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.

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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.