quality of this meeting alone.   But I am asking you to consider that it means so much more to the AAP-CA if you do choose to attend, as it permits me to work with AAP-CA leadership and volunteers to make the difference you would like to see in the many issues I share in this blog. I attend this annual CME meeting in its entirety, and am always happy to join groups for informal sidebars over drinks or dinner about what matters to you most in advocacy!

YOUR ACTION MATTERS: You can go to http://www.aap-ca.org/meetings/index.html#vegasa for more information on the AAP-CA 31st Annual Vegas CME meeting, held November 19-22 this year.

I hope you will seriously consider making a weekend of it-- there are lots of people to meet if you go on your own, or bring your family. (I can vouch that my son looks forward to the trip each year—he thinks the gondolas and roller coasters in Vegas are the best thing ever!)

Update #14 September 9, 2009

1. Bill to FUND Healthy Families to prevent disenrollment of up to 600,000 goes to Governor’s desk for signature, needs our help!

With strong advocacy by pediatricians, AB 1422 (Bass) cleared the 2/3 vote hurdle in the state Assembly and Senate and was sent to the Governor’s desk at 2:45pm yesterday, September 8th.

AB 1422 will raise money for the Healthy Families Program to cover state budget cuts by establishing a temporary gross premiums tax for Medi-Cal Managed Care plans. This tax on the plans will provide California the state matching funds needed to access increased federal funds.

AAP-CA sent a letter to the Governor urging him to sign AB 1422, and he has indicated that he would do so. However, yesterday the Governor threatened to veto 72 bills on his desk because he said lawmakers have ignored priority issues. We expect that AB 1422 will rise to the level of a priority issue for the Governor, and given his earlier statement that he is committed to signing it, that it has not been swept up in this larger political gamesmanship. But as reported in The Sacramento Bee, as of yesterday both the Senate and the Assembly were moving to withdraw their bills from the Governor’s desk “for safekeeping”. The move is so the bills can be shielded from veto, to be resubmitted when the Governor signals signing is again possible. (Thanks to the Sacramento Bee for timely reporting on this issue.)

YOUR ACTION MATTERS:
I hope to be able to report to you soon that the Governor made an exception for AB 1422 and signed it into law, as promised. However, as there are no guarantees in life, and things change, I urge you to contact the Governor TODAY to thank him for his commitment to sign AB 1422, and to stress the bill’s importance in addressing the PRIORITY issue of children’s health access.

You can reach the Governor at:
Phone: 916-445-2841 Fax: 916-558-3160 (new number) or through his website via email at http://gov.ca.gov/interact#email

Please also take the time to thank your Legislator if they voted for AB 1422. If you have a Legislator who voted against AB 1422, send a brief, respectful (not angry) note letting them know you disappointment in their action, and your hope that they will stand for children when the next opportunity arises. To identify your legislator and get their contact information, go to www.leginfo.ca.gov

For the vote record on AB 1422 in the Assembly, go to:
http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_1401-1450/ab_1422_vote_20090903_0332PM_asm_floor.html
For the vote record in the Senate, go to:
http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_1401-1450/ab_1422_vote_20090902_0402PM_sen_floor.html

2. AAP-CA Supports Food Stamp Waivers for Adolescents in Foster Care

As pediatricians know, children in foster care comprise one of the most vulnerable populations in California. AAP-CA is a strong advocate of measures to support the health and well being of these children as they grow and transition to adulthood. AB 719 (Lowenthal) would require the California Department of Social Services to seek a federal waiver and funds for a Transitional Food Stamps for Foster Youth demonstration project, effective July 1, 2010. The project would provide independent foster care adolescents with eligibility for food stamps without regard to income or resources.

With AAP-CA support, AB 719 passed the Assembly 75 to 0 and the Senate 22 to 12. It is expected to be acted on for concurrence between the two legislative houses this week, and then go to the Governor’s desk for signature (once the Governor indicates that he is again willing to sign bills that are not on his priority list).

While this is a relatively modest effort, until we see major reforms of the foster care system it will take a combination of positive measures like this one to help foster children and adolescents survive and flourish against the odds many face.

YOUR ACTION MATTERS:
AAP-CA is known in the Capitol for stepping outside of “typical physician issues”, and advocating on behalf of our most vulnerable patients in areas on which few voices are heard. If foster care is an issue near and dear to your heart, please contact the Governor’s office now and let him know that when AB 719 comes to his desk, it is important for him to sign it. Share briefly any experience you have in caring for foster children and the challenges they face.

You can reach the Governor at:
Phone: 916-445-2841 Fax: 916-558-3160 (new number) or through his website via email at http://gov.ca.gov/interact#email

Please also take the time to thank your Legislator if they voted for AB 719 (all Assemblymembers). If you have a Senator who voted against AB 719, send a brief, respectful (not angry) note letting them know you disappointment in their action, and your hope that they will stand for vulnerable children when the next opportunity arises. The only NO votes on AB 719 were Senators Aanestad, Ashburn, Benoit, Cox, Denham, Dutton, Harman, Hollingsworth, Runner, Strickland, Walters and Wyland.

To identify your legislator and get their contact information, go to www.leginfo.ca.gov

3. Please join me at the AAP-CA November CME meeting in Las Vegas to support AAP-CA advocacy efforts

AAP-CA hosts only one joint CME meeting each year of all four of the AAP-CA regional chapters. In its 31st year, this meeting provides critical support for AAP-CA advocacy efforts; without the revenue it produces, our ability to speak in Sacramento on your behalf is severely compromised.

It is held in Las Vegas at Caesars’s Palace, with attendance generally running at 600 or more pediatricians from around the country and around the world, and an always stellar array of speakers. I could hope to persuade you to consider attending on the acknowledged quality of this meeting alone. But I am asking you to consider that it means so much more to the AAP-CA if you do choose to attend, as it permits me to work with AAP-CA leadership and volunteers to make the difference you would like to see in the many issues I share in this blog. I attend this annual CME meeting in its entirety, and am always happy to join groups for informal sidebars over drinks or dinner about what matters to you most in advocacy!

YOUR ACTION MATTERS: You can go to
http://www.aap-ca.org/meetings/index.html#vegas
for more information on the AAP-CA 31st Annual Vegas CME meeting, held November 19-22 this year.

I hope you will seriously consider making a weekend of it-- there are lots of people to meet if you go on your own, or bring your family. (As a single mom, I can vouch that my son looks forward to the trip each year—he thinks the gondolas and roller coasters in Vegas are the best thing ever!)

Update #12, September 2, 2009

1. Bill to FUND Healthy Families to prevent disenrollment of up to 600,000 is stalled: CALL Legislators TODAY regarding AB 1422

AB 1422 (Bass) would raise money for the Healthy Families Program to cover state budget cuts by establishing a temporary gross premiums tax for Medi-Cal Managed Care plans. These plans currently pay a state tax of 5% that will end Oct. 1, 2009. AB 1422 would establish a short-term 2% tax instead that would sunset in two years, to bridge the time until longer-term solutions to Healthy Family cuts can be found.  This tax on the plans would provide California the state matching funds needed to draw down increased federal funds. Because AB 1422 brings in more money to these programs than it takes from them in the tax, there is no registered industry opposition to the bill, and the Association of California Health Plans supports it. AB 1422 also would increase the modest premiums under Healthy Families only for those at over 150% of the poverty level.

Without AB 1422, disenrollment of Healthy Families children is scheduled to begin October 1, 2009, with up to 600,000 of the program’s nearly one million children pushed into the ranks of the uninsured.

Initially, it looked like AB 1422 had bipartisan support and would get the 2/3 votes needed to make it to the Governor’s desk, since all Republicans but one that were present for the Senate Appropriations vote on the bill voted together with Democrats to send the bill to the Senate floor. However, organizations and individuals opposed to any new taxes have begun to pressure Republicans not to vote for AB 1422, with the specter of recall campaigns and retaliation not far behind. The Senate vote could occur as early as today, so the bill’s future is in immediate jeopardy.

YOUR ACTION MATTERS TODAY, SEPT 2nd:    AAP-CA is avowedly non-partisan, and has resisted the strong pull of both parties in Sacramento to endorse their differing view on taxes and tax structure. This longstanding policy of neutrality on specific taxes (some of which may pit provider against provider) has led AAP-CA to organizationally remain neutral on AB 1422. However, AAP-CA leadership also recognizes the immense importance of this bill to funding the Healthy Families Program, a core element of the state’s safety net that is on the verge of being decimated. The AAP-CA Board has therefore voted to aggressively publicize the existence of AB 1422, the fact that it may be in trouble due to lack of Republican votes, and to urge individual pediatricians who agree with the philosophy in this bill to contact their legislators, particularly Republican Senators, and to ask them to VOTE YES on AB 1422.   Please consider taking this action RIGHT NOW. Note that you can identify your legislator and get their contact information at www.leginfo.ca.gov.

2. AAP-CA partners with the California Women, Infants and Children (WIC)

October 1st, the California Women, Infants and Children program (WIC) is implementing changes to benefits and services that are consistent with AAP recommendations. These include providing fresh fruits, vegetables and whole grains to all WIC families, increased food packages for breastfeeding mothers, and access to full WIC food packages for children with special needs.

To support these new services, the physician form for WIC has been changed.

AAP-CA is working with WIC to promote these food package changes and to support pediatricians in accessing and understanding revised WIC forms and reporting requirements. Donald Miller, MD, FAAP who is a leader in AAP-CA, shares with you the new WIC changes via a brief You Tube video at http://www.youtube.com/watch?v=jpxIU5GZq7U.

YOUR ACTION MATTERS:  Download the new WIC forms at www.wicworks.ca.gov, to have ready for use in your offices.  Make sure children, breast-feeding mothers and other families in your practice can benefit from enhanced WIC services.

3. AAP-CA Joins the CA Network for Clean Air in supporting California’s efforts to reduce global warming and diesel emissions to provide a cleaner air environment for California’s children

AAP-CA is an active member of the California Network for Clean Air, joining other medical and public health organizations to promote policies that protect children’s health by mitigating and preventing air pollution.

The recent budgetary strains in the state have led to an attack on environmental clean air regulations, ignoring their money saving effects, as these regulations prevent illness and disability that otherwise burden our emergency rooms and our larger heath care system. On August 28th, the AAP-CA signed a joint statement to the California Air Resources Board’s (CARB) to reaffirm our commitment to policies reducing diesel emission and other air pollutants in order to reduce related morbidity and mortality. In particular, diesel pollution poses a serious threat to public health, contributing to 4,500 premature deaths, 71,000 asthma attacks and other respiratory symptoms and hundreds of hospitalizations for heart disease each year.  Effects of diesel pollutants are especially harmful to vulnerable populations, including developing children and those with respiratory conditions like asthma.

YOUR ACTION MATTERS: You can contact the California Air resources Board and voice your individual support for maintaining the AAP-CA supported policies that protect and promote children’s health and well-being. Go to http://www.arb.ca.gov/html/contact.htm for contact information via email or phone.

Update #11, August 25, 2009

1. Anthem Blue Cross responds favorably to AAP-CA request to address vaccine access concerns in specific new contracts.

The AAP-CA Pediatric Council, led by Chair Len Kornreich, MD, FAAP and Vice-Chair Chris Tolcher, MD, FAAP, has been actively engaged with Anthem Blue Cross regarding AAP-CA member concerns about the new Healthy Families Exclusive Provider Organization (EPO) and Access for Infant and Mothers (AIM) contracts. Primary concerns involved reductions in reimbursement rates of vaccines that, in many cases, were below vaccine cost.

AAP-CA cannot negotiate specific rates. However we were able to share with the plan the issue of inability to provide vaccines and other services when rates are inadequate to cover them, without discussing specific amounts.

As a result of these discussions, Anthem Blue Cross was highly responsive and has taken corrective action. They have agreed to reimburse vaccines at a level that is not less than your previous Prudent Buyer Agreement that included Healthy Families EPO and AIM programs. Specifically, Anthem Blue Cross will reimburse at whichever rate is greater: the provider's existing contract rates or the newer rates. They also expressed an interest in assisting providers in getting into vaccine purchasing groups with the goal of reducing vaccine purchase cost.

We realize there are other concerns besides vaccines in these new contracts, but we are happy with the results to date. We want to thank AAP-CA Chapter Directors and individual pediatricians for sharing with the District their concerns, so that we could take action on your behalf. We also want to thank those at Anthem Blue Cross, including Medical Director Jeff Kamil, MD, FAAP, for their willingness to take a second look at their payment policies structure at AAP-CA's request and to make corrections.

YOUR OPPORTUNITY FOR ACTION: While AAP-CA can not engage in contractual reimbursement discussions relative to dollar amounts, we can and will educate plans generally about barriers to access, including low reimbursement. Please share with us any issues you think might meet this standard, as our role is to support the needs of children in California by creating and sustaining their access to viable, quality pediatric care.

2. AAP-CA works with CA Immunization Branch on H1N1 Vaccine Planning

AAP-CA leaders Dean Blumberg, MD; Yasuko Fukuda, MD; Bill Mason, MD; Mark Sawyer, MD and others are working with the state to provide pediatrician input into the process to distribute H1N1 vaccine through our health departments in the fall. An online pre-registration process for physicians to obtain the vaccine is under development, and is expected to be up and running September 1, 2009.

In the meantime, concerns have been raised about the timing of vaccine distribution, although there is optimism that there will ultimately be adequate supplies for all who want the vaccine, not just high-risk. Questions have also been raised about whether there will be sufficient thimerosol-free H1N1 vaccine to enable compliance with California law prohibiting administration of thimerosol-containing vaccines to children under-three and pregnant women. There is also concern about how to address parents’ safety questions, given the limited time to test the vaccine, and about how reimbursement to pediatricians for the cost of administering the H1N1 vaccine will be secured.

YOUR OPPORTUNITY FOR ACTION: Please share any concerns or questions you have about H1N1 distribution and administration, and we will incorporate those into our planning discussions with the state. Send to kcalvin@aap.net.

3. Learn more about Health Care Delivery structure in your area

According to the California Health Care Foundation (CHCF), California’s sprawling size and the diversity of its regional health care systems result in care that is organized, delivered, and financed differently throughout the state. This month CHCF published six regional market reports based on 15 months of research, providing a first-time, in-depth analysis of six distinct California health care economies. The goal is to better understand the market dynamics for each region studied (the San Francisco Bay Area, Sacramento, Fresno, Los Angeles, Riverside/San Bernardino, and San Diego). Topics include the supply and organization of hospitals, physicians, and other providers; and the accessibility of services for low-income residents, of particular importance during the economic downturn.

YOUR OPPORTUNITY FOR ACTION: I learned a lot from their work. You can read these reports at http://www.chcf.org/topics/almanac/index.cfm?subTopic=CL712 For more information contact, Alexandra Matisoff-Li, CHCF amatisoff@chcf.org

Update #10, August 14, 2009

1. First Five Healthy Families Contribution Holds a Surprise

It was anticipated that the First Five Commission might commit significant funds to the Healthy Families Program. However, it was a surprise that First Five decided to give the full amount requested by Legislative leaders, $81.4 million, to pay for premiums and related enrollment expenses for children ages 0-5 years, with no requirement for MRMIB to secure other funds!

Earlier communications suggested that First Five money would be held for Healthy Families until MRMIB secured funds to fill the rest of the shortfall. Instead, this immediate gift of funds qualifies for the federal 2 to 1 match, thus generating an additional $162 million in federal matching funds for a total inflow to Healthy Families of $244 million. This is estimated to fund 200,000 children who would otherwise lose coverage.

None-the-less, MRMIB has indicated that an enrollment freeze is still in effect, expected to prevent over 300,000 eligible children from enrolling this year. Further, disenrollment of children currently covered is still expected to occur unless other funds are secured, with up to 670,000 children disenrolled this budget year, beginning October 1, 2009.

YOUR ACTION MATTERS: While it is important to absorb the tremendous losses of Healthy Families coverage that we still face, the funding by First Five is a tremendously significant and uplifting action at a time when things seemed unyieldingly bleak for children’s coverage in California. I encourage you to contact Kris Perry, Executive Director of First Five California at kperry@ccfc.ca.gov, with a note of appreciation to Ms. Perry and the state First Five Commission for taking this action. You may also want to thank First Five State Commissioner Maria Minon, MD, FAAP (former President of Orange County Chapter 4, AAP-CA) at mminon@choc.org.

Dr. Minon made an early and unwavering commitment to First Five support of Healthy Families.

2.Legislation to create voluntary addiction and mental health program for CA physicians

AAP-CA supports AB 526 (Fuentes) to assist physicians and surgeons in seeking treatment for addiction or mental health problems. The California Medical Association and the California Academy of Family Physicians are cosponsors of the bill.

California is one of only three states that do not have a physician health program to provide monitoring services to protect patients from undue risks from physician substance abuse or mental disorder. AB 526 would allow physicians to come forward and self-identify their needs for treatment and in so doing diminish risk to patient care.

For more information on AB 526 go to the Senate analysis at http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_0501-0550/ab_526_cfa_20090707_121621_sen_comm.html. AB 526 has passed the Assembly and is in the Senate for consideration by committee.

3. AAP-CA Supports AWARE antibiotic education efforts

AAP-CA is an active member of the Alliance Working for Antibiotic Resistance Education, (AWARE).

The mission of AWARE is to reduce the unnecessary use of antibiotics and reduce the prevalence of antibiotic resistant bacteria in California. Dean Blumberg, MD, FAAP, provides dedicated leadership in AWARE on behalf of AAP-CA.

The California Medical Association Foundation initiated AWARE in 2000 as a long-term, statewide effort to promote the appropriate use of antibiotics. The partnership includes physician organizations; healthcare providers; health systems; health plans; public health agencies; consumer and community based health organizations; federal, state and local government representatives; and the pharmaceutical industry. With over 80 participating organizations, AWARE has grown to be the largest, most collaborative project of its kind in the nation.

YOUR ACTION MATTERS: If this is an issue that interests you, please consider getting involved by hosting an AWARE presentation for your group or hospital, or by becoming a member of the AWARE speakers’ bureau. For more information go to http://www.aware.md/GetInvolved/Default.aspx

Update #9, August 13, 2009

1. Saving Healthy Families: Is Help on the Way?

This morning the First Five Commission at the state level will consider what level of support to give to the Healthy Families (HF) Program.

The Legislature has asked First Five to contribute $81 million to fill the $194 million shortfall created by recent state budget actions. Note that the total HF program shortfall is actually three times that, or $582 million. This is due to the 2 to 1 federal match under CHIP (formally known as SCHIP) that California lost when we did not put up the $194 million in state general funds. So while $81 million is only about 15% of the total state and federal shortfall, every “little bit” still helps. Not that it’s a little bit for First Five; that represents many other worthwhile efforts unfunded.

Note that funds from First Five are by no means a done deal, as they have asked that other sources be identified to share the responsibility, as a condition for their significant contribution of First Five funds. Other parties being courted to help shore up HF include health plans, foundations, as well as legislative fixes that might add revenue.

It is unclear at present whether new funds would mean a cessation or reduction in the number of kids dropped this year (currently estimated at over 400,000), or whether it might affect the closure of the program and the waiting list.

Note that any new one-year, non-state HF dollars are a short-term fix, at best, as California’s structural deficits are predicted by many to endure for 3-5 more years, meaning the HF program remains in real jeopardy.

AAP-CA will continue to advocate that California ensure that all children who live here can access quality pediatric health care through state or private coverage, but   the latest slashing of child health access, including these repeated hits to the Healthy families program, indicate real challenges still lie before us.

2.  AAP-CA comments on Possible CCS reform

The Department of Health Care Services has initiated an outreach and stakeholder input process regarding potential reform to the California Children’s Services Program (CCS). This process is being undertaken in preparation for the state’s submission of a federal waver application in September.

The state is seeking revenue neutral or cost-saving ways to improve CCS service delivery. Among the proposals being discussed is the elimination of the CCS delivery system, as we know it. Although eligibility and benefits would remain in some form, CCS services would be delivered through Medi-Cal managed care or some other contracted entity.

The AAP-CA has advised the state in writing that we strongly oppose such a move.

While CCS, like all long-standing programs, can certainly benefit from reform, the standards and expertise CCS has built over 80 years should not be discarded. One option the AAP-CA thinks merits consideration is to pilot having CCS manage the care for the whole child who has qualifying CCS conditions. This would involve increasing communication with primary care providers who choose to participate in a team approach with CCS specialists. AAP-CA is working with the California Children’s Specialty Coalition on providing the state with expert input, as these proposals continue to be debated.

3.  Legislation to Enable Pertussis Vaccine Requirement for Middle School Entry Passes Senate Health

AAP-CA supports AB 354 (Arambula), would allow the California Department of Public Health to place a pertussis booster vaccine among the necessary vaccinations for students prior to the start of the 7th grade.

AB 354 has passed through the Assembly and recently moved out of Senate Health on a 9 to 0 vote. Next stop is Senate Appropriations, where the cost of the bill to the state will be considered.

Similar bills have failed in the past due to concerns about increased costs to the Healthy Families Program of adding required vaccines. Ironically, such costs would now be mitigated, since there will be fewer kids insured through the programs. More generally, the AAP-CA continues to educate legislators about the significant cost-savings generated by vaccines, once the significant potential costs of vaccine-preventable disease are weighed against the much lower cost of the vaccine itself. A second barrier to the bill has come from those who opposed the HPV vaccine, and are concerned that any change in vaccine school entry rules make an HPV vaccine mandate for school entry more likely.

We are working closely with our coalition partners, including the California Coalition for childhood Immunization, to see that science and sound policy are heard in Sacramento to carry this important bill through to enactment. Opportunities for grass roots advocacy on AB 354 will be shared with you through this bill as they arise.

Update #8, August 3, 2009

1. AAP-CA Advocacy for Healthy Families Program Continues:

Massive State Budget Shortfall for Program When the Governor received the state budget from the full Legislature last week, it did not contain significant elements of the budget deal that had been reached by the Legislature and the Governor. This meant the budget was still out of whack, so the Governor unilaterally made additional cuts. These included $50 million more from Healthy Families (HF), on top of the existing cuts and underfunding of $144 million, for a total reduction in Healthy Families funds of $194 million. As a result, up to a million kids that would have gotten access to care through Healthy Families if those funs were available will instead be dis-enrolled or put on a waiting list.

HF waiting list numbers in the first two weeks have far exceeded estimates, with over 30,000 kids already on the list. To address these egregious cuts, third year UCSF resident Amy Whittle, MD represented the AAP-CA with testimony in Sacramento. She spoke before the Major Risk Medical Insurance Board (MRMIB), the oversight agency for Healthy Families, July 30th. Whittle emphasized the need to find secure funding for this critically important program, and in the meantime to follow carefully waiting list kids, so that we do not lose the ability to enroll them when funds are available.

Dr. Whittle was featured in news coverage on the meeting. See http://www.sacbee.com/capitolandcalifornia/story/2071024.html?mi_rss=Capitol%20and%20California

2. Final 09-10 State Budget Cuts Hit Health… Again

In addition to the Healthy Families cuts, the final budget for this year makes deep cuts across many child health programs, including:

Medi-Cal and CCS

The budget cuts state funding for Medi-Cal by $323.3 million in 2009-10 without specifying how those savings would be achieved. Outreach for enrollment funds have been eliminated and one of the budget bills privatizes eligibility processing for Medi-Cal programs, which would likely result in a private contractor taking over eligibility processing in California. Further, one of the signed budget bills requires the Department of Health Care Services (DHCS) to submit a Medi-Cal waiver to the federal government that includes “restructuring proposals” for several groups, including people with disabilities. The stated goals of the waiver include improving quality and decreasing cost. The bill requires DHCS to consult with a stakeholder advisory group, in which the AAP-CA is actively engaged.

In addition to the Medi-Cal cuts themselves, AAP-CA is deeply concerned about a proposal to eliminate county CCS offices, which has emerged as part of this restructuring discussion.

Department of Developmental Service

Regional Centers were cut $234 million in the budget deal. This is in addition to the $100 million state-funding reduction included in the February 2009 budget agreement. The Governor then made an additional $50 million cut to state funding for Regional Center services for children up to age 5 who have developmental disabilities.

Maternal, Child, and Adolescent Health (MCAH)

Significant cuts across many programs, including reductions to the Adolescent Family Life Program by $1.75 million, and elimination of state funding for the Black Infant Health Program to save $3 million.

Dental

The budget suspends state funding for the Children’s Dental Disease Prevention Program for savings of $2.9 million in 2009-10.

State budget issues in California, while exacerbated by the national and global economic downturn, are long-term and structural. The expectation is we will be facing continued state deficits for at least three more years.

AAP-CA is planning accordingly, working as a leader and in coalition with others to protect child health programs.

3. Red Flag Rule Implementation Delayed to November 1, 2009

As noted in an earlier post, the Federal Trade Commission (FTC) issued a set of regulations, known as the “Red Flags Rule,” requiring that certain entities develop and implement written identity theft prevention and detection programs to protect consumers from identity theft. Despite efforts by the American Medical Association to persuade the Federal Trade Commission that these new rules for creditors should not apply to MD’s, the rule is scheduled to include MD offices when it goes into effect. Fortunately, to give creditors and financial institutions more time to review this guidance and develop and implement written Identity Theft Prevention Programs, the FTC has further delayed enforcement of the rule from the anticipated August 1, 2009 start date to November 1, 2009.

The FTC's Red Flags Web site, www.ftc.gov/redflagsrule, offers resources to help entities determine if they are covered and, if they are, how to comply with the rule. The Commission also posted FAQs that address how the FTC intends to enforce the Rule and other topics - www.ftc.gov/bcp/edu/microsites/redflagsrule/faqs.shtm. The enforcement FAQ states that Commission staff would be unlikely to recommend bringing a law enforcement action if entities know their customers or clients individually, or if they perform services in or around their customers' homes, or if they operate in sectors where identity theft is rare and they have not themselves been the target of identity theft.

For more information on the Red Flag rule and tools for MD implementation, go to: http://www.ama-assn.org/ama1/pub/upload/mm/368/red-flags-rule-edu.pdf

Update #7, July 21, 2009

1. Healthy Families Budget Deal by the Numbers

The deal reached by the Governor and the Big 5 Legislative Leaders needs to be voted on by the full Legislature, which could happen as early as this Thursday 7-23. While intense advocacy by the AAP-CA and others may have saved the 10-year old program from extinction, the estimates of the likely total cuts to Healthy Families this budget year are grim.

Dollars:

• $ 70 million Conference Committee cut
• $ 20 million Underfunding in May revise budget
• $ 54 million Budget deal additional cut
• $ 144 million Total state dollars cut for 09-10
• $ 432 million Total loss to program including federal match

Children:

• 450,000 Kids that will be dropped from program 09-10 due to $54 million budget deal cut
• 335,000 Kids that will be put on a waiting list rather than accepted into the program due to $90 million ($70 plus $20) earlier cuts
• 785,000 Eligible kids that will lose or be denied Healthy Families this fiscal year.

Many questions remain as to how these cuts, if enacted and signed into law, will be implemented. There are conflicting reports as to whether eligibility will be dropped from 250% to 200% of the Federal Poverty Level, or whether the cuts will occur without eligibility changes.

California needed a budget. It could not function much longer without it. But the question of how it will function now, with a weakened safety net during a deep economic recession, remains.

2. CMA CEO Senator Joe Dunn resigns

Former state Senator Joe Dunn has announced his resignation after three years of service as CEO of the California Medical Foundation. He has cited his desire to spend more time with his children in Orange County as his reason for the change. Dunn will stay on until a new CEO has been found, and has also indicated his “hope to remain with the organization in a different role to support our new CEO and to continue the important work on behalf of the physicians and patients of California.”

The AAP-CA works closely with the CMA. AAP-CA District Chair, Myles Abbott, MD met with Joe Dunn earlier this year to discuss issues of shared interest. We wish Mr. Dunn well in his new endeavors, and look forward to working with his successor.

3. Red Flag Rule Applies to Physicians: August 1, 2009

In November 2007, the Federal Trade Commission (FTC) issued a set of regulations, known as the “Red Flags Rule,” requiring that certain entities develop and implement written identity theft prevention and detection programs to protect consumers from identity theft. Despite efforts by the American Medical Association to persuade the Federal Trade Commission that these new rules for creditors should not apply to MD’s, the rule is scheduled to include MD offices when it goes into effect August 1, 2009. Although its efforts to exempt physicians from these requirements are ongoing, the AMA has prepared a guidance document, along with sample policies so that physicians can incorporate a simple identity theft prevention and detection program into their existing compliance and HIPAA security and privacy policies in order to comply with the August 1st deadline. According to the AMA, its sample Policy includes simple, customizable policies and procedures to incorporate into your practice in order to comply with the requirements of the Red Flags Rule that entities have reasonable policies and procedures in place to identify, detect, and respond to Red Flags. Also included in this policy is the FTC's Identity Theft Affidavit (PDF), which can be used by patients who may be victims of identity theft.

For more information, go to: http://www.ama-assn.org/ama1/pub/upload/mm/368/red-flags-rule-edu.pdf

Update #6, July 20, 2009

This is the sixth in a new regular AAP-CA communications series: “Three for Thought” from Kris Calvin, AAP-CA CEO.

1.Governor and Legislative Leaders Agree on a Budget!!

Three days after the Legislature was due to go home for summer recess, Legislative Leadership and the Governor finally reached a budget agreement. (Funny how the threat of their “missing recess” seemed to have more of an impact on Legislators than issuing others IOUs.)

Details are sketchy, but according to numbers from The Sacramento Bee, much of this year’s budget fix looks to be pushing the problem into the future. While there will undoubtedly be deep and egregious cuts (expect Healthy Families to lose one quarter to one half its enrolled kids), close to half the budget savings appear to be in new state debt of one kind or another: $2 billion borrowed from local governments, $9.5 billion from education that must be paid back, and other short-term loans and accounting tricks.

Tomorrow we will know more about what this deal contains, and what we must do to advocate for patients and pediatric practice survival in leaner times. But the added pain from the inability to truly address our state’s structural imbalance today may not be fully realized for years to come. Stay tuned…

2. Proposed Policy Changes to Early Start Program

Policy changes proposed by the Department of Developmental Services may limit eligibility for Early Start services, effective October 1, 2009, to only those infants/toddlers identified as “developmentally delayed” and/or as having an “established risk,” and eliminate the use of so-called “non-required services” in the Early Start Program. The AAP-CA has been active in opposing narrowed eligibility and other policy changes to the Early Start program that would delay identification and intervention, and thus exchange short-term savings for longer-term higher costs and worse outcomes. Individual pediatricians may also want to comment.

Written comments on the proposed changes will be accepted until July 31, 2009 via fax to (916) 654-3255 or email to Michael Miguelgorry at michael.miguelgorry@dds.ca.gov

3. AAP-CA Advocacy Workshops Available On-Call!

Last week I had the pleasure of presenting a CME advocacy and public policy workshop to pediatricians and residents at Kaiser Permanente Medical Center in Los Angeles. We discussed the state budget, short-and long term advocacy challenges, ideas for new laws that would make a difference, and ways pediatricians can get involved.

As CEO of the AAP-CA, I am available to speak day or night, anywhere that groups of pediatricians gather and want to hear the latest on policy and opportunities for activism on behalf of children and pediatrics. Please let me know if you would like to schedule an interactive AAP-CA advocacy session.

Update #5, July 12, 2009

This is the fifth in a new regular AAP-CA communications series: “Three for Thought” from Kris Calvin, AAP-CA CEO.

In this new blog/memo Kris will highlight 3 issues or activities for thought for AAP-CA leaders (who will receive the note by email) and for members and the public, to be posted at www.aap-ca.org and on our soon to be established District Facebook page!! Options for Action are included, where appropriate. Chapters may post or share, as desired. “Three for Thought” features concise, highlighted ideas of significance to California children and pediatricians. Feel free to contact Kris for more information on any that tweak your interest!

1. State budget fix remains elusive: Advocacy for essential children’s health care programs continues

Legislative leaders and the Governor met throughout the weekend on budget matters, emerging with professed optimism that a budget deal might be settled this week. Yet huge budget issues remain. In particular, while education funding has taken center stage on the budget with the Governor’s proposal to suspend Prop 98, significant cuts in health and human services are deemed “inevitable” by Democrats and Republicans.

In short, no programs are safe until the ink is dry. AAP-CA is aggressively advocating on your behalf, but constituent contacts matter most. It is absolutely not too late to contact your state legislator and the Governor’s office to let them know that children’s health services, including Healthy Families and CCS, save dollars by (1) providing preventive care up front (2) through the medical home model and (3) especially in CCS, case coordination by pediatricians of complex cases.

Go to www.leginfo.ca.gov to identify your legislators and for links to their websites with their contact information.

2. Children protected from cuts in Medi-Cal optional benefits

Numerous optional Medi-Cal benefits (benefits not required under federal law) were cut effective July 1, 2009. In addition to adult dental, cuts include acupuncture, audiology, chiropractic, optometry, podiatry, psychology, and speech therapy.

As adults lose these services, some have incorrectly assumed that the services are also no longer covered for their children. Not so: according to the state, children age 20 and under who receive full-scope Medi-Cal are still eligible for all of the above benefits. Further, a child who has been receiving these benefits under the age of 21 may continue to do so past age 21 if their doctor orders continued treatment with a specific end date for the treatment. (Orders for a “lifetime” treatment will not be accepted.)

Note: The elimination of benefits for adults was challenged in court by the California Primary Care Association. The initial ruling in June permitted the adult benefit cuts to go forward, but more challenges are in process.

3. Focus on California Children’s Services: Policy Questions against a Background of Budget

Shortfall separate from the larger budget conversations, a dialogue has begun at the state level about options for improving care for children enrolled in the CCS program. To that end, the Department of Health Care Services, funded by the California Health Care Foundation (CHCF), is convening stakeholders, including AAP-CA, for focused discussions about the future of CCS. AAP-CA applauds the involvement of CHCF and this outreach by the state.

It should be noted, however, that while AAP-CA supports program improvements for CCS, there is real concern that discussions of program reform during periods of extreme budget shortfall inevitably translate into prioritizing reduction of short-term costs, without adequate attention to quality and the potential for long-term savings of more carefully thought through reforms. For example, one proposal being floated would eliminate county CCS offices altogether, and move case management of those children into managed care, including Medi-Cal managed care.

AAP-CA commits to being a voice for a thoughtful policy approach to CCS on behalf of children and pediatricians as this process goes forward. Watch future Three for Thought entries for updates and options for your action…

Update #4, July 1, 2009

1. No State Budget, Expect IOU's

As the clock ticked down to midnight last night, the end of the state fiscal year, it became apparent that California would do what it has not in 17 years: run out of cash for massive levels of current obligations.

Rumor has it that the responsibility for the missed deadline (although certainly not for the entire budget mess) falls at the Governor's feet. Republicans in the Assembly passed stop-gap measures that would have averted the cash crisis. Reportedly, Senate Republicans were poised to follow suit, but were asked by our Republican Governor not to vote for the compromise measures, as he had pledged to veto them. Senate Democratic leader Darrel Steinberg said of Schwarzenegger’s move that it “may be the most irresponsible act I have seen in my 15 years of public service. And for what? It's a monumental blunder.”

The failure to act on budget measures last night triggered a series of new education obligations under Prop 98, which increases the obligation of the state to K to 12 education by $11 billion over the next few years, deepening deficit woes.

In order not to default on our debt (and go bankrupt), California law prioritizes payments to bond holders. Education and Medi-Cal also take priority due to statutory and federal requirements. IOU's will therefore be issued in lieu of cash to lawmakers themselves, businesses that contract with the state, people owed tax refunds and local governments that administer Cal Grants, CalWorks and other social programs. In part, who will be effected by the IOU’s will now be determined by local government decisions about what to backfill.

It is expected that California Children's Services and other programs in which pediatricians participate may receive IOU's, since they are not protected by federal law or funded locally.

Although banks could honor the IOU's for depositors and then wait to be paid back (which some did the last time the state issued IOUs in 1992) signals from financial institutions show this is unlikely in the current financial climate. In addition, while the state controller's office has stated that the IOUs will be paid back Oct. 1 with interest, the state has not yet paid back IOU's it issued on a much smaller scale last year.

The first IOU's are expected February 1st. Watch future Three for Thought as to whether and how these IOU’s might affect children's health and pediatrics.

2. Healthy Families Waiting List Date Set: July 17th

Unless funds are forthcoming, the Healthy Families Program will close its doors to new enrollment July 17th, 2009, establishing a waiting list for the first time in the program's history. The net effect of proposed cuts on Healthy Families may be that the number of children currently served is slashed in half, from a million to close to 500,000.

Other funding sources, including private foundations and First Five money (if voluntarily committed by First Five) are being sought to mitigate the losses.

It is more than frustrating that the years of advocacy that finally resulted in successful reauthorization of the SCHIP program, as signed by President Obama in February, have been wiped out in California through our inability to come up with the $1 match for every $2 provided by the federal government.

We will keep you posted as to whether the waiting list goes into effect, and how pediatricians might help support other fund sources.

3. Good news: AAP-CA supported obesity prevention laws go into effect: Restaurants and Schools to make changes

As the result of three AAP-CA supported bills, beginning July 1, 2009 (today!):

• California becomes the first state to require restaurants to disclose how many calories are in their standard menu items. This will affect the over 100 chains in California that have at least 20 restaurants in the state.
• California schools can no longer offer artificially created trans fats in food sold in vending machines and by private, on-campus food service operations, including from fast-food outlets. The new law builds on earlier legislation that barred artificial trans fats in school cafeteria food.
• California high schools can no longer sell students sodas. The soda ban for high schools follows an earlier ban on these drinks at elementary and junior high schools. The new law will allow high schools to sell students only fruit and vegetable drinks with no added sweeteners; bottled water with no sweeteners; low-fat and nonfat milk; soy milk, rice milk and similar nondairy milks; and electrolyte-replacing sports drinks with no more than 42 grams of added sweetener per 20-ounce serving.

Update #3, June 6, 2009

In this Edition, thoughts (and Action Options) on the State Budget, Healthy Families, and Prematurity Coalition:

1. Party-Line Differences Continue to Block CA Budget Solutions

California has structural budget problems. When a downturn in the economy occurs, our state expenses dwarf revenues, yielding multi-year, multi-billion dollar deficits. Republican legislators say that the only way to stop that cycle is to slash expenditures. They further assert that increasing taxes in a downturn to address a deficit not only hampers recovery, but also yields a revenue windfall during good times that will ramp programs up, making needed cuts even greater in the next downturn. Democratic legislators counter that the safety net of health and human service and education programs is never more critical than during an economic downturn. Therefore new taxes (or “revenue enhancements”) are essential to support those programs as other tax revenues fall due to falling incomes.

Late last night (Sunday, June 28) Assembly Democrats passed on a simple majority vote a budget package that includes a tax increase of $2 billion. The package includes a 9.9 percent tax on oil production, a $1.50-per-package tax on cigarettes and a $15 per vehicle registration fee. By eliminating one tax and replacing it with a fee, Democrats argue that this new revenue does not require a two-thirds vote. Republicans oppose the move. Further, it is unlikely to pass the Senate and even if it does, the Governor has pledged a veto.

The difference in core values and approaches between the parties leaves us teetering on the brink of state bankruptcy. The crisis will become real to many with the expected issuance of IOUs by the state this week for payment obligations, if a solution is not found.

Arguments from both sides in the budget standoff are heartfelt, and not without merit. But the harm the lack of a budget is causing the state requires them to somehow find a way to the middle.

OPTIONS FOR ACTION 1: Let your Legislator know the direct effect the lack of a budget will have on children’s access to care, as Medi-Cal and other state programs become unable to pay their bills. Speak from the non-partisan perspective that compromise must be found. To find your state legislators by entering your zip code, go to http://www.leginfo.ca.gov/yourleg.html

2. Healthy Families Program Remains in Jeopardy.

The oversight body for the Healthy Families Program, the Managed Risk Medical Insurance Board (MRMIB), meets today in Sacramento. The agenda includes consideration of establishing a waiting list for Healthy Families (HF), which if enacted is estimated by advocates to lead to over 400,000 HF kids no longer having access to insurance through the program.

AAP-CA has contacted MRMIB to urge it not to take any action on a waiting list until the outcome of the budget standoff is known. AAP-CA leaders Richard Pan, MD, MPH and Mark Sawyer, MD participated in local press conferences highlighting the need to maintain coverage levels through the HF program.

Regardless of the action taken by MRMIB today, it is the Legislature that ultimately has the power to decide whether adequate funds are available to cover HF kids.

OPTIONS FOR ACTION 2: Let your Legislator know the importance of the Healthy Families Program. Emphasize that it saves the state money by getting kids into early and preventive care, leveraging a 2 to 1 federal match for that coverage. To find your state legislators by entering your zip code go to http://www.leginfo.ca.gov/yourleg.html

3. AAP-CA Participates in Premature Infant Health Coalition Summit

California has more than 56,000 premature births each year. At 10.7% of all California births, this is much higher than the national Healthy People 2010 goal of 7.6% of all births. A great percentage of these children have serious health and developmental conditions requiring far more than the average health, developmental and social service care to help them have the optimal outcome for their lives.

To help plan for and address these needs, Douglas Vanderbilt, MD, FAAP, representing the AAP-CA, joined 150 others June 1st in Sacramento at the first California Premature Infant Health Coalition Summit.

Funded in 2007, the Coalition’s goals are to:

1. 1.Create a strong, unified voice in California to help reduce the rate of premature births and improve outcomes for children born prematurely and their families.
2. 1.Provide a sustainable setting to network, share best practice and other information, address policy, resource and systems change, and to help keep decision makers and the general public educated and knowledgeable about premature Infant Health Coalition and products of the Summit, go to http://capihc.blogspot.com/

Update #2, May 31, 2009

This is the SECOND of a new regular AAP-CA communications feature:
“Three for Thought” from Kris Calvin, AAP-CA CEO. In this new blog/memo Kris will highlight 3 issues or activities for thought for AAP-CA leaders (who will receive the note by email) and for members and the public, to be posted at www.aap-ca.org and on our soon to be established District Facebook page!! Chapters may post or share, as desired.

“Three for Thought” features concise, highlighted ideas of significance to California children and pediatricians. Feel free to contact Kris for more information on any that tweak your interest!

1. AAP-CA Bill to Improve Vaccine Reimbursement Dies in Appropriations Committee

We appreciate all the work that went into AB 1201 by pediatrician leaders and staff at AAP-CA, and by our partner organization staff, particularly Teresa Kline at CMA. Vaccine reimbursement remains a critical issue for the viability of pediatric practice in California, and we look forward to reintroducing the bill in a better fiscal climate.

2. Threat to Eliminate Healthy Families Program is Real

3. Friend of Children’s Health, Cindy Mann, JD, Appointed Head of Federal Medicaid State Operations Division

Ms. Mann has been a stalwart children’s health advocate, working extensively with children’s advocacy groups on the reauthorization of SCHIP. The interests of children and the practice of pediatrics will be supported by having a leader as knowledgeable and dedicated to children’s health issues as Ms. Mann at the helm of the federal Medicaid State Operations Unit. (Finally, some good news in tough times!)

Update #1, May 23, 2009

This is the first of a new regular AAP-CA communications feature:
“Three for Thought” from Kris Calvin, AAP-CA CEO. In this new blog/memo Kris will highlight 3 issues or activities for thought for AAP-CA leaders (who will receive the note by email) and for members and the public, to be posted at www.aap-ca.org and on our soon to be established District Facebook page!! Chapters may post or share, as desired.

“Three for Thought” will feature concise, highlighted ideas of significance to California children and pediatricians. Feel free to contact Kris for more information on any that tweak your interest!

1. Healthy Families Program on Endangered List!!!

Now that the voters have turned down the May 19th budget ballot measures, the Governor’s office has presented options for addressing the projected $20-billion plus state deficit that include the wholesale elimination of the Healthy Families Program. This would add 1 million children to the rolls of the uninsured in California, and leave untapped over a billion dollars in federal funding for children’s health care in California!! AAP-CA is aggressively opposing this proposal.

A template letter of opposition and information about which policymakers to target for advocacy will be up on our website at www.aap-ca.org shortly. Additional general information on the state budget can be found at www.cbp.org.

2. Obesity Prevention: AAP-CA Speaks Out

On May 22nd Orange County state Senator Correa hosted a town hall and informational hearing on obesity prevention. The hearing was initiated by St Joseph's Health Systems with support from the AAP-CA. Mike Weiss, MD, President of Ch 4 of the AAP-CA, made a compelling presentation about the barriers faced in trying to address the childhood obesity epidemic, and how evidence-based programs like PE for Me (which Mike and others developed) can make a real difference.

Helpful information and data focused on obesity prevention in the school environment, shared by George Monteverdi, MD, FAAP, can be found at http://www.nasbe.org/index.php/file-repository?func=startdown&id=889.

3. Medical Home Concept in Proposed CA Legislation

The California Academy of Family Physicians (CAFP) has introduced AB 1542, a bill to codify in statute the definition of a medical home. This important bill would facilitate the future development of state policies, programs, and funding that support the medical home.

AAP-CA supports this concept, and is working with CAFP and the CMA to ensure that the language in the bill is consistent with AAP policy that physicians are best qualified to lead the patient-centered medical home. The bill text and analyses can be viewed at www.leginfo.ca.gov.