Will Humble Public Health, Public Health Law, Wills Blog

The People Speak. Will Public Health Policy Follow?

By now all of you know the results of the federal and state election results so I won’t recap them here – except to link the results to the prospects for public health policy.

The results in the US House of Representatives suggest that it’s unlikely there will be another effort to repeal the Affordable Care Act.  That doesn’t mean that the ACA is no longer in jeopardy. There’s still an outstanding lawsuit challenging the mandate for health insurance plans to cover preexisting conditions as well as other provisions in the ACA (AZ is on the list of states challenging the law). The US Justice Department will presumably continue to decline to defend the ACA in court.

The fact that the US House will be controlled by the Dems means that there will be an opportunity for additional oversight of the decisions that the federal agencies are making with respect to public heath and health care (e.g. CMS, EPA, DHS, USDA etc.).  That oversight authority can be used to ensure that the administrative decisions made by the federal agencies are consistent with their statutory authority.

There will be no party changes in the executive branch here in Arizona and we will continue to have the same governor and presumably the same agency heads. The makeup of the state legislature looks like it will shift a little- but party control won’t change. The Senate will likely remain 17-13.  In the House it looks like the new split will be a razor thin 31-29. 

Many of the bills that we supported last year passed with bipartisan support- and it remains important to look toward public health policies that are founded with evidence and for us to continue to frame the issues in a way that builds bipartisan support for sound public health policy.

Will Humble Medicaid, Opioids, Prevention, Wills Blog

New Federal Opioid Intervention Becomes Law

A couple weeks ago congress passed and the president signed the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. Much like Arizona’s Arizona Opioid Epidemic Act – approval of the bill was bipartisan, with a House vote of 393-8 and 98-1 in the Senate.

The final bill creates, expands and reauthorizes programs and policies across several federal agencies, and focuses on prevention, treatment and recovery. The text of the Act is extremely long, but you can view a high level summary on this landing page.

Some of the provisions are in line with recommendations in the 2017 ADHS Opioid Response Report like calling for changing an old federal regulation that prohibited Medicaid from covering patients with substance abuse disorders who were getting treatment in a mental health facility with more than 16 beds. The effect of the former law limited the number of beds available for low-income patients suffering from addiction- so hopefully the network of treatment facilities will expand as a result of this change in the law. The new federal law allows for 30 days of residential treatment coverage.

The new law allows nurse practitioners and physician assistants to prescribe buprenorphine, which is an anti-addiction medication that requires a special license and extra training.  For the next 5 years, it will also allow nurse anesthetists, nurse midwives and clinical nurse specialists to prescribe buprenorphine.  Right now, only about 5% of doctors are licensed to prescribe it.  It’ll take time for the inventory of prescribers to increase because of the training that’s required- but over time this provision will help network capacity especially in rural areas.

The Act also creates a grant program for comprehensive recovery centers that include housing and job training, as well as mental and physical health care. It will also increase access to medication-assisted treatment.

Some aspects of that law that relate to Medicaid include:

  • Temporarily requires coverage of medication-assisted treatment under Medicaid;

  • Prohibiting the termination of Medicaid eligibility for juveniles who are inmates of public institutions;

  • Requiring CMS to establish a demonstration project to increase provider treatment capacity for substance-use disorders;

  • Requiring state Medicaid programs to establish drug management programs and drug-review and utilization requirements for at-risk members; and

  • Extending enhanced federal matching rate for expenditures regarding substance-use disorder health-home services under Medicaid.

Interestingly, the bill includes a provision to help stop the flow of black-market opioids into the country by mail, especially synthetic fentanyl and its analogs.  The US Postal Service will need to provide the name and address of the sender and the contents of at least 70% percent of all international packages, and 100% of packages from China.

All international shipments will need to have the name and address of the sender by the end of 2020.  The Postal Service was also given the authority to block or destroy shipments for which the information isn’t provided.

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act is long and comprehensive so I can’t cover everything….  But the bottom line is that public health policy – both here in AZ and now nationally is beginning to address the epidemic.

Will Humble Medicaid, Nutrition, Physical Activity, Prevention, Wills Blog

More States Implementing School-based Nutrition & Physical Activity Policies

Obesity remains a complex health issue in the United States. Several factors—including behavioral, environmental, and genetic—interact and contribute to increasing obesity rates. Approximately 19% of children and adolescents aged 2-19 years old are obese and face a greater risk of developing chronic and other conditions like diabetes, heart disease, cancer, high blood pressure, asthma, and sleep apnea. By 2012, the estimated annual cost of obesity in the United States was $147 billion, in addition to other social and emotional costs.

The causes of childhood obesity include unavailability of healthy food options, easy access to unhealthy foods, lack of physical activity, as well as policy and environmental factors that do not support healthy lifestyles. Schools play a significant role in diet and activity through the foods and drinks offered and the opportunities for physical activity provided.

Recognizing the unique position of schools, states have enacted and proposed legislation to prevent and reduce childhood obesity by: (1) ensuring that nutritious food and beverages are available at schools, and (2) establishing physical activity and education standards at schools. Below is an overview of current laws and recent state and territorial legislative activities to increase the availability of healthy foods and opportunities for physical activity in schools.

School Nutrition Legislation

Children and adolescents consume much of the food they need each day while at school. Children may receive meals from federal programs like the National School Lunch Program and the School Breakfast Program, or they may purchase competitive food and drinks (i.e., food that’s purchased from school-based vending machines, snack bars, or concessions outside of the school’s food service program). Many states have adopted policies to make competitive foods healthier, set limits on food for rewards, and impose restrictions on food and beverage marketing in schools.

A Colorado statute prohibits public schools from making available any food or beverage that contains any amount of industrially produced trans-fat on school grounds. In Kentucky, each school must limit access to retail fast foods in cafeterias to no more than one day each week. Laws in New Jersey prohibit the sale of foods of minimal nutritional value, all food and beverage items listing sugar as the first ingredient, and all forms of candy on school property during the school day.

In 2017, California’s governor approved a bill limiting the advertisement of food and beverages during the school day in schools, school districts, or charter schools participating in federal lunch and breakfast programs. California also prohibited participation in corporate incentive programs that reward children with food and beverages that do not comply with nutrition standards. New Hampshire proposed similar legislation prohibiting the advertisement of any food or beverage that does not meet the minimum nutrition standards as set forth by the school district, as well as participation in a corporate incentive program that rewards children with food and beverages.

Recognizing that many schools lack the necessary equipment to support the storage, preparation, and service of minimally processed and whole foods, the Washington State legislature introduced a bill that would establish a competitive equipment assistance grant program for public schools to improve the quality of food service meals that meet federal dietary guidelines and increase the consumption of whole foods. In 2017, Puerto Rico proposed a bill requiring that vending machines located in public schools only contain products of high nutritional value according to the standards imposed by the federal government.

Physical Activity Legislation

According to CDC, children and adolescents should have one hour or more of physical activity every day. State policymakers often target physical activity and education curriculums in K-12 schools to combat the childhood obesity epidemic. Promising trends include: improving physical education curricula, integrating physical activity into the school day and maximizing recess opportunities, as well as enhancing physical activity opportunities in school-based after-school programs.

Many states have statutes in place or have proposed legislation imposing physical activity and education requirements in schools. Last legislative session, Arizona approved a new law mandating that public schools include recess in their curriculum. Other states have gone further. 

Iowa, Louisiana, North Carolina, and Texas require 30 minutes of physical activity each school day. Arkansas requires 90 minutes of physical activity each week for grades K-6. South Carolina sets a minimum standard of 150 minutes per week for grades K-5. Colorado requires 600 minutes of physical activity each month for full-time elementary students.  Tennessee amended its statute to require a minimum of 130 minutes of physical activity per full school week for elementary school students and a minimum of 90 minutes for middle and high school students.

Will Humble Prevention, Public Health, Public Health Law, Vaccination, Wills Blog

Educating Parents to Improve Vaccination Rates

It’s no secret that many states including Arizona are struggling to maintain enough vaccination coverage to achieve “herd immunity”.  Herd immunity simply means that you have enough vaccination coverage to protect the entire community – including people that for medical reasons can’t be vaccinated and folks who’ve been vaccinated but still may be susceptible (because vaccines aren’t 100% effective). Generally, herd immunity happens when a community has a vaccination rate above 95%.

A couple of months ago the ADHS released their latest school reporting data on vaccine exemption rates (medical, personal and religious).  Here’s a 2-page summary of some of the results.  This year’s report covers the 2017-2018 school year. The data show that:

  • Immunization rates have decreased across all age groups from 2012 to 2017;

  • Personal exemption rates continue to be highest in charter schools, followed by private and public schools in 2017; and 

  • Overall personal exemption rates increased in the last year- going from 3.9% to 4.3% for pre-school; 4.9% to 5.4% for Kindergarten and 5.1% to 5.4% among 6th graders.

Requiring kids in public school to be vaccinated is one of the most important public policy tools to ensure herd immunity.  Arizona does that through statutes labeled ARS-872 & ARS-873 – which require kids to be vaccinated if they attend public school (unless they have an exemption). In Arizona, there are medical, religious, and “personal” exemptions. The problem over the last few years is that more and more parents are exercising the personal exemption option.

According to our current statute, parents can get a personal exemption if they “… sign a statement to the school administrator stating that (they) have received information about immunizations provided by the ADHS and understand the risks…” (as defined in R9-6-701-708). Despite numerous interventions to improve immunization rates among AZ school children- we continue to lose ground. In several parts of the state and among certain demographic groups (high income zip codes and some charter schools for example) we’ve lost herd immunity- which means we’re at real risk for outbreaks.

Arizona’s public health system has been doing some creative work to improve our immunization rates. One of my favorites is an innovative on-line immunization education course that’s designed to serve as part of a potential new personal exemption process. The Maricopa County Department of Public Health worked with a University of Arizona medical student and the ADHS Immunizations Program to design and conduct the test pilot program. The new education course was piloted at 16 schools in Maricopa County (8 elementary, 5 middle or junior high and 3 high schools) last school year.  The pilot objectives were to:

  • Learn how to best implement the immunization education module developed by ADHS in Maricopa County schools;

  • Get feedback from school staff regarding the use of the module to ensure a smooth rollout in the future; and

  • Identify whether parents learned new information about vaccine preventable diseases and vaccines using a brief anonymous pre-and post-knowledge assessment survey.

The pilot was small & wasn’t designed as a formal study and therefore wasn’t able to draw any conclusions about the effectiveness of the modules- but it’s a promising intervention that has a good chance of helping improve immunization rates.

There’s a lot of interest among a host of public health stakeholders in continuing to pursue this educational (informed consent) process as part of the personal exemption process.  I’m optimistic that executive branch decision-makers will recognize the value that a more robust parent education policy can have in improving rates and that AZ will continue to develop and implement this innovative intervention.

Part of what makes me optimistic are comments that the Governor recently made during an interview with the Arizona Republic in which (about 25 minutes into the interview) he states that “This is a public-health issue, I’m a big believer in freedom and choice on a lot of issues, but… if your kid’s going to be in the public-school system in Arizona, they’re going to be vaccinated.”

The bottom line is that despite our work to date, vaccination rates continue to decline and are below the herd immunity threshold in some parts of the state and among some demographic groups.  Additional interventions are clearly needed.  Perhaps the education modules will help.  But it may be that the only real solution is to look to other states that have eliminated the personal exemption.  California provides a promising case study.

Will Humble Prevention, Vaccination, Wills Blog

CA Eliminates Personal Exemption & Vaccination Rates Improve

California has also been struggling to maintain herd immunity vaccination rates- especially in higher income areas.  After trying a variety of interventions- and following a measles outbreak associated with Disneyland, CA passed Senate Bill 277 (SB277) in 2015 which abolished all nonmedical exemptions in California.

Their intervention worked.  In the following years, CA had sharp increases in vaccination rates among kindergarteners entering school. During the 2014–2015 school year the statewide kindergarten full-vaccination rate was only 90.4%. After implementing the new law, the kindergarten full-vaccination rate rose to >95% and has stayed there. 

By the way- a few months ago the Second District Court of Appeal in Los Angeles found that the CA law didn’t violate freedom of religion or the right to an education. The court said that… “Compulsory immunization has long been recognized as the gold standard for preventing the spread of contagious diseases”.  The court said the new law was not discriminatory and was a valid measure to protect public health.

Will Humble Affordable Care Act, Health Insurance, Prevention, Public Health Law, Wills Blog

CMS Opens Door to Waivers that Subsidize Weaker Health Insurance Plans

Section 1332 of the Affordable Care Act gives the HHS and the Department of Treasury authority to review and potentially approve a “State Innovation Waiver” related to Marketplace insurance if a state’s waiver application provides “coverage to a comparable number of residents of the state as would be provided coverage absent the waiver” and “provides coverage that is at least as comprehensive and affordable as would be provided absent the waiver”, and “doesn’t increase the Federal deficit“.

If a state’s waiver is approved by HHS, a state can get pass-through funding equal to what they would have received without the waiver.  Back in 2015 the Obama Administration issued guidance regarding the requirements to get a 1332 waiver. 

Last week CMS replaced the 2015 guidance with new guidance for 1332 waivers that would (if the guidance stands up to judicial review) allow states to implement what CMS is calling “State Relief Empowerment Waivers”.  It’s a name they invented- not a name that’s outlined in the ACA.  The new guidance will likely have an impact beginning in the 2020 open enrollment period- not the current open enrollment period.

CMS says they will now allow a wider range of insurance coverage levels in waiver requests, including plans that don’t comply with the ACA’s basic coverage requirements. For example, state 1332 waivers will now be able to include Association Health Plans and short-term limited duration insurance. Under the guidance, states could get a federal subsidy to subsidize the purchase of these plans. 

To be honest I don’t think the short-term limited duration insurance part of the guidance will stand up to judicial review because the ACA states that the waivers must provide coverage that is at least as comprehensive and affordable as would be provided absent the waiver. Short term limited duration plans and some association health plans do not.

Association Health Plans and short-term plans don’t necessarily include coverage for essential health benefits, which can leave plan participants with high out-of-pocket costs or discourage individuals from seeking timely treatment. For example, short term plans don’t usually cover pre-existing conditions and generally don’t offer coverage for behavioral health services, prescription drug costs, or maternity care.

Under the new guidance, CMS’ analysis of affordability and coverage will be based on the types of coverage made available to state residents rather than on the coverage that residents buy.  Again, I wonder how they’ll keep this in accord with the statutory ACA requirements of 1332 waivers. 

CMS says their analysis will focus on the aggregate effects of a waiver rather than on the effects on a subgroup of state residents. In other words, CMS will consider the overall improvements in affordability and coverage for state residents- even if there’s a negative effect for a subset of folks. 

Right now, there are only eight 1332 waivers (they were approved under the 2015 guidance).  Those 1332 waivers mostly focused on reinsurance programs to lower premiums in the federal marketplaces.

Will Humble Immigration Policy, Public Health Law, Wills Blog

Weigh in on the US Department of Homeland Security’s new “Public Charge” Rules

The US Department of Homeland Security is proposing new changes to what is commonly referred to as their ‘public charge’ rule.  If they’re adopted as-is, the new regulations would make it harder for families who are following all the rules of legal immigration to enter the U.S. or obtain a green card to become a legal, permanent resident. This means people trying to become new Americans legally would risk their status simply by turning to available services of Medicaid (and possibly CHIP/KidsCare), SNAP (aka food stamps), Medicare Part D, and housing assistance. You can learn more about what “public charge” is here. 

DHS is accepting public comments on their rule package through December 10.  We’d like your help to put together comments from the Arizona public health community.  Here’s some background:

DHS already uses information about whether applicants for legal permanent residency receive Temporary Assistance for Needy Families and Supplemental Security Income (SSI) when they evaluate applications.  After these proposed new rules are adopted, they’ll also consider whether applicants receive Medicaid (AHCCCS), Medicare Part D Low Income Subsidy, the Supplemental Nutrition Assistance Program (food stamps), and Section 8 Housing program.  Once adopted, applicants that receive any of these benefits will be far less likely to be approved for a status change or stay extension.  I didn’t see any exemptions for children- so presumably benefits used by any noncitizen family member including kids would count.  Here are some take-aways from the proposal:  

  • This is an issue of legal immigration- unauthorized migrants are largely ineligible for public assistance;

  • The use of public benefits by citizen children would not be considered a public charge;

  • This does not directly impact green card holders (the public charge test is not applied to green card holders applying for citizenship);

  • While CHIP (KidsCare) hasn’t been included in the proposed list of benefits that will count against individuals, the proposal draft seeks comments about whether CHIP should be included;

  • The proposed rule is not retroactive – meaning the public benefits received before the rule is final will not be counted as a public charge; and 

  • The proposed rules would not apply to refugees because existing statute prevents DHS from using the criteria for refugees.

  • Even though the new draft doesn’t include vaccinations (VFC), WIC and marketplace insurance- many families will believe that the regulations do include these benefits and will elect not to use these important safety net benefits- as doing so will risk their immigration status.  As a result, families will have a more difficult time improving the health status of their families.  An estimated 200,000 Arizonans will be impacted directly and many more may avoid using services they need due to fear and misinformation. The good news is that your voice matters! 

Turning in public comments matters because: 1) Federal law requires the government read and consider every unique comment before issuing a final rule and significant or copious comments could slow down the process and give policymakers more time to reconsider the final rule change; 2) Comments can later provide an opportunity to challenge the regulations in court; and 3) Comments give our communities a chance for their voice to be heard.

DHS will group all identical comments and count them as one comment. To make the most impact, it’s important to add your own words and ideas to your comments so it can be counted as a unique comment. Take a moment to highlight how your professional career or personal experiences has informed your view of what the Feds are proposing.  Below are example comments for you to consider using or modifying, along with your own words, and step by step instructions on how to submit your own comments.  

I oppose the Department of Homeland Security’s proposed rule change to “public charge.”  The policy will undermine access to essential health, nutrition, and shelter for immigrants and their family. One in four children in Arizona, and nearly 20 million children nationwide, live with at least one immigrant parent. By forcing choices no family should have to make, it puts our whole country at risk. This will policy is short-sighted and will only create costs shifts to states as well as create, bigger more expensive problems down the road. DHS should immediately withdraw its proposal. 

A community’s overall health depends on the health of all of its members. The proposed rule change will lead to higher rates of uninsured adults and children. Without insurance, families may delay care or forego it altogether. This means there will be more children in school, and adults in the workplace, without needed preventive services and untreated illnesses. Treatment for life-threatening conditions such as asthma keeps children in school. More people delaying care until the last possible moment will strain emergency resources. Hospitals’ and clinics’ uncompensated care burdens will increase. Children with Medicaid and CHIP have better health as adults, with fewer hospitalizations and emergency room visits; they also earn more and pay more in taxes. 

CHIP (KidsCare in Arizona) is designed especially for working families and should not be considered a public charge. Including CHIP would be a double hit to families who work hard and play by all the rules of our immigration system only to have the American dream become that much more unattainable. 

The loss of access to SNAP would further exacerbate food insecurity. SNAP is a critical source of support for struggling households; research shows how SNAP lifts people out of poverty, reduces hunger and obesity, and improves school attendance, behavior, and achievement. The consequences of food insecurity are especially detrimental to the health, development, and well-being of children.

We’ll be turning in public comments on the rule change before the December 10 deadline…  but please consider turning in your own unique comments!

History of Considering Public Benefits

The term “public charge” as it relates to admitting immigrants has a long history in immigration law, appearing at least as far back as the Immigration Act of 1882.  In the 1800s and early 1900s “public charge: was the most common ground for refusing admission at U.S. 

In 1999, the INS (DHS didn’t exist yet) issued Rules to “address the public’s concerns about immigrant fears of accepting public benefits for which they remained eligible, specifically medical care, children’s immunizations, basic nutrition and treatment of medical conditions that may jeopardize public health.” Here’s that final Rule from 1999, which didn’t include Medicaid our housing benefits in the public charge definition.

Will Humble Medicaid, Wills Blog

National Medicaid Performance Measures for Kids Released

Medicaid and the Children’s Health Insurance Program serve nearly 46 million children which is 33% of the kids in the US- which means that these programs are a huge leverage point for improving health outcomes.  Measuring the effectiveness of these programs is critical to improving their performance and in providing the information needed to design policy interventions.

The Centers for Medicare & Medicaid Services plays a key role in promoting quality health care and as part of their accountability standards they have a core set of health care quality measures for children in Medicaid and CHIP that by applying a standardized set of measures designed to measure and improve the quality of care. 

The 2017 Child Core Set includes 27 measures among the following domains of care: 1) Primary Care Access and Preventive Care; 2) Maternal and Perinatal Health; 3) Care of Acute and Chronic Conditions; 4) Behavioral Health Care; and 5) Dental and Oral Health Services. 

CMS released this year’s “Chart Pack” last week, which includes an analysis of state performance on 19 of the reported measures.  Arizona reported data from 11 of the indicators.  I Haven’t had the time to dive into the details, but if you’re interested in learning more you can explore the performance measures and the results in the September Report

Will Humble Affordable Care Act, Health Insurance, Wills Blog

Several More Insurers Enter AZ Marketplace

Consumers who buy their health insurance from the federal marketplace at www.HealthCare.gov will have new options and new prices to consider before they make a decision for 2019 coverage. During the upcoming open enrollment period (November 1 through December 15)  there will be 4 companies to choose from with several different plans.  Pima County will go from 1 to 3 companies for 2019 and the remaining 13 counties will continue to have BlueCross BlueShield of Arizona as their HealthCare.gov insurance company.

Because financial assistance for Affordable Care Act plans is tied to the price of the price of a Silver plan in each county or zone, Arizonans will generally see more financial assistance and little, if any, change in their current monthly premium. 90% of Arizonans who get coverage from HealthCare.gov receive financial assistance in the form of refundable tax credits to help lower their monthly premium.

November 1 to December 15 is open enrollment this year at www.healthcare.gov.  Free local help from unbiased health insurance Assisters is available by calling 1-800-377-3536 or by visiting www.CoverAZ.org/Connector.

Will Humble Air Quality, Climate Change, Prevention, Public Health, Wills Blog

Here’s Why We Endorse the Clean Energy for a Healthy Arizona Initiative

The AzPHA Board of Directors has endorsed Proposition 127- the Clean Energy for a Healthy Arizona ballot initiative. Proposition 127 would increase the state’s renewable portfolio standard (RPS) which is a mandate that electric utilities acquire a minimum amount of electricity from renewable energy sources. Here’s the actual  Proposition 127 Ballot Language. 

As of 2018, Arizona’s renewable portfolio standard (RPS) is 15% renewable by 2025. Proposition 127 would increase our RPS each year until reaching 50% in 2030.

The Initiative defines renewable energy as electricity generated by  solar, wind, certain hydropower, geothermal, and landfill gas energy.  The definition of renewable energy under the initiative doesn’t include nuclear power. For our state, most of the new renewable energy that would be created would probably mostly be solar.

APS reports it currently generates about 12% of its energy from renewable sources which includes utility-owned plants and power being generated by customers through rooftop solar.  Tucson Electric Power reports 13%. Right now, Arizona gets 6% of its electricity from solar power.

It’s no secret that Arizona Public Service (APS) doesn’t want Proposition 127 to pass.  Their current strategic plan  is to mostly meet future electricity needs by building new gas-fired power plants.  You can see the resource plan APS filed at the Arizona Corporation Commission in 2017 and APS’ recent RFP for new power plants to get an idea about their current strategic plan.

This is an over-simplification- but the public policy question posed by Prop 127 is whether it’s in the public’s best interest to meet future generation demand with mostly natural gas plants or solar.

There are compelling health reasons why Proposition 127 makes sense from a public health perspective. Burning fossil fuel, including natural gas, creates air emissions (oxides of Nitrogen and volatile organic compounds) that form ozone. Ozone adversely affects human health by increasing cardiovascular and respiratory disease.  It can decrease lung function and causes more people to visit emergency rooms or even be admitted to the hospital because of asthma or allergy related illnesses. Some studies have even linked preterm birth to air pollution.

But, if it turns out that the health benefits from cleaner air come at the cost of higher electricity prices- then the health gains from the improvement in air quality would need to be weighed against the public health costs to low income folks who already struggle to pay their electric bills- worsening the social determinants of health for low income people.

Before we took a position on Proposition 127, I and our Board carefully examined what impact the initiative might have on future electricity prices.  After all, income is a primary driver of health status, and if the Initiative were to increase electricity prices more rapidly than under the current RPS standard, then it could end up having a net negative impact on public health among low income Arizonans.  That’s why we carefully examined the cost issue before taking a position.

One of the best and most objective sources of information about the relative costs of generating electricity I found is the US Energy Information Administration’s 2018 report entitled  ”Levelized Cost and Levelized Avoided Cost of New Generation Resources in the Annual Energy Outlook 2018”.   The report examines capital, operational and transmission costs as well as off sets from the tax credits.  It takes a little time to read but worth the effort.

The bottom line is that solar energy generated using photovoltaic cells is on par or slightly cheaper than energy generated with natural gas.  Solar plants have a higher capital cost but lower variable (operational cost) because they don’t need fuel (free photons are the fuel).  Solar also benefits from tax credits- which is part of the cost equation.

One of the reasons why solar power is now slightly cheaper than natural gas energy is that the cost of solar panels has decreased rapidly in recent years (in part because of increased global solar panel manufacturing capacity in China).  The cost of utility-scale solar has fallen 77% since 2009.  The cost of battery storage fell 79% between 2010 and 2017.  Another reason why solar costs less in the long run is because of the federal tax credits that are available to utilities that use solar to generate electricity.

Prop 127 also requires 20% of renewable energy eventually be “decentralized” – basically roof-top solar.  That means incentives will be created to encourage solar installation. Done thoughtfully, that could provide an opportunity to prioritize installation of panels on homes in lower income areas, relieving pressure on monthly budgets of families who most need that relief while increasing the value of their property.

The bottom line is that after reviewing as many objective facts as we could find, we concluded that Proposition 127 provides net health and environmental benefits.  That’s why we’re supporting Proposition 127.

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