California's Children

Commentaries on Supreme Court healthcare reveal interesting asides

June 29 2012: In the (educated and thoughtful) commentaries following in the wake of yesterday's announcement by the Supreme Court that the primary points of the Affordable Care Act were constitutional, we have found -- and will continue to post as we read more -- some interesting sideline points covered in the decision.

In a fine analysis of why Chief Justice John Roberts stepped outside his conservative cohort, "Why Did Roberts Do It? To Save the Court," David L. Franklin, Vice Dean and Associate Professor of Law at DePaul University, posting on Slate, notes [emphases ours]:

...striking down Congress’ threat to eliminate all Medicaid funding to states that refuse to expand eligibility, is the most surprising. Although based on the common sense notion that Congress shouldn’t be allowed to bribe states by making them offers they can’t refuse, it fails to provide a yardstick by which to measure such coercion. My hunch is that this holding will be read narrowly and will not imperil the many “cooperative federalism” programs that already exist, from No Child Left Behind to Title IX to the Clean Air Act. But it is only a hunch.

The Budget Games: next up, Controller John Chiang

Full budget details can be read here.

UPDATE, June 29, 2012: In a comment on Educated Guess, Education Sector's Senior Policy Analyst, Rob Manwaring writes:

[State Controller John] Chiang will stand alone when he makes his decision on whether this next iteration of a gimmick ridden budget is balanced. The Legislature will pass the budget, the Governor will sign it, and then all eyes will turn to the Controller. He may be able to look past the rosy revenue assumptions the budget makes because those assumptions are at least to some extent backstopped by additional cuts (although not completely from my read). But, once again, the Controller will have to face the many maneuvers that the budget proposes for Prop 98.  And while [former exec. director of the State Bd. of Education and education policy consultant] John Mockler and [the California Teachers Ass'n.] may be able to look the other way on these moves in exchange for a 2012 education funding initiative, the Controller will not be able to take that future promise into his calculation. He will have to look at the proposed manipulation of Prop 98 through realignment and its handling of child care and determine whether these moves can support a “balanced” budget... Is the Controller ready to take this on? Time will tell.

UPDATE June 28, 2012:  Governor Jerry Brown released details of "blue pencil" cuts to the '12-'13 budget this morning--the biggest, a $30 million cut to state preschool (Title V centers) and all non-Proposition 98 food monies.

Tim Fitzharris, Ph.D., legislative advocate for the Child Development Policy Institute, details the line item vetos:

Surprising everyone, Governor Brown went far beyond his agreement with Democratic legislative leaders, making deeper, devastating cuts to Child Development with his blue pencil, line item veto.  Here is what he did, with his justification:

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  • Child Development, Preschool Education (Proposition 98). "I reduce this item from $510,975,000 to $481,033,000.  I am reducing $29,972,000 from preschool programs, which are administered by Title 5 centers that contract directly with the Department of Education.  While I would have preferred to restructure rates and reform the program to achieve savings, the across-the-board reduction in slots is necessary to help bring on-going expenditures in line with existing resources." 

o    Alternative Payment.  "I am reducing $20,000,000 from voucher-based child care programs, except for those serving current and former CalWORKs families.... With this reduction, a total of $1.3 billion in non-Proposition 98 General Fund and federal funds remain to support child care programs administered by the Department of Education." (ED. NOTE: I assume this is a reduction in CAPP funding.)

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  • Local assistance: Child Nutrition.  "I am eliminating the $10,100,000 legislative augmentation which would provide a supplemental child nutrition reimbursement to private schools, private child care centers, and other meal sponsors that are not eligible for Proposition 98 funding..."

 

Supreme Court upholds state Medicaid expansion worth $15bil to CA

Full text of Supreme Court's decision on the Affordable Care Act.

June 28, 201:  Under interpretations through the tax code, the Supreme Court upheld the constitutionality of major portions of President Obama's Affordable Care Act, with Chief Justice John Roberts surprising political forecasters who had called Justice Anthony Kennedy the swing vote (Kennedy voted with the consevatives in the 5-4 split decision).

The focus of early attention was the yes vote on the individual mandate, requiring the purchase of medical insurance; however, for social welfare and health professionals at the state level, the part of the ACA dealing with Medicaid has the greatest immediate impact on community health services for the poor.

As the Los Angeles Times reports this morning:

Californians are waking up to news from the U.S. Supreme Court ... upholds a key component of President Barack Obama's Affordable Care Act.

As one of the law's biggest financial beneficiaries, the state stands to gain as much as $15 billion annually in federal money for health programs.

  According to Amy Howe on the SCOTUSblog, in the decision announced this morning upholds that the Medicaid expansion is constitutional, but that withholding funds from states that choose not to comply with the ACA regulations is not constitutional (see p. 55 of the full text of the opinion, offered in the link above).

With yesterday's transfer by the '12-'13 budget signing of 880,000 poor children from Healthy Families into the state Medi-Cal system, a "win" on that $15 billion was a royal flush on the river for Governor Brown.

As NPR reported yesterday:  there's another important constitutional question before the court that most pundits haven't talked about much — a broad expansion of Medicaid, the joint federal-state program for people with low incomes.

"Medicaid often doesn't get as much attention as other matters, so it's not shocking," says Alan Weil, executive director of the National Academy for State Health Policy. "But given the stakes for the Medicaid program, I think it warrants a little bit more attention."

Specifically, the court has been asked whether the part of the law that would expand Medicaid to an estimated 17 million more people over the next 10 years is an unconstitutional infringement of states' rights.

About half of the people who are expected to gain coverage under the Affordable Care Act gain it through the Medicaid program. So this is not a small change to Medicaid and it's also not a small part of the Affordable Care Act.

- Alan Weil, National Academy for State Health Policy

The law would expand Medicaid coverage to everyone with incomes under 133 percent of the federal poverty level. In 2012, that's $14,856. In practice, the expansion will mostly cover adults without children or disabilities, since low-income children, parents and those with disabilities are mostly already eligible.

But unlike the rest of Medicaid, whose costs are mostly shared between the federal government and the states, the federal government picks up the entire cost of the additional coverage for the first several years; eventually states have to pay 10 percent.

Healthy Families' dumped; 880K kids moved to Medi-Cal

UPDATE, June 28, 2012: The movement of 880,000 children from Healthy Families to Medi-Cal was retained in the budget signed by the Governor Wednesday night. Administered by the state's Manageed Risk Medical Insurance Board, Healthy Families, considered one of the state's most effective and non-bureaucratic programs, will be scrapped. As the Los Angeles Times reported last night:

...The Brown administration has insisted there won't be gaps in children's healthcare coverage. But activists are concerned that medical care will be harder to find because doctors get less money for care they provide under Medi-Cal.

Republicans, who have generally championed budget cuts, opposed the elimination of Healthy Families and threatened to withhold votes needed to extend a healthcare provider fee that would generate $183 million for state coffers. A vote on the fee is expected later this year...

Budget contains 3-week cut to school year if tax initiative fails

June 28, 2012:  If voters reject Governor Brown's tax initiative on the November ballot, pubic school funding will be cut another $5.5 billion ($441 per student; 8.4% off current funding). In a last-minute attempt to give schools "flexibility" in dealing with what may be impending budget crises, the Senate agreed to an education bill that would chop three weeks fron the school calendar over a two-year period. The revised education finance bill, AB 1476, tucked into the overall budget that was signed last night, allows school districts to cut twice as many instructional days from the calendar over the next to years as the Governor had proposed in his May budget revise. The resulting 160-day minimum, would put the number of days California's children spend in school at "likely the lowest in the nation," according to John Fensterwald of  Educated Guess.

From Fensterwald:

...In one sense, nothing has changed. Brown hasn’t suggested less funding for schools than the $53.6 billion for 2012-13 that the Legislature approved in passing the budget last week. Districts will have to negotiate a shorter year with their unions; they can’t declare it unilaterally, and most districts won’t go that low.

But the language in AB 1476 (section 50, midway through a very long bill) is a stark message that a defeat of the tax increase will create more than a one-year revenue crisis for schools.

A Senate staff member said that the intent of the trailer bill language is to give districts more flexibility to cope with terrible choices. Most districts won’t go to a 160-day year, but it will be an option. Because districts must submit balanced budgets for two years beyond the current year, districts can negotiate with certainty for continued furloughs through 2013-14. 

Lowering the minimum year to 160 days now would be too late for those districts and unions that already have negotiated potential cuts. Sacramento City Unified teachers earlier this month approved a two-day furlough, plus an additional 10 days, lowering the school year to 168 days, if the tax initiative fails.

Reported on for California's Children by Elizabeth J Carlyle.