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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><div><div><div><div><div><div><div><p class=MsoNormal align=center style='text-align:center'><span style='font-size:9.5pt'><img width=540 height=163 style='width:5.625in;height:1.6979in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_1" src="cid:image001.jpg@01D62DB4.61BA4990" alt="cid:image003.jpg@01D413DA.65584930"></span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782content"><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#7F7F7F'>May 19, 2020</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;font-variant:small-caps;color:red'>CALL YOUR REPRESENTATIVES TO REJECT BUDGET PROPOSAL TO TAKE AWAY PROP 56 FUNDS FOR SUPPLEMENTAL PAYMENTS</span></b><span style='font-size:9.5pt;font-variant:small-caps'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#0070C0'>  </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><a href="https://actnow.io/mmqqXtO"><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#1155CC'>CMA</span></a><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:45.7pt;margin-bottom:11.25pt;margin-left:0in'><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>ACCMA and CMA are urging physicians to </span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><a href="http://r20.rs6.net/tn.jsp?f=001EiChAsnhHjrOXKw770Y_IrLGvn0-Vsd_-wZfHcwz-PsWuIH7RKPZGb-1zJYjpub6KRNHa7V59GDkUgsZSI7CSWekm4494zKgxMvhFHDwTmYtX6LuR6GrMw_RxK1AGLhO25dI0S3hPn4GEv7usFNLTQ==&c=-FXjOC1wFTnswmh-aqbb9CoAeoUzWnAU9763x_JHpH73tH_425Umrw==&ch=5ommAFNhxeeM3yyhsksZInlJ10uGth3ea2XrXQp6eT6gIQV63rA9cQ==" target="_blank"><b>contact their local legislators </b></a><b>today as they debate the Governor’s proposed “solutions” to balance the health care budget. It is critically important the legislature understand the need to protect access to care for Medi-Cal enrollees and </b><a href="http://r20.rs6.net/tn.jsp?f=001EiChAsnhHjrOXKw770Y_IrLGvn0-Vsd_-wZfHcwz-PsWuIH7RKPZGb-1zJYjpub6KRNHa7V59GDkUgsZSI7CSWekm4494zKgxMvhFHDwTmYtX6LuR6GrMw_RxK1AGLhO25dI0S3hPn4GEv7usFNLTQ==&c=-FXjOC1wFTnswmh-aqbb9CoAeoUzWnAU9763x_JHpH73tH_425Umrw==&ch=5ommAFNhxeeM3yyhsksZInlJ10uGth3ea2XrXQp6eT6gIQV63rA9cQ==" target="_blank"><b>REJECT the Governor’s repurposing of Proposition 56 tobacco tax revenue.</b></a> <o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:45.7pt;margin-bottom:11.25pt;margin-left:0in'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>On May 14, Governor Newsom proposed taking virtually all of the Proposition 56 Tobacco Tax Revenue to help close the state’s budget deficit. CMA is urging the Legislature to stand with physicians to protect patient access to care and <b>REJECT</b> the Governor’s proposal to cut payments to Medi-Cal providers and eliminate the state’s $272 million provider loan repayment program. <o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:45.7pt;margin-bottom:11.25pt;margin-left:0in'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Difficult decisions will be made by the Legislature over the coming weeks to address the state’s fiscal challenges. But state leaders cannot balance the state budget on the backs of patients and the physicians who have risen to meet COVID-19 crisis.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:45.7pt;margin-bottom:11.25pt;margin-left:0in'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Newsom’s new budget proposal violates the will of the voters when they passed Proposition 56, and breaks the governor’s promise to ensure the initiative supports increased access to care. Ending this vital program will eliminate access to care for hundreds of thousands of patients from low-income, rural and underserved communities across California, and punish physicians who want to ensure all patients, regardless of income or zip code, have access to a physician when they need one.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:45.7pt;margin-bottom:11.25pt;margin-left:0in'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:45.7pt;margin-bottom:11.25pt;margin-left:0in'><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Contact Numbers for Assemblymembers</span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Asm. Jim Frazier, District 11: (916) 319-2011 or (707) 399-3011<o:p></o:p></span></li><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Asm. Tim Grayson, District 14: (916) 319-2014 or (925) 521-1511<o:p></o:p></span></li><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Asm. Buffy Wicks, District 15: (916) 319-2015 or (510) 286-1400<o:p></o:p></span></li><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Asm. Rebecca Bauer-Kahan, District 16: (916) 319-2016 or (925) 328-1515<o:p></o:p></span></li><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Asm. Rob Bonta, District 18: (916) 319-2018 or (510) 286-1670<o:p></o:p></span></li><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Asm. Bill Quirk, District 20: (916) 319-2020 or (510) 583-8818<o:p></o:p></span></li></ul><ul style='margin-top:0in' type=disc><li class=MsoNormal style='margin-right:60.7pt;margin-bottom:11.25pt;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Asm. Kansen Chu, District 25: (916) 319-2025 or (408) 262-2501<o:p></o:p></span></li></ul><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:45.7pt;margin-bottom:11.25pt;margin-left:0in'><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Contact Numbers for Senators</span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l2 level1 lfo2'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Sen. Bill Dodd, District 03: (916) 651-4003 or (707) 224-1990<o:p></o:p></span></li><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l2 level1 lfo2'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Sen. Steve Glazer, District 07: (916) 651-4007 or (925) 258-1176<o:p></o:p></span></li><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l2 level1 lfo2'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Sen. Nancy Skinner, District 09: (916) 651-4009 or (510) 286-1333<o:p></o:p></span></li><li class=MsoNormal style='margin-right:45.7pt;margin-bottom:11.25pt;mso-list:l2 level1 lfo2'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Sen. Bob Wieckowski, District 10: (916) 651-4010 or (510) 651-4010<o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:30.95pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p></div><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#7F7F7F'>May 15, 2020</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p></div><p class=MsoNormal><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:red'>Revised state budget proposal includes major health care cuts</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#0070C0'> <o:p></o:p></span></p><p class=MsoNormal><a href="https://www.cmadocs.org/newsroom/news/view/ArticleId/48885/Revised-state-budget-proposal-includes-major-health-care-cuts"><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#1155CC'>https://www.cmadocs.org</span></a><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><a name=14786></a><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>May 15, 2020<br><br><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Gov. Gavin Newsom released his updated state budget proposal this week for the fiscal year 2020-21. While the Governor’s January proposal provided billions in new revenues and health care spending, the revised proposal reflects an economy battered by the fallout from COVID-19, and sets the state for a month-long fight over program priorities in the Legislature and with the Newsom Administration. <o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>California began 2020 with a strong economy, historic reserves, a structurally balanced budget and a projected surplus of $5.6 billion. However, the Governor’s financial analysts now predict revenue declines of $41.2 billion due to job losses and business closures due to the public health emergency.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Meanwhile, the state’s social service obligations are expected to dramatically increase as millions of Californians seek help to deal with the economic devastation wrought by the COVID-19 outbreak. ealth and Human Services spending is expected to increase by $7.1 billion, reflecting increased caseloads for safety net programs, including an additional 2 million Californians on Medi-Cal due to the skyrocketing number of the recently unemployed who may be eligible<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>These updated predictions result in an overall budget deficit of approximately $54.3 billion, of which $13.4 billion occurs in the current budget year (2019-20) and $40.9 billion in the currently being debated budget year (2020-21). This overall deficit is nearly 37% of the General Fund spending authorized in last year’s budget.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>In his May budget revision, Gov. Newsom proposed reclaiming the health care funding made possible by the Proposition 56 tobacco tax, and instead uses it to address the looming budget deficit. While the administration’s plan protects funding for Proposition 56 graduate medical education, it eliminates the loan repayment program for physicians and dentists who agree to see more Medi-Cal patients.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Absent additional federal funds, Gov. Newsom proposes making the following health care program reductions:<o:p></o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoNormal style='margin-right:30.7pt;mso-list:l0 level1 lfo3'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>$1.2 billion in Proposition 56 funding that had been used to provide supplemental Medi-Cal payments to physician and dentists, family health services, developmental screenings, non-emergency medical transportation, value-based payments, and loan repayments for physicians and dentists.<o:p></o:p></span></li><li class=MsoNormal style='margin-right:30.7pt;mso-list:l0 level1 lfo3'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Adult dental and all optional benefits including audiology, incontinence creams and washes, speech therapy, optician/optical lab, podiatry, acupuncture, optometry, nurse anesthetists services, occupational and physical therapy, pharmacist services, screening, brief intervention and referral to treatments for opioids and other illicit drugs in Medi-Cal, and diabetes prevention program services, for a total General Fund savings of $54.7 million.<o:p></o:p></span></li><li class=MsoNormal style='margin-right:30.7pt;mso-list:l0 level1 lfo3'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The elimination of special carve outs for Federally Qualified Health Centers for a savings of $100 million ($50 million General Fund).<o:p></o:p></span></li><li class=MsoNormal style='margin-right:30.7pt;mso-list:l0 level1 lfo3'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Other health care programs totaling over $300 million in savings for budget year 2020-2021.<o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The Governor has also tabled new health care proposals from his January budget, including his plan to expand Medi-Cal coverage to include all adults aged 65 or older, regardless of their immigration status (approximately 90,000 adults). It would have built upon the coverage currently offered to children up to age 19, and young adults aged 19-26.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The Governor has also opted not to seek a new Office of Health Care Affordability and to delay implementation of <a href="https://www.dhcs.ca.gov/provgovpart/Pages/CalAIM.aspx"><b>the CalAIM initiative</b></a>, which sought to reform Medi-Cal care.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Gov. Newsom has called on the federal government to step up to support states, including California. His new budget proposal contains billions in cuts that will be restored only if Congress and President Trump send more aid to states. This week, the House passed the Heroes Act, which contains funding that would help offset Newsom’s proposed “trigger restoration” cuts of $14 billion<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>California Medical Association (CMA) President Peter N. Bretan, Jr., M.D. called on state lawmakers to <a href="https://www.cmadocs.org/newsroom/news/view/ArticleId/48883/CMA-President-Peter-N-Bretan-Jr-M-D-statement-on-Gov-Newsom-39-s-May-budget-revision"><b>ensure Californians are protected</b></a>, regardless of what action may or may not come from Washington. “Unfortunately, the budget outlined by Gov. Newsom will create additional pressure and uncertainty for physician practices. While we agree that the federal government must do more to stabilize our health care system and our economy, we know we cannot depend on federal action to ensure we have a budget that truly reflects California values.”<o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.7pt'><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-right:15.7pt'><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-right:15.7pt'><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-right:15.7pt'><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></b></p><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><strong><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt'> <o:p></o:p></span></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>Contact us at: </span><span style='color:black'><a href="mailto:calaaem.news.service1@gmail.com" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>calaaem.news.service1@gmail.com</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'><br><br>For more articles, visit our </span><span style='color:black'><a href="https://www.aaem.org/get-involved/chapter-divisions/calaaem/news-service" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>archives</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>. <br><br></span><span style='color:b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