Good morning, California.

“Falling chunks of concrete from the Richmond-San Rafael Bridge struck a car and forced a complete closure of the busy span on Thursday, causing traffic jams and diversions across the region. … It was the latest jolt for an aging span that periodically suffers gashes and holes.”—The San Francisco Chronicle.

CA's healthcare crisis to come

California needs more doctors, nurse practitioners and psychologists.

California has a decade to recruit and train a new generation of healthcare workers, or the state will face a new crisis,  according to a new report.

  • The state needs to invest at least $3 billion, and probably more like $6 billion, warns the California Future Health Workforce Commission in the study released this week. The commission is co-chaired by University of California President Janet Napolitano and Dignity Health chief executive Lloyd Dean.
  • Among the most acute shortages: “Frontline workers” including community health and home care workers and medical assistants. High skilled professionals also are needed, including primary care physicians, nurse practitioners, psychiatrists and psychologists.

Expanded use of nurse practitioners would reduce emergency room visits, saving $58 million per year, the report finds. But: 

  •  California’s medical school enrollment rate is third lowest in the nation, so the state must rely on medical students returning or on migration from other states and nations.
  • And California does not have the educational capacity to produce enough health professionals to meet current and projected needs.

The report: “When anticipated population growth, aging, and increasing diversity are taken into account, the picture becomes even more dire.”

 The report suggests a need to focus on underserved parts of the state. The San Joaquin Valley, for example, is “one of fastest-growing and least healthy regions of California,” and yet has 138 physicians for 100,000 population, far below the statewide average of 237 doctors for every 100,000 residents.

Kaiser Health News: “Some of the commission’s proposals would face challenges— especially financial ones. Creating more residencies for primary care physicians and psychiatrists, for example, would cost an estimated $1.56 billion over a decade. And the state’s physicians are likely to oppose giving nurse practitioners more authority.”

Evading CA's vaccination law

Doctors are exempting schoolchildren from vaccinations for supposed medical reasons at far higher rates as parents seek to evade landmark 2015 legislation intended to increase immunization, CALmatters’ Elizabeth Aguilera writes. 

Legislators aren’t sure what to do. But one solution might be for government public health officials to review medical exemptions and veto those that seem spurious.

Sen. Richard Pan, the Sacramento physician who authored the vaccine requirement: “I think we need the health departments to basically say when someone is abusing that authority—and to withdraw that authority and invalidate exemptions that were fraudulent.”

Stormy Daniels, meet Lorena Gonzalez

Stormy Daniels calls for a strippers' exemption.

Leading the Legislature’s effort to define who is or isn’t a gig worker, Assemblywoman Lorena Gonzalez has shrugged off adult film actress Stormy Daniels’ claim that strippers should be exempt from a ruling that requires companies to treat workers as full employees.

  • The issue—one of the hottest policy arguments at the Capitol at the moment—arises from the California Supreme Court’s landmark Dynamex decision last June that companies must treat contract workers as employees. The decision calls into question the business model of Uber, Lyft, TaskRabbit and, perhaps, strip joints.

Daniels’ L.A. Times opinion piece earlier this week: “As independent contractors, we can perform when, where, how and for whom we want. If we are classified as employees, club managers would be empowered to dictate those conditions.”

Famous for having had sex with Donald Trump, Daniels does work for Déjà Vu, a company that owns strip clubs in several states and has been the target of a federal suit over wages, Politico has reported.

  • Gonzalez is willing to exempt physicians and other professions in which workers are higher paid and have bargaining power, and she doesn’t want to stop outsourcing. But much as she respects their work, she said, exotic dancers don’t fit that mold, and ought to be classified as employees.

Gonzalez: “What’s their retirement plan? Do they have health care? No. Do they have workers compensation? No.”

What’s ahead: Uber and other companies are trying to negotiate some sort of arrangement. An Assembly committee will hold a hearing on the issue in March.

A $2 million misunderstanding

The CCPOA wants its money back.

We’ve all heard of buyer’s remorse. Now comes donor’s remorse, courtesy of the California Correctional Peace Officers Association, long a major campaign contributor.

  • The union representing prison officers made a highly unusual demand on Jan. 14 that a campaign committee for a tough-on-crime initiative headed for the 2020 ballot return $2 million it gave on Dec. 28, KQED’s Marisa Lagos has reported.
  • The Keep California Safe initiative would roll back several more liberal criminal justice measures passed during Gov. Jerry Brown’s tenure, including some that were voter approved.

Kurt Stoetzl, the union’s new president, wrote:

“As you may not be aware, this contribution was made by our past president in the final hours of his term. This contribution was made without the new leadership of CCPOA having the opportunity to evaluate the proposed initiative, to determine if the goals of your Issues Committee, and the initiative, are in step in the goals of CCPOA.”

The letter requests a full refund so the union can “ determine whether or not we are in support.” The apparent response: Crickets.

  • Repeated calls from me to the union and its past president, the now retired Chuck Alexander, went unanswered. Consultants Jeff Flint and Ray McNally, who are being paid by the Keep California Safe campaign, also failed to return repeated calls.

Democratic Assemblyman Jim Cooper of Elk Grove, the initiative’s main proponent, told me Thursday he has no control over the money. That’s the responsibility of the board members of the initiative committee. 

Cooper: “I think they’re in a predicament.”

Who’s in a predicament? I asked.

Cooper: “Everybody involved.”

Grassley to CA: Pay up

There’ll be no break from Congress for as many as 2.6 million Californians facing higher state taxes brought about by President Donald Trump’s 2017 tax law, McClatchy’s Washington DC bureau reports.

  • The 2017 tax overhaul limited state income and local property tax deductions for people in high-cost, high-tax states.

McClatchy: “In 2015, 2.6 million Californians took the state and local tax deduction, including 751,000 California households with incomes under $250,000 who probably will owe a combined $1.1 billion in 2018.”

The loss of that state and local deduction hits suburban coast counties hard, including Orange County. There, Democrats gained four congressional seats after Republicans supported what amounts to a tax hike for many voters.

  • Trump offered to revisit the issue, McClatchy reports: “There are some people from New York who have been speaking to me about doing something about that, about changing things. I’d be open to talking about it.”

However, Republican Sen. Chuck Grassley of Iowa, chairman of the committee that would consider such a tax bill, has no interest.

  • McClatchy quoted Grassley’s spokesman Michael Zona calling the deduction “a federal subsidy for states to raise taxes on their residents without political consequence,” and calling on states “to lower their taxes instead of insisting that taxpayers from lower-tax states subsidize their profligate spending.”

Money matters: The Center for Public Integrity and Mother Jones detailed the connection between the Republicans’ approval of the 2017 tax bill, and donations from wealthy donors.

Commentary at CALmatters

Self-driving tech could worsen social and environmental problems.

Alvaro Sanchez and Susan Shaheen, The Greenlining Institute, and UC Berkeley’s Transportation Sustainability Research Center: Self-driving vehicle technology could exacerbate entrenched social and environmental problems, if we don’t make deliberate policy choices, especially for marginalized groups. We can easily imagine a dystopian scenario in which people with money purchase personal self-driving cars, while the rest of us are mired in congested streets, with reduced mobility as public transit gets short-changed due to ridership loss.

Janet Napolitano and Lloyd Dean, University of California and Dignity Health: California faces a serious gap in health care workers. Seven million Californians, the majority of them Latino, African American, and Native American, live in Health Professional Shortage Areas — a federal designation for counties experiencing shortfalls of primary care, dental care, or mental health care providers. The California Future Health Workforce Commission offers solutions.

Have you been paying attention? Take our news quiz and see

Who’s the only Democrat Californians like better for president than U.S. Sen. Kamala Harris? What does state Sen. Bill Dodd want to do about wildfires? How many California inmates suffer from a serious mental illness? These questions and more await in this week’s quiz.

Please email or call with tips, suggestions and insights, [email protected]org, 916.201.6281. Shawn Hubler, [email protected]edits WhatMatters. Thanks for reading, please tell a friend and sign up here.

See you Monday.