Good afternoon and welcome to the Alameda County Board of Supervisors Personnel Administration and Legislation Committee for Monday, November the 24th, 2025.

May have roll call, please.

Supervisor for Donato Bass.

Present.

Supervisor Cam.

Present.

We have a quorum.

Thank you.

Did you need to give any instructions for participation by online?

Just to make sure we go through the protocols.

Welcome to the Alameda County Board of Supervisors Personnel Administrative Legislative Committee.

We are now conducting this meeting on Teams.

The link to join the meeting is on the agenda posted on ACGov.org.

You may also find the teleconferencing guidelines there as well.

For in-person participation, please fill out a speaker card and hand it to the clerk for online participation.

Please use the raise the hand function.

If you're calling in, please dial star five to raise your hand.

Thank you.

Thank you.

This is the only committee meeting that's using teams.

That's the reason I want to make sure that we have that clear.

So let's start with the federal legislative update from CJ Lake.

Thank you, Supervisor.

Uh, you have John Assini and Emily Bacche de Silva.

Uh, in terms of the schedule this week, uh, short one, Senator House are both out of session this week uh for the Thanksgiving holiday, and they will return to DC uh next week, the week of December 1st, uh, to close out the rest of the year.

And the last day that they will be in session next month will be December 19th.

Um, the really the hot topic for this week is around the Affordable Care Act uh extension negotiations over the ACA enhanced premium tax credits took center stage in the Senate last week as lawmakers work to define the parameters for a year-end agreement on the expiring subsidies.

During Wednesday's Senate Finance Committee hearing, members of both parties expressed congressional action for reforming the ACA, though they said that it's unlikely to happen before the December 31st deadline.

Senate Democrats continued to push for an extension of the ACA enhanced premium tax credits, arguing that any lapse will significantly increase the cost of premiums for millions of Americans.

Meanwhile, Republicans use the hearing to mostly outline their areas of concern with the ACA, but acknowledged a major structural change would not realistically be drafted and implemented before the end of the year.

Much of Wednesday's hearing was focused on a proposal to replace the ACA subsidies with financial deposits directly into health savings accounts for ACA marketplace bronze plan consumers.

These are the zero premium plans that people uh low income or middle income people typically uh participate in.

Many Democratic senators rejected the proposal, arguing that redirecting subsidies into HSAs would push individual plans uh with less comprehensive coverage and would not meaningfully address premium increases.

Senate finance committee leadership had indicated they plan to release an updated PBM reform, possibly by the end of the year to also help contribute to lowering costs for individuals and families on the insurance market, though some congressional republicans are floating a more sweeping Republican-only health care package through a reconciliation package that would could that could start next year.

Um I'll just note that the likelihood of a second reconciliation package, particularly on health care, um, moving through a Republican conference is fairly low.

Republicans are almost never aligned on health care policy, a reconciliation package, as we saw earlier this year is very difficult to get.

Um, not only would they have to pass another budget resolution, but they also would have to find a pay for in order to um uh make it budget neutral, which is a necessary component for uh a reconciliation bill to pass.

There are significant political concerns on the part of uh mostly Republican or House Republicans in particular on finding additional pay force to pay for the ACA tax credits, which is a provision that they broadly do not support in the first place.

Um, and many of the provisions that were uh thought about for health care reform were ultimately stripped out of the last bill, either through political means because it didn't have support of the overall Republican conference, um, or it was stripped out by the Senate parliamentarian um during the bird bath phase.

Um, so a pathway for a partisan reconciliation package remains incredibly unclear.

So, congressional leadership in the White House to a lesser extent continue to float this as a possibility to kind of keep the health care debate alive without actually providing any sort of legislative text that would fit that framework.

Um, the health care conversation got even more interesting last night.

When the White House leaked, they would release a framework to extend the expiring affordable care act subsidies for two years, while limiting the subsidies to people with incomes up to 700% of the federal poverty line.

In this framework, enrollees would also pay in minimum premium payment.

So the zero premium options would no longer be legal.

This framework plan lasted about four hours until congressional Republicans broadly panned the plan this morning, leading the White House to indefinitely delay the release of the framework and leave Republicans without a plan to coalesce around.

Without White House buy-in, the House and Senate still remain um at odds with one another, and they continue to spar over how best to address the lumen premium increase that is due to hit next year.

I'll stop there in case there are any questions before I move on to my next uh segment.

And of course, if Emily has anything else to add, I welcome the floor for her.

Supervisor Fortune Abbas, any questions on this segment uh related to the Affordable Care Act and Healthcare?

Um, thanks for the update so far.

It sounds pretty frustrating.

Um, given that there was a promise for a December vote.

What are the next steps to hopefully continue to figure out if there is a path forward?

I mean, frankly, the next steps are incredible are incredibly unclear.

Um there may still be a vote in the Senate on an extension, a one-year extension of the health care subsidies that is doomed to fail because only Democrats and perhaps a couple of Republicans will vote for it in the Senate.

Um, but a straight extension is not going to pass the House, even if it does get out of the Senate, which it likely won't.

Um, this leaves Republicans again in the driver's seat in order to try to find a solution to this problem.

But as we've seen in previous years, um it's very difficult for Republicans to find a plan that they can all agree on on health care generally, and with the timeline being what it is, getting a plan that can get the okay from the House, Senate, and the White House is just increasingly difficult.

Um the next the next step for people facing these premium increases, hopefully that Republicans find a plan that is amenable to them.

Um, but the the likelihood of that happening um diminishes with each passing week.

Okay, it's just incredibly frustrating, especially given the results of the uh recent elections, but we all know that.

Thanks.

Thank you.

Um, so are there Republicans hearing from their constituents?

I mean, even uh Congresswoman Margie Taylor Green, she was clear that uh her constituents need to see these Affordable Care Act subsidies in order not to pay what, $3,000 per individual per month for health care.

And I would expect that would be similar in the other Republican districts as well.

Yeah, it's been interesting.

Uh Georgia in particular has a very robust um Affordable Care Act individual marketplace.

Um, so the impact that it has on Georgia voters has been particularly acute, hence why Marjorie Taylor Green has been so out front on this issue, as has Senator Osoff, who's of course in cycle this year.

Um constituents from around the country uh have been calling their members.

There's been a lot of incoming from the part of the constituents to Republican members of Congress.

However, there still isn't a plan to coalesce around, nor is there really any appetite to have the government spend additional money with appropriate offsets.

Um, one of, you know, the big issue that Republicans have when there are the extensions of these expensive tax credits, is there's a significant part of their conference that seeks to have that paid for, um, while there are other members of the conference, which is significantly smaller, along with Democrats that are happy to extend it and simply put that on the deficit.

Um, you know, this there's a less of a concern for individual for Democrats to put money on the deficit when it comes down to health spending, um, as we do that on a number of other issues.

Um, but for Republicans, they want to have a pay for and if you to find a pay for, you have to cut from somewhere else in the government.

Um, and many of those payfors were gobbled up during um the OBBBA fight.

Um, so if they did want to get this paid for, it would have to come out of um likely places where Democrats um are supportive of, which are SNAP and Medicaid, and Republicans aren't willing to go down that path considering that the lion's share of their ideas to get those pay fors were again uh claimed during the last reconciliation fight.

So they are in quite a pickle to try to find a way that can get an extension of this that is a minimal to sort of all factions of the Republican conference.

Thank you.

I understand uh the budget neutrality uh push and pull, obviously, if the president is even going back on the tariffs with food because of the cost of an affordability of food, um, that's gonna have to come out somewhere if he was counting on essentially that tax.

And so uh there's not gonna be an easy um ask.

Either way, appreciate that.

Do you want to go to your next segment?

Yes.

So I have two more things um to discuss, and then I can then hand it over to to Emily and to Amy for the state update.

But in addition to the ongoing uh debate on the affordable care act, um the FY26 appropriations conversation continues um at the congressional level.

Um, in addition to the FY26 minibus, which included the AG, MILCON VA and LED branch bills, uh, that was included in the continuing resolution.

Senate leadership has indicated that it wants to advance several other FY26 appropriations bills.

Uh, this would include the transportation housing urban development bill, the labor HHS bill, the common commerce, justice and science, uh, the defense bill, and potentially the interior environment package.

Senate leaders are evaluating uh timing to bring measures to the floor, and appropriators have expressed interest in grouping multiple bills into another bipartisan package to maintain momentum on full year funding.

House appropriators have also publicly stated a willingness to push the FY26 process forward through an additional minibus, but this would likely be a much smaller package.

Uh, last Thursday, the uh four corners of the appropriations committees in the House and the Senate.

So the chair and the ranking members from both both chambers had a meeting to discuss the future of FY26 appropriations where they just continued the conversation.

No immediate deals were immediately established.

Um, but it is possible that they reach an agreement on some kind of minibus package.

Originally, defense and labor age were going to be the anchor for this bill.

This, of course, represents a significant swath of the discretionary spending that the federal government provides every year.

Um, but with the announcement of the education department largely closing, um, it's become increasingly unlikely that labor age will be a part of that package because the proprietors are a little concerned as to where the money would go to the department of education through the education title and labor age if the agency is not operational.

So those conversations continue to be ongoing as many of the uh responsibilities of the Department of Education are being contracted out to the labor department, but that's not how appropriations work.

So they need to figure out a way where the education money will flow to education um in a in a legal way rather than simply being um transferred over to the labor department.

Um the we expect that this conversation will continue in earnest um in December.

Um, but it's unclear if they'll able to reach an agreement.

Um, we also anticipate that an earmark package will be part of the FY26 bill.

Um, and I'll just remind everyone that federal funding expires on January 30th.

So Congress is already working with a shortened timeline to try to find agreement on overall FY26 appropriations.

Um, and then finally, um, many of you already know, but I'll just say very quickly that last Monday, almost immediately following our last PAL call, the Department of Homeland Security issued a proposed rule seeking to change how it enforces the public charge rule, which is an issue that we are well familiar with.

This proposed rule gives DHS agents a short list of factors to consider when determining whether an issue to issue or renew a visa green card or other admission into the country.

And it's based on statutory authority for the federal government to prevent any person who is unwilling to take care of himself or herself of becoming a public charge.

The two previous rules in 2019 and 2022 amended the public charge rule with the latter establishing the current test that depends on whether the individual received cash benefits or long-term institutionalization from the government receipt of Medicaid benefits was excluded from both of those rules, but consideration for the proposed rule that was released last week would change that.

This rule would allow the DHS officers to be permitted to make case-by-case decisions based on the totality of circumstances, whether or not the alien is considered to be self-sufficient rather than the regulatory factors and definition that guided the 2019 or 22 rules.

In the past, changes of the public charge rule have sometimes had the effect of discouraging individuals concerned of its implications from seeking care when they seek or need medical or Medicaid eligibility.

And if the rule is ultimately finalized, it will immediately take effect.

Thank you.

Just appreciate the brief report.

It's something that I was tracking last week.

And as Chair Tam said, I remember this very vividly in terms of the first Trump administration and the big mobilization around it.

Thank you to uh CJ Lake.

I did invite you all to our Alameda County together for all meeting next Thursday.

This is one of three updates that we hope to hear a little bit more about.

And it seems like something that the county should potentially send a comment letter on.

Is that something that's in the works with the CAO?

John, the question I see uh Jessica's hands raised.

Yeah, I think I think Jessica can answer for this for the uh CAO's office.

Good afternoon.

This is Jessica Blake Mara, interim policy director with Alameda County Health.

We've been in conversation with the CAO and with um SSA to collaborate on a comment letter.

So that is in the works and should be coming to PAL committee in the next few weeks.

Thank you so much.

Thank you.

John, did you want to turn it over to Emily now?

Uh sure.

Yep.

Emily, I know that you're on the road right now, but if you have any other items to add, um now's a good time.

I think you I think you covered it all.

Thank you.

Sounds good.

Thank you.

Thank you.

Hope you have a safe trip and happy Thanksgiving.

Um, we'll move to the state legislation update from Full Moon Strategies.

Good afternoon, Amy Costa with Full Moon Strategies with your state legislative report.

Uh I'm going to start off by talking about last Wednesday, the legislative analyst office released their 26-27 budget California's fiscal outlook.

This really marks the official beginning of the 26-27 budget cycle.

It comes on the heels of several department of finance bulletins released in recent months that I've reported out here that show state revenues are actually outpacing the 25-26 budget projections.

However, it was primarily bad news in the LAO's fiscal report for the state's budget position.

The LAO is estimating an $18 billion budget deficit for budget year 26-27.

This is $5 million more than was previously anticipated when the budget was passed.

Despite recent cash reports showing revenues trending above our previous projections, the LAO indicates that most of those additional revenues will result in increased spending obligations due to the constitution related to proposition 98, our K through 14 school spending, and proposition two, our reserve or rainy day funds.

The LAO also assumes other program spending is growing by around $6 billion more than previously estimated.

This is significant because historically the LAO has generally had lower estimates on non-98 spending than the administration due to some differences between the two's estimating methods.

If the administration's spending estimates are in line with the LAOs, the estimate will be slightly higher because the LAO does not assume building an operating reserve, which has become even more crucial given the reduction in critical disaster funding from the federal governments.

The LAO also notes that revenues in recent months could be analyzed to show revenue growth across the next fiscal years.

However, their forecast provides a smaller temporary bump in revenues based on a potential stock market downturn.

They highlight that increases in income tax revenue are largely driven by overenthusiasm around artificial intelligence, which might be a transitory over exuberance in the stock market.

There are structural deficits of projected $35 billion that are projected to consider to persist, and these are largely consistent with the administration's estimates from the enacted budget.

They indicate that the overall budget position for policymakers is weak for the following three reasons.

One, structural deficits despite revenue improvements.

Revenue estimates do not assume a recession, which could also make the state's fiscal position worse.

And the state has used most of its budget resiliency tools in recent years, including the use of reserves, deferrals, and budgetary borrowing.

There are a couple of key assumptions in the LAO's deficit, which is they historically use what we call a current law approach to the analysis, which means that the lion's share of this increased revenue will be used to fund proposition 98 K through 14.

The LAO is projecting that of the 11 billion dollars in increased revenues, and this is across fiscal years 24-25 through 26-27, $5.1 billion will be needed to fund the K through 14 constitutional funding requirements.

They also assume 1.9 billion in additional funding for K through 14 schools above the formula due to settle up obligations.

As I mentioned, shows that across state programs spending is about $6 billion higher than was projected during the budget enactment.

Assuming the state will not achieve over $3 billion in statewide administrative efficiencies, including within the Department of Corrections.

They also note spending will be higher, of course, related to the passage of HR1.

The LAO assumes only $1.3 billion in increased costs in the budget year related to the HR one impacts, and they are projecting those expenses to grow by $5 billion by 2930 fiscal year.

Of this amount in 2930, the LAO projects Medi-Cal costs will grow by five by $3 billion, pardon me, and CalFresh by $2 billion.

The federal government could, of course, take actions that impact both the current year and the budget year and beyond related to the managed care organization or provider taxes.

I would note that I worry that the HR1 impact number the LAO has put forward may be low because it assumes no backfills to HR1 reductions by the state at all.

Notably, their forecast does not lower the revenue amounts the state garners from provider taxes, and that will be a significant number for policymakers to uh adjust in the next budget.

Um they do indicate that there could be additional cost shifts due to recent guidance on provider taxes, but they know it could be significantly higher depending on the disposition of those provider taxes.

Um, with that, I'll take a pause before I get to the rest of my report because I know that's a lot of information.

Um, and uh if there's any questions I can answer based on the LAO's uh forecast, I'd be happy to do so at this point.

Supervisor Rodinetta Bass.

Um that's that's really helpful.

Um we briefly discussed last time and also at our last board meeting, or the joint board meeting with um Alameda Health System the need for revenue, and I know that uh introduction of new bills is not for a little while, but um, are there any bills that are sort of on the short list for revenue generation?

I know Assemblymember Bonte had a bill that would, as I understand it, essentially require some of the bigger businesses whose workers are supplemented by Medi-Cal to pay their fair share.

Is there sort of a short list of potential revenue bills that could move forward?

Yeah, great question, Supervisor.

I think more likely people are probably looking towards the initiative process for revenue boosting measures.

In the legislature, of course, it requires a two-thirds vote, which in an election year may prove difficult.

Um, there are certainly um ballot initiatives in circulation right now aimed at this very kind of issue.

Um, one um would be an extension of um Prop 30 and Prop 55, originally initiated by Governor Jerry Brown, which is set to sunset in 2030.

Um, secondarily, there is also a billionaire tax that's in circulation right now, a little bit more complicated, and I fully anticipate there will be perhaps other revenue measures specifically aimed at the loss of revenue from the managed care organization or provider tax, um, because it's usually in the ballpark of about 12 billion dollars, so a key part of the state's budget architecture.

Um, and um, of course, the downside of all of those is that they have to be passed before we could actually garner those revenues.

So there may be a bit of a lag um between um the 26-27 budget and when those revenues come in.

Thank you.

Thank you.

So uh the projection that you mentioned for the FY2627 um budget.

Uh you said that right now we're looking at an $18 billion budget deficit with um five million, five billion dollars more to come.

And you said this is the result of um primarily the um the health care component that's tied to HR one.

So the state, my understanding is that um they'll offset some of the premium cost to the tune of like $30 out of the $100 per person.

But where is most of this um deficit coming from?

Is it because they have to fund um certain uh residents that they that the federal government normally wouldn't fund, like those with unsatisfactory immigration status, or is what component is driving most of the deficit?

There's a couple of different factors, supervisor.

It's a great question.

I would say even before the passage of HR one, the state's uh medical caseload um was off.

Um, you know, with the expansion of those with unsatisfactory immigration status, um the caseload was higher.

And we can see here that across the state, some of those caseload forecasts have been off, and the LAO is extrapolating that, you know, there's perhaps, you know, up to $6 billion more in spending than was forecast when the budget was passed in June, July.

Um, and then take that into account, and then you layer on HR one.

And what the LAO analysis points out is that yes, there will be some HR one impacts in 26-27.

It's really in the out years though that they grow even more significantly in programs like Medicaid and CalFresh.

And so obviously things can happen between now and then, you know, both at the federal level or the state level, but it's it's a convergence of those factors.

And of course, it's all the more disappointing because revenues are actually coming in higher.

It's just that revenues are not coming in at the same pace as the spending.

And yes, you're absolutely right.

A lot of that is actually in the Health and Human Services world.

Although they also note in the enacted budget, the state had some projections around some administrative savings throughout state departments, including some significant savings at the Department of Corrections.

And the LAL is projecting that those savings actually will not come to pass in the same numbers as were projected upon enactment of the budget.

Thank you for that clarification.

I mean, clearly that means that we can't cut our way out of trying to address this deficit, is what I'm hearing, because that also trickles down to the county, and you may have heard from our health care services agency.

Um, that the I mean healthcare services that we are also anticipating that we may look at some RIFT and nutritions uh and staffing because of these cuts uh translated from the federal government down to the state and to the county.

Okay, thank you.

You want to do that.

Absolutely, go ahead.

Yeah, uh I have a lot of segments now around uh lawsuits, and so that's where I'll go next.

A lot of lawsuits uh happening because of some of the federal government actions.

Um, our attorney general Banta urged the USDA to correct mistakes that risk denial of SNAP benefits to certain eligible non-citizens.

Also on Wednesday, attorney general Rob Bonta, joined by 21 other attorneys generals, submitted a letter to the United States Department of Agriculture challenging its recent guidance on supplemental nutrition assistance program or the SNAP program.

Uh, the attorneys general or argue that the USDA's interpretation of HR1 or the big beautiful bill is inaccurate because it permanently excludes certain humanitarian migrants, such as refugees, asylum, and parolees from SNAP benefits, even after these individuals adjust their status to lawful permanent residents.

The letter explains that the USDA's guidance incorrectly suggests that these individuals either cannot gain SNAP eligibility upon becoming LPRs or must observe a five-year waiting period.

In contrast, the law dictates that they should be immediately eligible once they obtain LPR status.

Attorney General Rob Bonta stressed in a statement that the USDA's misinterpretation threatens to wrongfully deny food assistance to thousands of otherwise eligible legal permanent residents.

The attorney generals urged the USDA to correct these errors by acknowledging that certain lawfully residing non-citizens become immediately eligible for SNAP upon adjusting their status to LPR, rectifying the inconsistencies and errors in the eligibility instructions that are confusing state agencies and refrain from penalizing states for any errors resulting from these federal instructions.

Lastly, it was reported that the Trump administration has formally indicated to a federal judge its plan to resume transferring confidential Medicaid recipient data to immigration and customs enforcement or ICE as early as next month.

This data includes personal information such as phone numbers, addresses, and emergency statuses.

And the administration, through the Centers for Medicare and Medicaid Services or CMS, argues that this transfer is a lawful measure to combat waste fraud and systemic abuse in the Medicaid program.

This announcement comes in response to a preliminary injunction issued by San Francisco-based US district judge in August, which temporarily blocked the data sharing until federal agencies completed a reasoned decision-making process.

The federal agencies believe a recent CMS notice and an ICE memo satisfied as court imposed requirement, setting the stage for the freeze to potentially be lifted on December 9th, 14 days after the CMS notice was published.

The resumption is strongly opposed by California, which is leading a coalition of 21 other states that sued in July to present this transfer.

The legal team for California has already challenged the federal government's claim that its notices are adequate, with a state deputy attorney general asserting that they do not meet the court's requirement for reasoned decision making.

Crucially, CMS has already shared Medicaid data from California and a handful of other blue states with ICE.

While the use of this information for immigration enforcement has been prohibited since the August ruling, the resumption would allow ICE to start utilizing the data.

California Attorney General Rob Bata maintains that action is illegal and is designed to create a culture of fear that discourages undocumented immigrants from accessing necessary health care.

A court ruling is scheduled for December 9th to determine whether the temporary order blocking the Medicaid data transfer can be extended.

The U.S.

district court judge has suggested that the federal government consider delaying the resumption until after the holidays.

We will monitor both of these court cases and report out accordingly.

With that, I'm happy to answer any questions.

Supervisor Portugal.

Questions, comments.

Well, I am glad to hear that these um that this litigation is happening.

In terms of the data sharing between the federal government and ICE, including Medicail information, do you have any more context into what exactly that data is and how it might relate to Alameda County residents?

I am certainly willing to ask some of my colleagues about how it might relate to Alameda County.

My understanding is that the data includes personal information.

So it includes things like phone numbers, addresses, and immigration status.

And of course, the fear being that those can be utilized to locate study.

You know, and I can certainly ask more about the context of Alameda County, but you know, it's our understanding that some of this data from California has already been shared.

It's already been shared.

Yes, okay.

And we don't know.

We're one of a handful of states where some of this has been shared according to the court filings.

Okay.

Is this the type of data that would normally be protected by HIPAA?

Um that basically protects patient health information and privacy of health care.

I'm not an attorney, but I would certainly think so, given that it is ultimately a health care program that is involved here.

And I think for those of us who are around during the last Trump administration, there were similar issues about the sharing of data specifically as it related to emigrants and whether or not it would be shared with ICE.

Okay.

Thank you.

Appreciate that.

Any other questions or comments?

Are there any uh public comments on either our federal or state legislative update?

There are no speakers.

Okay.

Are there any uh public comments on items that are not on today's agenda but within the purview of the health committee?

I mean, not excuse me, the PAL committee for the board supervisors.

There are no speakers.

Oh, thank you.

Um, well, those online please identify yourself so we can appreciate your participation.

No one wishes to speak.

No one's raising their hand to identify themselves.

Okay.

Thank you.

Appreciate everyone's updates and their participation.

Uh, this meeting is adjourned.

Thank you.

Thank you.

Thank you.