AzPHA Member Call to Action: Protect AZ's Voter Initiative Process

107 years ago Arizona's founders protected ordinary voters with a state constitution that guaranteed AZ residents the power of referendum, recall and initiatives.

Many of the bold moves to improve public health policy have come via citizens initiatives. A few examples are:

  • The Smoke Free Arizona Act;
  • The TRUST Commission for tobacco education and prevention;
  • First Things First;
  • Proposition 204 (from 2000) which extended Medicaid eligibility to 100% of federal poverty

This legislative session, Arizona's legislative and executive branches passed and signed two bills (HB2244 and HB2404) that will impair our ability to use voter initiatives to improve public health in the future.

  • HB 2404 prevents signature gatherers from getting paid by the signature (for voter initiatives), making it more difficult to provide the work incentive needed for gatherers to be efficient.  This will be a barrier to getting the large number of signatures needed to put citizens initiatives on the ballot in the future.
  • HB2244 changes the citizen's initiative compliance standard from "substantial compliance" to "strict compliance" with the requirements for putting initiatives on the ballot. This new law will make it easier to reject petitions if there are any errors on the document.

Fortunately, a new non-partisan political committee called The Voters of Arizona www.votersofarizona.com is challenging these new limits on voter initiatives. Their goal is to collect 75,000 signatures by August 12 in an effort to keep these new laws on hold (called a referendum) until the Arizona voters have an opportunity to weigh in during the November 2018 election.

As an ordinary Arizona citizen, you can help preserve the current voter initiative process. To learn more about the referendum effort or to collect signatures visit www.votersofarizona.com

If you'd like to help gather signatures for this important effort you can click here.

This is part of what Arizona is supposed to be about, what we always have been about. The people serve as a check on the government and in particular, the Legislature. It’s pretty clear to me that this Legislature is doing what it can to try to take that power away from the public so we're not going to let them get by with it."
- Grant Woods, Co-Chair, Voters of Arizona

Weekly AzPHA Public Health Policy Update - End of Session Review

The Arizona State Legislature's 2017 Regular Legislative Session ended yesterday.  We had some solid gains in terms of public policy that influences public health.  We also had some missed opportunities and some losses (especially when it comes to future voter initiative possibilities), but on the whole, lots of good things happened.

A big thank you to Eddie Sissions and all of the members of the AzPHA Public Policy Committee for their work tracking and advocating for and against bills this session.  Thank You!

Access to Care

Emergency Dental Care

The biggest public health win came inside the Budget.  Arizona will shortly be providing all of the matching funds needed to ensure that all adult Medicaid members have access to emergency dental services (up to a cap of $1,000 per person per year).  Adult Medicaid members that are members of AHCCCS' Arizona Long Term Care System had emergency dental services restored last year, so this year's action fills the last gap in dental emergency care for adults.  Kids that have their insurance through AHCCCS have comprehensive dental coverage that includes preventative services. 

Primary Care Loan Repayment

The state budget authorized an additional $350K per year to go into the state's loan repayment program, bringing the total funds to $1M per year... which will potentially qualify Arizona for up to an additional $1M in federal funds.  These new resources are timed perfectly to take advantage of the revamping of the program over the last few years.  In a nutshell, this program gives primary care and other front line health practitioners an opportunity to get significant relief for their student loan debt by practicing in rural and underserved AZ.

Newborn Screening

The state budget includes a measure allowing the Arizona Department of Health Services to increase their newborn screening fees by $6 per test so the AZ State Lab can afford to test babies for Severe Combined Immune Deficiency syndrome.  Babies born with Severe Combined Immunodeficiency look normal at birth but they can’t fight infections. They often die before 1 year of age without medical treatment.  But if SCID is caught at birth (before the onset of infection) a bone marrow transplant can successfully treat the disorder.  It’s especially important to test for SCID in Arizona because the disorder is much more common in certain populations in Arizona: 1/2,000 among Navajo’s and Apache’s and about 1/20,000 among Latinos.

Clarifying Certified Registered Nurse Anesthetist Practice

Nurse anesthetists are a kind of registered nurse who is skilled in the administration of anesthesia and pain management.  They are a key practitioner all across Arizona, especially in rural areas.  Some disconnects with respect to the supervision of nurse anesthetists and prescribing and administration authority had been causing access to care problems especially in rural AZ.

In a nutshell, SB 1336 outlines medication orders and prescribing authority for nurse anesthetists and makes it clear that a physician isn't liable for anesthetic administration by a nurse anesthetist.  It also modifies the definition of "presence" (relating to supervision) of these folks, and outlines medication orders and prescribing authority.  This new law got through the process with some hard work and compromise by folks who kept their eye on the access to care ball in AZ.

Outpatient Occupational Therapy for Adult Medicaid Members

AHCCCS currently provides coverage for occupational therapy services in an inpatient hospital setting to all of their members (when medically necessary), for outpatient members under 21, and for adults that are enrolled in the Arizona Long Term Care System portion of AHCCCS.  The state budget funds AHCCCS so that it can start providing coverage for occupational therapy as an outpatient health service for all their enrollees (when it's medically necessary).

Involuntary Commitment Procedures

Existing state law has procedures for civil commitment of a person for mental health treatment if a court finds enough evidence that the person (as a result of mental disorder), is a danger to self or others, or has a disability in need of treatment but won't or can't accept voluntary treatment.  The court can then order the patient to undergo treatment.

Last year, the State Supreme Court amended the rules for enforcement of Tribal Court Involuntary Commitment Orders to allow the enforcement of tribal court orders upon the acceptance by the clerk of the filing of the tribal court order rather than upon the certification of the order.  In other words- some tribal members had delays in getting treatment because of the new rules. 

HB2084 will allow a mental treatment facility to admit a patient for involuntary treatment for a mental health disorder pending the filing of a tribal courts involuntary commitment order, providing a mechanism for a more smooth access to care- especially for tribal members. 

Tools for Schools

Asthma Management

Schools will be better able to help kids with asthma to manage their symptoms next school year thanks to the passage of HB 2208.  It will let trained school staff to administer (or help administer) an inhaler for a student in respiratory distress.   The new law also outlines the training required and provides immunity from civil liability (lawsuits).

The old statute allowed kids to have & use inhalers if it was prescribed by a doctor and the school had an annual written documentation from the parent or guardian authorizing the student to have and self-administer their inhaler.  The new law will let trained school district and charter school staff to help the child to use their inhaler. 

UA's Western Region Public Health Training Center has Stock Albuterol Inhaler Training for School Personnel available on their website already... and the e-learning course provides the training needed for schools to implement this new law. 

Sunscreen Use at Schools & Camps

Schools, parents and kids will be better able to protect children from damaging UV rays as a result of the passage of HB 2134 which will make it clear that kids can take and use sunscreen at school and camps... and that school, preschool and camp staff can help them put it on. 

Why was this needed, you ask?  The FDA regulates sunscreen as an over-the-counter drug.  School districts set their own policies concerning the administration of "medication" (including over the counter sunscreen) to kids.  Some school districts and camps prohibit the administration of "over-the-counter drugs" (e.g. sunscreen) unless a parent provides written consent and an order from a physician.  This new law will make it clear for schools, camps, and day cares that it's OK for kids to have and use sunscreen.  It'll also give schools, camps and day cares protection from lawsuits.

Injury Prevention

Distracted Driving

Arizona will shortly join the 47 other states that have laws on the books restricting the use of smart phones while driving.  SB 1080 will ban brand-new teen drivers from using their smart phone while driving for the first 6 months of their license (if they're under 18).  Using the phone in an emergency will still be OK.  Tickets can only be issued if the driver committed another violation.  The new law allows sound only smart phone functions under specified conditions.  Prior to this, the only other limitation in AZ to this kind of distraction was for school bus drivers. 

Drug Overdose & Poisoning Prevention

HB 2493 sets up a drug overdose review team at the ADHS (much like the child fatality review team).  It'll be a 21-member consisting of nine heads of various government entities (or their designees) and 12 members appointed by the ADHS Director to:

  • Develop a data collection system regarding drug overdoses;
  • Conduct an annual analysis relating to drug overdose fatalities;
  • Develop standards and protocols;
  • Provide training and technical assistance to local Teams;
  • Develop investigation protocols for law enforcement and the medical community;
  • Study state and local laws, training and services in order to recommend policies to decrease drug overdose fatalities; and
  • Educate the public regarding drug overdose fatalities.

Looks like a good opportunity to get some better surveillance, standards, protocols, and explore new laws that could help with the ongoing opioid painkiller epidemic.

Safety Net


HB2091 was passed at the very end of the Session and will (assuming it's signed) remove the requirement that SNAP (food stamp) recipients file fingerprints prior to becoming eligible for benefits.  This had been a barrier for seniors to participate in the program because of perceived stigma.

HB2372 was also passed in the waning minutes of the Session and (if signed) will extend the Temporary Assistance for Needy Families program to 2 years lifetime participation from the current 1 year.

New Laws Posing Public Health Challenges

Changes to the Voter Initiative Process

Many of the bold moves to improve public health policy have come via the citizens initiative process that's written into Arizona's constitution.  A few examples are the Smoke Free Arizona Act; the Tobacco, Revenue, Use, Spending and Tracking Commission (Proposition 303 from 2002) for tobacco education and prevention; First Things First; and Proposition 204 from 2000 which extended Medicaid eligibility to 100% of federal poverty for childless adults and creating the AZ Area Health Education Centers.  Future citizens initiatives geared to improve public health will be more difficult to get on the Arizona ballot as a result of the passage of 2 new laws:  HB 2404 & HB 2244.

  • HB 2404 prevents signature gatherers from getting paid by the signature (for voter initiatives), making it more difficult to provide the work incentive needed for gatherers to be efficient.  This will make it more difficult to get the large number of signatures that are needed to get citizens initiatives on the ballot in the future.
  • House Bill 2244 changes the citizens initiative compliance standard to "strict compliance" with all of the requirements regarding the entire process of getting on the ballot.  The previous criteria meant that citizens initiatives needed to be in "substantial compliance" with the requirements.  This new law does require the Secretary of State generate a rule handbook with the requirements. 

A group of folks will be organizing to collect 75,000 signatures by August 12 in an effort to keep these new laws on hold (called a Referendum) until the voters of Arizona have an opportunity to weigh in during the November 2018 election.  We'll stay in touch with the groups organizing this effort and we'll keep our AzPHA members informed regarding how they can participate in the signature gathering process.

Family Planning

One component of the state budget requires the Arizona Department of Health Services to apply to become the Title X family planning grantee in Arizona. Federal Title X funds provide about $5M in family planning resources statewide.  When I was the ADHS Director we never applied to be the Title X grantee because the Arizona Family Health Partnership (an Arizona nonprofit) did such a good job administering the grant.

The challenge that this new law poses is that if ADHS is successful becoming the Title X grantee, they'dbe prohibited by state law (ARS 35-196.05) from contracting with Planned Parenthood of Arizona to provide the family planning services- and many many Arizonans rely on Planned Parenthood a their access point for family planning.

Missed Opportunities

There were several missed opportunities to improve public health that were proposed but failed to get through the legislative process:

  • Voluntary Certification for Community Health Workers
  • Comprehensive oral health coverage for pregnant Medicaid members
  • Requirements for recess time for physical activity in schools
  • Requirement for hospitals to offer influenza vaccines to seniors in hospitals
  • Regulation of tanning bed studios
  • Changing the age at which folks can but tobacco products and e-cigarettes to 21 from 18

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Note: according to state law, most of these changes won't come into effect until 90 days after the end of the legislative session- which is in mid August.  

I'll be doing a webinar at 12 noon on May 25 summarizing this year's legislative session.  Tiffany has sent out a couple of notices inviting people to register- and we'll send out a couple more.

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Our Public Policy Committee will continue to meet over the phone on an ad-hoc basis the rest of the year to talk about policy at the federal level and issues that may relate to AHCCCS waiver requests.  We will also be following efforts to collect signatures to suspend implementation of the voter initiative laws until voters have an opportunity to approve or deny the laws at the ballot box in November 2018.  Our materials will continue to be posted on Basecamp.  For information about participating in the committee activities contact tiffany@azpha.org

Weekly AzPHA Public Health Policy Committee

From all indications, it looks like this year's legislative session is about to wrap. Most of the bills besides the budget bill have been through the legislative process and either have been passed and signed or have died. The last bolus of work is to pass and sign a state budget for the next fiscal year.  That will happen in the next few days- maybe even before the end of the week.  

We're still hopeful that the budget will include funding for adult emergency dental services for all Medicaid members. Right now kids that have their insurance through AHCCCS get comprehensive dental coverage- which is a good thing.  

Adult Medicaid members that are part of the Arizona Long Term Care System have coverage for emergency dental treatment up to $1,000 per year, but other adult Medicaid members don't have any dental care coverage- which leads to poor oral health outcomes.  We're crossing our fingers that the financial match will be provided for this in the final state budget.

Here's a summary of where we are with the various bills that relate to public health this legislative session:

Good New Public Health Laws

Asthma Management

HB 2208 was passed and signed a few weeks ago.  Once it becomes effective later this summer, it will authorize trained school districts and charter schools to administer (or help administer) an inhaler for a student in respiratory distress.   The new law also outlines the training required and provides immunity from civil liability (lawsuits).

The old statute allowed kids to have & use inhalers if it was prescribed by a doctor and the school had an annual written documentation from the parent or guardian authorizing the student to have and self-administer their inhaler.  The new law will let trained school district and charter school staff to help the child to use their inhaler.  The new law will also protect the school from lawsuits.

Lucky for Arizona, we're ready to implement this already thanks to AzPHA members Dr. Lynn Gerald at the UA's Mel and Enid Zuckerman College of Public Health and Dr. Doug Taren at the UA's WesternRegion Public Health Training Center. The Training Center has Stock Albuterol Inhaler Training for School Personnel available on their website already.  

The e-learning course provides the training needed for schools to implement this new law.  Thank you Dr.'s Gerald & Taren for your leadership in this area of public health!

Sunscreen Use at Schools & Camps

HB 2134 will become law 90 days after the end of the legislative session. It'll  make it clear that kids can take and use sunscreen at school and camps... and that school, pre-school and camp staff can help them put it on. 

Why was this needed, you ask?  Well, the FDA regulates sunscreen as an over-the-counter drug.  School districts set their own policies concerning the administration of "medication" (including over the counter sunscreen) to kids.  Some school districts and camps prohibit the administration of "over-the-counter drugs" (e.g. sunscreen) unless a parent provides written consent and an order from a physician.  
 
This new law will make it clear for schools, camps, and day cares that it's OK for kids to have and use sunscreen.  It'll also give schools, camps and day cares protection from lawsuits.  Hooray.

Involuntary Commitment Procedures

The Governor signed HB2084 which will allow a mental treatment facility to admit a patient for involuntary treatment for a mental health disorder pending the filing of a tribal courts involuntary commitment order.  We advocated for this bill because it provides a mechanism for a more smooth access to care- especially for tribal members.  Now that it's been signed, it'll become law 90 days after the legislative session ends.

State law already has requirements and procedures for civil commitment if a court finds enough evidence that the person (as a result of mental disorder), is a danger to self or others, or has a disability in need of treatment but won't or can't accept voluntary treatment.  The court can then order the patient to undergo treatment.

Currently, an order from an Arizona tribal court is recognized by the other courts in AZ and enforceable by any court of record in this state, subject to the same procedures, defenses and proceedings for reopening, vacating or staying as a judgment of the court. 

Current statute says a patient committed to a state mental health treatment facility by a tribal court order is subject to state jurisdiction.  Last year, the State Supreme Court amended the rules for enforcement of Tribal Court Involuntary Commitment Orders, to allow the enforcement of tribal court orders upon the acceptance by the clerk of the filing of the tribal court order rather than upon the certification of the order.  In other words- some tribal members had delays in getting treatment because of the new rules. 

This new law will fix that delay in treatment, which is a good thing for public health we think.

Nurse Anesthetists  

SB 1336 was passed and signed a couple of weeks ago.  In a nutshell, the new law outlines medication orders and prescribing authority for nurse anesthetists and ill make it clear that a physician isn't liable for anesthetic administration by a nurse anesthetist.  It also modifies the definition of "presence" (relating to supervision), and outlines medication orders and prescribing authority for a nurse anesthetis.  

AzPHAsupported this Bill and submitted information to the committee providing information about how this bill would be good for access to care in rural AZ- which had been facing challenges as a result of the existing laws.

Teen Texting & Driving

SB 1080 was signed by the Governor last week and will ban brand-new teen drivers from using their smart phone for the first 6 months of their license - if they're under 18.  Using the phone in an emergency will still be OK.  Tickets can only be issued if the driver committed another violation.  It allows anaudible tool like Mapquest under specified conditions.

The only other limitation in AZ to this kind of distraction is for school bus drivers.  Arizona will now join 48 other states that restrict smart phone use!

Drug Overdose Review Team

HB 2493, which sets up a drug overdose review team at the ADHS (much like the child fatality review team) will also become law later this summer.  The new law sets up a21-member consisting of nine heads of various government entities (or their designees) and 12 members appointed by the ADHS Director.

The Mission for the Team is to:

  • Develop a data collection system;
  • Conduct an annual analysis relating to drug overdose fatalities from the preceding year;
  • Aid in the development of local Teams;
  • Develop standards and protocols;
  • Provide training and technical assistance to local Teams;
  • Develop investigation protocols for law enforcement and the medical community;
  • Study state and local laws, training and services in order to determine if changes are needed to decrease drug overdose fatalities and, as appropriate, take steps to implement these changes; and
  • Educate the public regarding drug overdose fatalities.

Looks like a good opportunity to get some better surveillance, standards, protocols, and explore new laws that could help with the ongoing opioid painkiller epidemic.

Good Public Health Bills Not Yet Passed

Emergency Dental Coverage for Medicaid Members

We're still hopeful that the budget will include funding for adult emergency dental services for all Medicaid (AHCCCS) members. Right kids that have their insurance through AHCCCS get comprehensive dental coverage- which is a good thing. 

Adult Medicaid members that are part of the Arizona Long Term Case System have coverage for emergency dental treatment up to $1,000 per year, but other adult Medicaid members don't have any dental care coverage at all- which has led to all sorts of bad oral health outcomes among adult Medicaid members (they had emergency dental coverage before the Recession- but that funding was a casualty of the recession).  We're crossing our fingers that the financial match will be provided for this in the final state budget.

Newborn Screening for SCID

SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests passed through the Senate and the was unanimously approved by the House Health Committee. 

Babies born with Severe Combined Immunodeficiency look normal at birth but they can’t fight infections. They often die before 1 year of age without medical treatment, but if caught at birth,  before the onset of infection, a bone marrow transplant can successfully treat the disorder.  It’s particularly important to test for SCID in Arizona because the disorder is much more common in certain populations in Arizona: 1/2,000 among Navajo’s and Apache’s and about 1/20,000 among Latinos. 

Bills Good for Public Health that Died

Community Health Workers

Sadly, HB 2426, which would have set up a pathway for Community Health Workers in AZ, appears to be dead for this year.  Had it passed, it would have set up a pathway for Community Health Workers in AZ to voluntarily become certified... which would be a big step forward for this important health profession.  It would have  expanded  the use of CHWs in Arizona’s healthcare system in part by making it easier to get reimbursement for their services.

The Arizona Community Health Workers Association did a great job of organizing and is in a solid position to keep the momentum going next legislative session.  

Influenza Vaccines in Hospitals

HB 2090 which would have required hospitals to offer influenza vaccines to seniors during the cold and flu months appears dead for whatever reason.  It would've provided an additional access point for getting a flu vaccine among a high risk population- but alas- it won't become law this year (although hospitals could of course elect to offer the vaccines if they want).

Physical Activity

HB 2082, which would have required that schools have some recess time went down in flames.  To be honest, I think it would have passed but didn'tbecause of a heated remark made by the Bill's sponsor made on social media about the school voucher bill that the Governor signed.  Here's the story about it in the AZ Republic.   Lesson: relationships are important.

Tanning Beds

HB 2194 which would have prohibited kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free is effectively dead for this year, again. 

Bills Bad for Public Health that Luckily Died

Traffic Safety Cameras

Let's face it. Getting a ticket in the mail for speeding or running a red light is no fun.  But evidence suggests that photo enforcement of red lights is an effective public health intervention, which is why we advocated against HB2525.  It would have banned traffic safety cameras in AZ.  While it passed out of the House, it stalled and died in the Senate. 

It's sure to be back next year.  My advice to some towns that are over-using photo enforcement is to tone it down- or you'll end up ruining it for everybody.

Weekly AzPHA Public Health Policy Committee Update

AHCCCS Waiver Request

AHCCCS received several hundred comments regarding their proposed waiver request as required by Senate Bill 1092.  The law requires AHCCCS to annually apply the Centers for Medicare and Medicaid Services (CMS) for an Amendment to their Demonstration Waiver that would implement the following requirements for “able-bodied adults” receiving Medicaid services:

  • Limit lifetime AHCCCS coverage for all able-bodied adults to 5 years except for certain circumstances.
  • Require all able-bodied adults to become employed or actively seeking employment or attend school or a job training program and require them to verify on a monthly basis compliance with the work requirements and any changes in family income.
  • Ban eligible persons from enrolling in AHCCCS for 1 year if the person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements.

AzPHA submitted our response letter on the waiver application back in February.  Several hundred people and organizations turned also in comments regarding the waiver request.  More than 90% of the commenters expressed concerns about the various items in the waiver including the 5 year limitation on benefits, monthly income reporting and other proposed requirements.  Five percent (5%) of the commenters expressed support for the waiver request.

Here are links to the: 

CMS will now consider whether or not to approve the request (CMS has the final say regarding whether to approve any or all of the pieces of the waiver).  My guess is that the discussions will be on-going between CMS and AHCCCS this Summer.  

CMS denied a similar request last year, but for obvious reasons many of us in the public health world are concerned that this year's request may be approved - given the changes in leadership at CMS in the last few months.

State Legislative Update

Activity at the Arizona State legislature is pretty much just focused on the development of a budget for the next fiscal year.  We're still hopeful that the budget will include funding for adult emergency dental services for all Medicaid (AHCCCS) members; authorization to raise the fees needed to add Severe Combined Immune Deficiency (SCID) to Arizona’s Newborn Screening Panel; added funds for state’s loan repayment program which would enable the state to qualify for a full $1M in matching funds.

Nurse Anesthetists  

SB 1336 was passed and signed last week, clarifying the scope of practice for nurse anesthetists.  We've been in support of the bill because it will be good for access to care in rural AZ.  Hospitals have had increasing difficulty recruiting physicians due in part to a lack of clarity in Arizona law that leads doctors to believe they’ll be held liable for the work of  nurse anesthetists. At a time when we already face a shortage of nurses and physicians – particularly in rural and underserved communities, our focus should be eliminating red tape and empowering these health care professionals to do their jobs 

Teen Texting & Driving

SB 1080, which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license - if they're under 18) continued it comeback last week.  It passed through the House Rules Committee and the full House and is headed back to the Senate for a final approval before going to the Governor for consideration.

Natural Experiment Shows AZ did the Right thing by Expanding Medicaid

Between 2012 and today the US has been conducting a natural experiment on herself.  The US Supreme Court ruling on the Affordable Care Act allowed states to decide whether or not to expand Medicaid to 133% of federal poverty.  Some stated did it and some didn't....  so we have a kind of case control study.  Now that it's been several years, let's look at the data and see who made the better decision.  

The Kaiser Family Foundation recently conducted a comprehensive review of the scientific literature and found that states that expanded Medicaid under the ACA had did better than their peers that didn't expand.  In a nutshell, the report found that the states that expanded Medicaid improved healthcare insurance coverage, access to care, utilization, and health care affordability.  Interestingly (for me at least) was the fact that states that expanded had better economic outcomes than those that didn't... including positive effects on state budgets, employment and the labor market.

Additionally, a New Health Affairs article found that there were no significant increases in spending from state funds as a result of expanding Medicaid (in the states that expanded).  The Health Affairs study found that "... expansion states did not experience any significant increase in state-funded expenditures, and there is no evidence that expansion crowded out funding for other state priorities."  

Statistically, states that expanded Medicaid had budget savings, revenue gains, and higher overall economic growth when compared to their peers that didn't expand Medicaid.  Studies also found that expansion states had lower Medicaid spending per enrollee for the new ACA adult eligibility group compared to per-enrollee spending across all groups.

Medicaid expansion resulted in health insurance coverage gains among the low-income folks including specific vulnerable populations.   Most research found that Medicaid expansion improved access to care, utilization of services, the affordability of care, and financial security among the low-income population (just as you'd expect). 

The report is really well referenced.  It's a great resource for folks looking for a one stop shop for data on the impact that Medicaid expansion has had over the last few years.  

Above all, it's great information for policy makers as it provides objective evidence regarding the impact that Medicaid expansion had in states that expanded v those that chose not to expand.

Take a look and bookmark these two studies.

Weekly AzPHA Public Health Policy Committee Update

The big news this week is really about the changes to the voter initiative that were passed and signed last week.  The reason why we consider these bills as laws that impact public health is that the voter initiative process is sometimes the only real vehicle to get through policy based public health interventions.  

For example, the Smoke Free Arizona Act was passed by Initiative in 2006.  Prior to that, there had been no traction in the legislature to pass a statewide smoke free law.  Another really important voter initiative that had a big impact on public health (access to care) was Proposition 204 about a dozen years ago- which brought Arizona's Medicaid eligibility threshold up to 100% of federal poverty.  Without that pre-existing intervention- it would have been much harder to expand Medicaid eligibility back in 2013.  

Here's a summary of what's been happening to the voter initiative process lately:

  • Last week, the Governor signed into law HB 2404 which will prevent signature gatherers from getting paid by the signature (for voter initiatives- not for candidate signatures).  This will make it more difficult to get the large number of signatures that are needed to get citizens initiatives on the ballot in the future.
  • The Governor also signed House Bill 2244 over the weekend, which will change the compliance standard for voter initiatives to "strict compliance" with standards from the previous (judicially determined) "substantial compliance".  It also requires that the Secretary of State generate a rule handbook with the requirements.  This new law will make it harder to get initiatives on the ballot (including future initiatives with public health policy implications).
  • Senate Bill 1236 is almost completely through the legislative process but hasn't been totally signed off on yet as it hasn't had a final vote yet in the Senate (it passed the House last week).  It's complicated- but it basically puts in a series of regulations regarding who can be a petition circulator (e.g. no felony convictions) and the regulates how they keep and submit their records plus alot more.  Here's the latest Fact Sheet on the latest amended version. 

Teen Texting & Driving

SB 1080, which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license - if they're under 18) came back to life last week!  It had been looking good until it hit a roadblock in the House Rules Committee- as Rep. Phil Lovas had decided that he wasn't going to hear it in committe.  But last week, he accepted a job in the Trump administration and the new Rules chair (Rep. Mesnard) put it on the agenda today (Monday 4/17) at 1 pm in HHR1.  

We've signed in support and I've sent this NHTSA summary document to the members that shows that teens are the largest age group reported as distracted at the time of fatal crashes and have the highest prevalence of cell phone use while driving.  One of the nice things about SB 1080 is that the bill hits the mark on the highest risk population - and at a time when their driving habits are developing.

Physical Activity

HB 2082 is in trouble I think.  It would have required that schools have some recess time to help them get some physical activity.   To be honest, I'm a little worried about this one now because of a heated remark made by the sponsor on social media about the school voucher bill that the Governor signed.  Here's the story about it in the AZ Republic.   Sometimes things like this can derail bills. Lesson: relationships are important.

Nurse Anesthetists  

SB 1336 is waiting for the "Final Read" in the Senate.  Still looking OK though.  AzPHA is in support and submitted information to the committee talking about how this bill would be good for access to care in rural AZ.

Newborn Screening for SCID

SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests still needs House Rules Committee approval, but isn't on the agenda again this week.  We have no reason to believe that it's in trouble.  

There are only 3 states left that don't test for it or don't have plans in place to test for it (including AZ), and with Arizona having so many high risk folks (American Indians of Askabathan descent) we clearly need to get this done.  Like I said though, no signs of trouble.

Sunscreen Use

HB 2134 would make it clear that kids can take sunscreen to school and camps... and that school and camp staff can help them put it on.  It's basically in the process of getting concurrence between the Senate and House versions. No sign of trouble really.

Drug Overdose Review Team

HB 2493 would set up a drug overdose review team at the ADHS (much like the child fatality review team).  It  passed the Senate Health & Human Services Committee last week but still needs to get through the Committee as a Whole and then the full Senate, but it will need to go back to the House because it was amended slightly to clarify an issue related to naloxone administration (a rescue drug for opioid poisoning).  No signs of trouble, really.

Arizona Budget

Not much public news about the AZ budget this week....  but when the tumblers click - they click fast!   

We're in support of proposals in the (executive) budget to: 

1) fund adult emergency dental services for all Medicaid (AHCCCS) members - up to $1,000 annually (this had been a benefit prior to the Great Recession); 

2) add Severe Combined Immune Deficiency (SCID) to Arizona’s Newborn Screening Panel;  and 

3) increase funding to the state’s loan repayment program by $350K (potentially allowing the state to qualify for a full $1M in matching funds from HRSA).   

We believe that these are all important proposals that will improve public health in Arizona. Our Public Policy Committee will be paying close attention to the budget process and will advocate for these important initiatives.

Weekly AzPHA Public Health Policy Committee Update

Teen Texting & Driving

SB 1080, which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license - if they're under 18).  It passed the Senate and passed the House Transportation and Infrastructure Committee on March 1 but has been stuck in the House Rules Committee ever since.  There was a public statement in the Capitol Times by the Committee Chair (Rep. Phil Lovas) that he doesn't intend to hear the bill in the House Rules Committee (which would kill the bill).  

Through my years in public health I've always been sensitive to make sure that our policies and interventions are careful not to infringe on civil liberties.  It's pretty clear to me that this proposal would improve public safety by imposing a reasonable behavior expectation for new drivers. The only other limitation in AZ to this kind of distraction is for school bus drivers- this seems like a modest bill that will help set a good expectation for new drivers.  We're encouraging AzPHA members that live in Rep. Lovas' district to reach out and encourage him to hear the bill in the House Rules committee.  I sent a note to him and other committee members last week and will do another one this week. 

Physical Activity

HB 2082 which would enhance recess time in Arizona is looking good but still has a ways to go.  It passed its hearing in the Senate Education Committee (but was amended to eliminate the 50 minute per day requirement).  The Bill was heard in Senate Rules on 3/27 but still needs to go back to the House since it was amended to just require the recess period without the 50 minute time requirement.

Nurse Anesthetists  

SB 1336 passed the Senate last week and, after a compromise amendment, passed through the House Health and Rules Committee but still awaits a floor vote in the House.  AzPHA is in support and submitted information to the committee talking about how this bill would be good for access to care in rural AZ.

Newborn Screening for SCID

SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests passed through the Senate and the was unanimously approved by the House Health Committee.  It still needs House Rules Committee approval and then would go to a house floor vote.  It wasn't on the Agenda for today's House Rules Committee.  We haven't heard that there is any trouble with the bill, but we're keeping our ears to the ground.  

Sunscreen Use

HB 2134 would make it clear that kids can take sunscreen to school and camps... and that school and camp staff can help them put it on.  It passed the full Senate last week but was transmitted back to the house on 4/4/17 because it was amended in the Senate.  No sign of trouble really.

Drug Overdose Review Team

HB 2493 would set up a drug overdose review team at the ADHS (much like the child fatality review team).  It  passed the Senate Health & Human Services Committee last week but still needs to get through the Committee as a Whole and then the full Senate, but it will need to go back to the House because it was amended slightly to clarify an issue related to naloxone administration (a rescue drug for opioid poisoning).

Arizona Budget

Not much public news about the AZ budget this week.  Much of the work happens behind closed doors in meetings among folks that are appointed to important positions in the Executive Branch and members of the legislature- especially those in the Appropriations Committees.

We're in support of proposals in the (executive) budget to: 1) fund adult emergency dental services for all Medicaid (AHCCCS) members - up to $1,000 annually (this had been a benefit prior to the Great Recession); 2) add Severe Combined Immune Deficiency (SCID) to Arizona’s Newborn Screening Panel;  and 3) increase funding to the state’s loan repayment program by $350K (potentially allowing the state to qualify for a full $1M in matching funds from HRSA).   

We believe that these are all important proposals that will improve public health in Arizona. Our Public Policy Committee will be paying close attention to the budget process and will advocate for these important initiatives.

Trump Administration Budget Proposal & Call to Action

A few weeks ago the President submitted his FY 2018 budget blueprint.  If the proposal were approved as-is, it would have a significant impact on public health resources in Arizona.  The proposal calls for cutting more than $15 billion from the Department of Health and Human Services (HHS) which is an 18% decrease from 2017 levels.  Many of the Agencies that provide grant funds to Arizona's public health system are located in HHS.

While the budget doesn't provide specific funding levels for the Centers for Disease Control and Prevention (CDC) or the Health Resources and Services Administration (HRSA), spending reductions of this magnitude would certainly force significant cuts to many if not all public health programs if the proposal moves forward as it stands.  The proposed budget also would cut 31% from the Environmental Protection Agency's current budget- which could have implications for clean air/water/waste assurance.

The APHA issued a statement opposing the budget proposal and also issued a statement opposing proposed cuts to FY 2017 public health and prevention programs.  APHA-led coalitions, the Friends of HRSA and the CDC Coalition, sent letters to House and Senate Labor-HHS-Education appropriations subcommittee leaders urging support for adequate funding for HRSA and CDC in the FY 2018 appropriations process. 

We're encouraging AzPHA members to send a message to their members of Congress opposing the proposed budget cuts by visiting APHA’s action alerts page.

Weekly AzPHA Public Health Policy Committee Update

Not much has changed with respect to individual health-related bills since last week...  with a couple of exceptions, so you can read last week's update for the most part to find out where things stand.  The Governor did sign a couple of health-related bills last week- so I'll touch on those and then transition to the state budget.

Involuntary Commitment Procedures

The Governor signed HB2084 which will allow a mental treatment facility to admit a patient for involuntary treatment pending the filing of a tribal courts involuntary commitment order.  We advocated for this bill because it provides a mechanism for a more smooth access to care- especially for tribal members.  Now that it's been signed, it'll become law 90 days after the legislative session ends.

Deliveries

The Governor also signed  SB 1367 (abortion; live delivery; report; definition).  It'll become law 90 days after the end of session as well.  Under already existing law, when a baby is "delivered alive" during an abortion, doctors are required to ensure that "all available means and medical skills are used to promote, preserve and maintain the life" of the baby.  But, the existing law didn't specifically provide a definition of the words "delivered alive" leaving room for professional judgment.  The bill that was just signed specifically defines "delivered alive" as showing one or more of these signs of life: breathing, a heartbeat, umbilical cord pulsation or definite movement of voluntary muscles.

Now that it will become law later this year, the Arizona Department of Health Services will be required to set policies that clinics, hospitals and physicians will need to follow to care during a procedure or delivery thatfits the new definition of "delivered alive".  The requirements will include having neonatal emergency equipment and trained staff in the room for all abortions performed at or after 20 weeks of pregnancy.  Many people expressed concerns that it will require doctors to perform unproductive medical procedures on a fetus born early because of fatal abnormalities.  Healthcare providers represented by the Arizona Medical Association and the AZ Chapter of American College of Obstetrics and Gynecology also expressed these concerns. 

State Budget

Each year the Governor of AZ submits a proposed budget for all the activities of state government including the operation of all the state agencies.  The budget process and outcome is is always very important in terms of public health- because so much of the budget directly and indirectly impacts things that influence public health.

Much of the real action on the budget happens behind closed doors in meetings among folks that are appointed to important positions in the Executive Branch and members of the legislature- especially those in the Appropriations Committees.

AzPHA is in firm support of proposals in the (executive) budget to: 1) appropriate the funding needed to bring back adult emergency dental services among all Medicaid (AHCCCS)  members - up to $1,000 annually (this had been a benefit prior to the Great Recession); 2) add Severe Combined Immune Deficiency (SCID) to Arizona’sNewborn Screening Panel;  and 3) increase funding to the state’s loan repayment program by $350K (potentially allowing the state to qualify for a full $1M in matching funds from HRSA).   

We believe that these are all important proposals that will improve public health in Arizona. Our Public Policy Committee will be paying close attention to the budget process and will advocate for these important initiatives.

Weekly AzPHA Public Health Policy Committee Update

Last week was an important one in terms of public health policy to say the least!

All of you know by now that the American Health Care Act didn't attract enough support in the US House of Representatives to pass (it didn't come to the Floor because the Speaker knew the votes weren't there).  

AHCA would have fundamentally changed the Medicaid funding by switching it to a block grant or per capita cap. AHCCCS has an easy to read 2-page summary of how AHCA would have impacted Medicaid in Arizona.  The proposal also would've eliminated the Prevention and Public Health Fund, a critical resource for protecting Arizonans from dangerous infectious diseases and other crucial public health issues like the opioid poisonings. 

A big THANK YOU to all of our members that reached out to the AZ delegation last week in response to our Action Alert.  Adding your voice as an independent advocate for public health is important!

Nobody really knows what's going to happen in the future regarding prospective efforts to modify or repeal the Affordable Care Act.  Our Public Policy Committee team will continue to be vigilant - and we'll update you here is we hear anything. On to things at the State Legislature:

Health Bills Passed

Asthma Management

HB 2208 will let school staff administer or help a student self-administer an inhaler for things like asthma episodes when it becomes law later this year (under certain circumstances).  It passed both houses & has been signed by the Governor.  Well done Dr. Lynn Gerald at the UA Mel & Enid Zuckerman College of Public Health for informing this debate.

Tribal Courts & Involuntary Commitment

HB2084 which would allow a mental treatment facility to admit a patient for involuntary treatment pending the filing of a tribal courts involuntary commitment order has passed both houses of the legislature and has been sent to the Governor.  Looking good.
 

Health Bills in the Final Stretch

Physical Activity

HB 2082 which would enhance recess time in Arizona is looking good.  It passed its hearing in the Senate Education Committee (but was amended to eliminate the 50 minute per day requirement).  We're pleased that the Bill appears to be headed to the Governor's desk (although it needs to complete the Senate Rules Committee & go back to the House since it was amended).

Nurse Anesthetists  

SB 1336 passed the Senate last week and, after a compromise amendment, passed through the House Health Committee but still awaits the House Rules Committee hearing before going to the House floor.  AzPHA is in support and submitted information to the committee talking about how this bill would be good for access to care in rural AZ.

Newborn Screening for SCID

SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests passed through the Senate and the was unanimously approved by the House Health Committee.  It still needs House Rules Committee approval and then would go to a house floor vote.   

Sunscreen Use

HB 2134 would make it clear that kids can take sunscreen to school and camps... and that school and camp staff can help them put it on.  It passed the Senate Education Committee last week but still needs approval of the Senate Rules Committee before going to a final Senate floor vote.

Drug Overdose Review Team

HB 2493 would set up a drug overdose review team at the ADHS (much like the child fatality review team).  It  passed the Senate Health & Human Services Committee last week but still needs the Rules Committee hearing before a final vote of the Senate. 

Teen Texting & Driving

SB 1080 would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license (if they're under 18).  It passed the Senate and passed the House Transportation and Infrastructure Committee on March 1.   Still waiting for the Rules Committee hearing.

Health Bills that look Dead for Now

Influenza Vaccines in Hospitals

HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months was assigned to Senate Health and Human Services Committee.  No hearing date is set yet… so this one is on a pretty short leash right now. 

Traffic Safety Camera Prohibition

HB2525 passed the House last week but was never heard in the Senate Transportation and Technology Committee, so it's effectively dead for this year (for now).   

Tanning Beds

HB 2194 which would have prohibited kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free is effectively dead for this year.  

On to the Budget...

Now that most of the House and Senate work on bills is winding up- full attention will turn to the budget negotiations.  We'll focus some time on next week's update on the budget and our related public health priorities- like restoring adult emergency dental as a benefit under Medicaid.  

If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org and she’ll get you on our list.  We have a weekly call every Monday at11 am and someone from the committee is always down at the Legislature for key hearings.

Video | American Health Act - federal Medicaid payment reform: implications for states

AzCRH Director and AzPHA member , Dan Derksen, MD, discusses the American Health Care Act and its implications for state Medicaid programs.

The American Health Care Act fundamentally changes the financing of state Medicaid programs. It repeals Title XIX of the Social Security Act’s statutory 50% minimum federal funding of state Medicaid programs. It caps Medicaid funding to states – either as a block grant, or a per person cap.

Currently there are 74 million Americans covered by Medicaid and the Children’s Health Insurance Program (CHIP).Over half of those covered are children. Sixteen million people have been added to Medicaid and CHIP since the first open enrollment period of the Affordable Care Act in October of 2013. Eleven million were added in the 31 states expanding Medicaid. 

» Download PDF

» Watch video at link & learn more:  https://vimeo.com/209444118

Weekly AzPHA Public Policy Committee Update

We're at a critical point in Congress' attempts to repeal the Affordable Care Act.  The current proposed plan (called the American Health Care Act or AHCA) would fundamentally change the Medicaid funding approach by switching it to a block grant or per capita cap. The full House will likely vote on the on the proposed law this Thursday, March 23.  AHCCCS has an easy to read 2-page summary of how AHCA would impact Medicaid in Arizona.  It's worth a look for sure.

Right now about 1.9 million low-income Arizonans have their health insurance through AHCCCS.  About 400,000 Arizonans are included in the main eligibility groups initially affected by the changes proposed by the AHCA.  The proposed law would change the enhanced federal funding for childless adults (with incomes up to 100% FPL) and the expansion population of adults (people with incomes 100-133% FPL).  The AHCA would allow the State to continue claiming enhanced federal matching funds for members who are enrolled as of December 31, 2019 but don't have a break in eligibility (for more than one month).  The bill would also limit federal payments to states to a fixed amount per eligible enrollee starting in FY 2020. 

The law in its current form would also eliminate the Prevention and Public Health Fund, a critical resource for protecting Arizonans from dangerous infectious diseases and other crucial public health issues like the opioid poisonings.

Passage in the House of Representatives is not a foregone conclusion, and your voice is needed now to add to the chorus of folks with concerns about the current proposal.  Please visit the American Public Health Association web tool today to urge your Congressional Representative to revise the plan to allow Arizonans to maintain their healthcare coverage and make coverage, premiums and co-pays affordable for all Arizonans and to protect the Prevention & Public Health Fund.

You can also directly contact your Representatives by calling, emailing, and tweeting them! Join the movement today! 

    Representative Paul Gosar (CD4)

    (928) 445-1683: Prescott | (480) 882-2697: Gold Canyon | (202) 225-2315: DC Office

    http://paulgosar.house.gov/contact/ | Twitter Handle: @RepGosar

    Representative Martha McSally (CD2)

    (520) 881-3588: Tucson | (520) 459-3115: Sierra Vista | (202) 225-2542: DC Office 

    https://mcsally.house.gov/contact | Twitter Handle: @RepMcSally

    Representative Kyrsten Sinema (CD9) 

    (602) 956-2285: Phoenix | (202) 225-9888: DC Office 

    https://sinemaforms.house.gov/forms/writeyourrep/ | Twitter Handle: @RepSinema

    Here’s this week’s summary regarding the action at the State Legislature.  

    Physical Activity

    HB 2082 which would enhance recess time in Arizona is looking good.  It passed its hearing in theSenate Education Committee last week (but was amended to eliminate the 50 minute per day requirement).  It's still an improvement, and we're pleased that the Bill appears to be headed to the Governor's desk (although it needs to go back to the House since it was amended to get rid of the 50 minute per day requirement).

    The data suggest that physical activity during the school day improves cognitive skills and attitudes, enhances concentration and attention, and improves classroom behavior: The Association Between School-based Physical Activity, Including Physical Education, and Academic Performance a few years ago has the data.  

    Community Health Workers

    Sadly, HB 2426, which would have set up a pathway for Community Health Workers in AZ appears to be dead for this year.  It wasn't heard in the Commerce and Public Safety Committee this week, meaning that it's effectively finished for this year.  But- the Arizona Community Health Workers Association did a great job of organizing and is in a solid position to keep the momentum going next legislative session.   

    Asthma Management

    HB 2208 which would (under certain circumstances) let school staff administer or help a student self-administer an inhaler for things like asthma episodes passed the full House awhile back and has now passed the required Senate committees and even both Caucuses.  All good news so far.  

    Nurse Anesthetists

    SB 1336 passed the Senate last week and, after a compromise amendment, passed through the House Health Committee last week.   AzPHA is still in support and also submitted information to the committee talking about how this bill would be good for access to care in rural AZ.

    Newborn Screening for SCID

    SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests passed through the Senate and the was unanimously approved by the House Health Committee.  This one is looking good.

    Traffic Safety Cameras

    HB2525 passed the House last week but was never heard in the Senate Transportation and Technology Committee, so it's effectively dead for this year (for now).   

    Teenage Texting & Driving

    SB 1080 which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license (if they're under 18) passed the Senate and passed the House Transportation and Infrastructure Committee on March 1.   Still waiting for the Rules Committee hearing.

    Sunscreen & Tanning Beds

    HB 2134 which would make it clear that kids can take sunscreen to school and camps... and that school and camp staff can help them put it on will be heard in the Senate Education Committee Wednesday at 9 am.  We're of course signed up in support. 

    HB 2194 which would have prohibited kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free is effectively dead for this year.  

    Drug Overdose Review Team

    HB 2493 which would set up a drug overdose review team at the ADHS (much like the child fatality review team) was assigned to the Senate Health & Human Services Committee.  No hearing date set yet.

    If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org and she’ll get you on our list.  We have a weekly call every Monday at 11 am and someone from the committee is always down at the Legislature for key hearings.

    Weekly AzPHA Public Health Policy Committee Update

    Here’s this week’s summary regarding the action at the State Legislature.  We’re still looking through the information from the congressional budget office regarding the American Health Care Act. 

    Physical Activity

    HB 2082 is a good bill that would require schools to have 50 minutes of unstructured recess per day from K through 5th grade. It passed the House awhile back and is being heard in the Senate Education Committee on Thursday, March 16 at 9 am in Senate Hearing Room 1.  AzPHA is of course supporting it.  We also sent the committee members a letter this week pointing out that the literature suggest that physical activity during the school day improves cognitive skills and attitudes, enhances concentration and attention, and improves classroom behavior.  The data were published by the CDC in a report called The Association Between School-based Physical Activity, Including Physical Education, and Academic Performancea few years ago.  

    Community Health Workers

    HB 2426, which would set up a pathway for Community Health Workers in AZ, passed successfully through the House but faces a tough time in the Senate.  It’s been assigned to the Commerce and Public Safety Committee where it will need to be heard in Committee by Monday, March 20 (the last scheduled Committee meeting before the deadline).  The committee is chaired by Senator Steve Smith of District 11 (Casa Grande, Maricopa, Eloy, Avra Valley).  We sent out an Action Alert this week to our members urging them (especially any that live in District 11) to reach out to Senator Smith (602) 926-5685and urge him to hear the Bill in committee next week.

    Asthma Management

    HB 2208 which would (under certain circumstances) let school staff administer or help a student self-administer an inhaler for things like asthma episodes passed the full House awhile back.  Last week it passed through the Senate Health and Human Services committee.  All good news so far.  On to the Senate floor and ultimately to the Governor for his signature.

    Nurse Anesthetists

    SB 1336 passed the Senate last week and was assigned to the House Health Committee where it will be heard this week (Thursday am at 9 am in HHR 4).  Interestingly, it is the only bill on the House Health Committee agenda this week.  It would basically let nurse anesthetists issue a medication order in the scope of his or her practice.   AzPHA is signed in support and also submitted information to the committee talking about how this bill would be good for access to care in rural AZ.

    Newborn Screening for SCID

    SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests passed through the Senate was unanimously approved by the House Health Committee last week.  This one is looking good.

    Tribal Courts and Involuntary Commitment 

    HB2084 which would allow a mental treatment facility to admit a patient for involuntary treatment pending the filing of a tribal courts involuntary commitment order was assigned to Senate Judiciary Committee and was quickly approved by that committee last week. Looking good.    

    Traffic Safety Cameras

    HB2525 passed the House last week.  It would ban traffic safety cameras in AZ.  We're against this one. It was assigned to the Senate Transportation and Technology Committee.  No hearing set yet.  If it’s not heard in committee by next week this is probably dead (for now).

    Teenage Texting & Driving

    SB 1080 which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license (if they're under 18) passed the Senate and passed the House Transportation and Infrastructure Committee on March 1.   

    Sunscreen & Tanning Beds

    HB 2134 which would make it clear that kids can take sunscreen to school and camps... and that school and camp staff can help them put it on was assigned to the Senate Education Committee. No committee hearing set yet in the Senate.

    HB 2194 - which prohibits kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free was assigned to the Commerce and Public Safety and Health and Human Services Committees.  That's called being "dual assigned" and it's almost always a bad thing for a bill because it will need to pass through both committees unless we can convince the President of the Senate to withdraw it from one of the committees.

    Flu Vaccines at Hospitals

    HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months was assigned to Senate Health and Human Services Committee.  No hearing date is set yet.  All bills need to be heard in the second Chamber by 3/24… so this one is on a pretty short leash right now.  

    Drug Overdose Review Team

    HB 2493 which would set up a drug overdose review team at the ADHS (much like the child fatality review team) was assigned to the Senate Health & Human Services Committee.  No hearing date set yet.

    Voter Initiative Stuff
    Perhaps some of the most troubling bills and resolutions in terms of public health have to do with the voter initiative process.  Many of the real big achievements in public health have been voter initiatives (e.g. Smoke Free Arizona Act).  A couple of the bills that would change how voter initiatives work would require voter approval, but a couple could be approved by the Legislature (with the Governor’s signature).  We're not alone in our opposition to these proposals- lots of people are concerned about them. Here's a quick summary:

    •  HCR2002 & HCR2007 (which would need to be approved by voters to become effective in the 2018 general election) passed the House has been assigned to the Senate Judiciary Committee.  These bills haven’t been scheduled yet but we expect there to be action the week of March 20.  
    • HCR2029 passed the house yet but would require signature gatherers to get a certain number of signatures in each of the 30 legislative districts.  This one would ultimately need to be approved voters in the 2018 general election.  Sent to the Senate but it's not assigned to a committee yet.
    • HB 2404 passed through the House (as amended) and would prevent signature gatherers from getting paid by the signature (for voter initiatives- not for candidate signatures).  This one could become law without voter approval and was assigned to the Senate Judiciary Committee where it’ll be heard on Thursday at 9 am.

    AHCCCS Waiver Comment Period Extended to March 29, 2017.

    Senate Bill 1092 was passed and signed into law in 2015 requiring the AHCCCS to annually apply the CMS for an Amendment to the current AHCCCS Section 1115 Waiver that would implement the following requirements for “able-bodied adults” receiving Medicaid services:

    • Limit lifetime AHCCCS coverage for all able-bodied adults to 5  years except for certain circumstances.
    • Require all able-bodied adults to become employed or actively seeking employment or attend school or a job training program and require them to verify on a monthly basis compliance with the work requirements and any changes in family income.
    • Ban eligible persons from enrolling in AHCCCS for 1 year if the person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements.

    The initial deadline was February 28, however, AHCCCS has extended the deadline to March 29.  AzPHA submitted comments on the Waiver in February.  Here’s a link to the waiver application and our response letter.    We encourage all AzPHA members to look at our response letter and use what you think is useful to turn in your own comment letter to AHCCCS via e-mail to publicinput@azahcccs.gov by March 29.

    If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org and she’ll get you on our list.  We have a weekly call every Monday at 11 am and someone from the committee is always down at the Legislature for key hearings.

    Is the American Health Care Act Good for Arizonans?

    AZPHA has a track record which goes back to decades of advocating for the advancement of public health.  When it comes to achieving that goal, many factors come into play. At the cornerstone is the importance of preventing illnesses and injuries - think of the old saying "a stitch in time saves nine".  

    But prevention (things like vaccines, epidemiology, food safety and security, nutrition, maternal and child health, assurance and licensure, physical activity) isn't enough to improve health outcomes.  Folks need access to healthcare too for both preventive checkups and other care that might be associated with acute or chronic medical conditions.

    That's one of the reasons that we were so pleased when the Affordable Care Act passed a few years ago.  Not only did the law make strides toward providing healthcare to people that didn't have health insurance, but it also implemented interventions and aligned incentives to keep people healthier.  An essential core public health value. 

    I've never been one to believe that there's only one way to improve health outcomes and provide better access to care, but I've always believed that the ACA brought us down the road toward achieving those goals.  

    When Americans voted in the last election, there were clear differences of opinions amongst candidates for various offices about the effectiveness of the ACA.  Now that the election is over, elected officials are in the process of implementing policy decisions related to access to care and public health that could have very real-life consequences. 

    This week the US House of Representatives leadership unveiled their plan to overhaul the US healthcare system and repeal and replace the ACA.  It's called the American Health Care Act. There would be a lot of changes to the US healthcare system if it ultimately passes as-is. It's complicated, but I'll try to hit the high points.  

    For one thing, the bill would repeal the individual mandate that people get health insurance or face a tax penalty.  A main reason that the individual mandate was included in the ACA is to broaden the pool of people buying health insurance- a tool to lower overall costs.  It's unclear how premiums will be kept in check without the mandate.  The proposal mentions the creation of high-risk pools, something that has been tried before but hasn't been successful.

    The bill would offer people "refundable tax credits" to help people buy health insurance rather than the current subsidy system. Current ACA subsidies to buy insurance in the state and federally facilitated ACA marketplaces would end and be replaced by lower advance-able refundable tax credits.  I can't intuitively see how making this kind of change makes buying insurance more affordable- but maybe I'm missing something.   It would generally keep intact the ACA's requirement that health insurance cover people with pre-existing health conditions- but it would let insurers charge higher amounts to people that let their health insurance lapse.  

    Perhaps some of the biggest changes in terms of access to care would be in the Medicaid system- our health care system for low income people. Low income has long been linked to worse health outcomes for a host of reasons- so it's no surprise that many of the health disparities in the US are among people that have their health insurance through the Medicaid system.  

    The American Health Care Act would restructure the Medicaid program so that states get a set amount of money from the US every year, placing a lot more financial risk on the states basically transferring financial risk from the federal government to the states.  Down the road, this would likely result in more stringent enrollment criteria, lower payments to providers, and fewer covered services in states- limiting healthcare among those with the largest health disparities.

    The plan would also repeal the federal funding that helped finance Medicaid expansion up to 138% of the federal poverty limit.  Thirty one states have expanded Medicaid as allowed by the ACA (including AZ of course).  It's unclear what the plan would be to get this group (people between 100 - 138% of federal poverty access to healthcare).  

    The proposal also freezes Medicaid funding to Planned Parenthood for a year.  Thus would limit low income women's access to cancer screening, family planning etc. in many parts of Arizona.  

    Finally, the proposed plan would eliminate the Prevention and Public Health Fund which would have a profound impact on core public health functions at the CDC and in state and county public health programs.  The plan eliminates the fund in FFY 2018, substantially reducing CDC investments in states for things like vaccines, programs to reduce chronic diseases, epidemiology and laboratory capacity.  This would result in an immediate reduction in about $9.3M/year in public health funding in Arizona.  

    Perhaps the most damage would be done to the "317" vaccine program, which would be reduced by 50%. The 317 Immunization Program plays a critical role in achieving national immunization coverage targets and reductions in disease. This critical program supports vaccinations from newborns to seniors.  Hardly a smart idea, since vaccines are the number one and most cost-effective public health intervention of the last 100 years.

    By eliminating these public health investments in evidence-based disease prevention programs states (including Arizona) could also lose critical programs that fight obesity, tobacco, and respond to public health threats like outbreaks of infectious diseases.  

    The Prevention and Public Health Fund represents 12% of CDC funding - so that kind of loss to the agency would inevitably result in lost public health prevention capacity across the country.

    Remember, the proposed American Health Care Act released this week is just that- a proposal.  In order to be implemented, it would need to be approved by our federal elected officials- people that work for us- the American people.  

    To view APHA's stance on the AHCA, please click here

    Let's make sure they're acting in our best interest by asking important questions and adding our public health voice to the debate.  

    Weekly AzPHA Public Health Policy Committee Update

    Today, I thought I'd focus on the mechanics of how folks can track bills, get involved in the process, and sign in to support, oppose, or be neutral on bills. If I can do it, anybody can do it.

    The main URL to bookmark in your computer is http://www.azleg.gov - which is the State Legislature's official website.  It got a major overhaul this year and is a lot easier to work with (at least I think so, but I've heard some groaning from some folks).

    If you have the number for a bill you're interested in following, simply go to the upper right corner of the http://www.azleg.gov website and punch in the numbers. Up pops the bill and including it's recent status, committee assignments and the like.

    You'll see that bills have committee assignments on the Bill Status pages. You can easily check the committee agendas each week on the website too.  Simply go to the "Committee Agenda" and pull up the agenda for the committee you"re interested in.  Most of the bills that we've been following and advocating for or against have been assigned to either the House Health Committee or the Senate Health and Human Services Committee.  Committee assignments for the following week are usually posted on Friday afternoon.

    You can click on each bill and find out who has signed in for or against or neutral too.  Just go to the tab over each bill that says "RTS Current Bill Positions" and you can see who has signed in support or against each bill.  Sometimes you'll see our name up there (AzPHA).  You can even do it yourself from your home or office.

    All you need to do is create an account with an email address and a password and you'll be able to sign in and support or oppose or be neutral on bills.  If you plan to actually be down there and attend the committee hearing, you can request to speak once you sign in, too.  You can create an account using the button at the top of screen where it says "Sign On".  

    It's fun and easy.  Give it a try.  Now for the committee assignments and hearings this week for the bills we're interested in:

    Community Health Workers

    HB 2426 which would set up a pathway for Community Health Workers in AZ to voluntarily become certified (a good thing) got assigned to the Commerce and Public Safety Committee (probably not a good thing). We thought it would go to Health and Human Services.  Thus assignment will cause us to figure out a new strategy.  So, committee hearing for the bill has not been scheduled yet. 

    Asthma Management

    HB 2208 which would (under certain circumstances) let school staff administer or help a student self-administer an inhaler for things like asthma episodes was assigned to Senate Health and Human Services and will be heard onWednesday, March 8 at 2 pm.

    Vaccines

    HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months was assigned to Senate Health and Human Services Committee.  No hearing date is set yet. 

    Sunscreen & Tanning Beds

    HB 2134 which would make it clear that kids can take sunscreen to school and camps... and that school and camp staff can help them put it on was assigned to the Senate Education Committee. No committee hearing set yet.

    HB 2194 - which prohibits kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free was assigned to the Commerce and Public Safety and Health and Human Services Committees.  That's called being "dual assigned" and it's almost always a bad thing for a bill because it will need to pass through both committees unless we can convince the President of the Senate to withdraw it from one of the committees.

    Physical Activity

    HB 2082 which would require all schools to have 50 minutes of unstructured recess per day from K through 5th grade was assigned to the Senate Education Committee.  No hearing set for it yet.  

    Tribal Courts and Involuntary Commitment 

    HB2084 which would allow a mental treatment facility to admit a patient for involuntary treatment pending the filing of a tribal courts involuntary commitment order was assigned to Senate Judiciary Committee and was quickly approved by that committee last week. Looking good.

    Nurse Anesthetists

    SB 1336 passed the Senate last week and was assigned to the House Health Committee.  It would basically let nurse anesthetists issue a medication order in the scope of his or her practice.  No committee hearing scheduled yet.

    Drug Overdose Review Team

    HB 2493 which would set up a drug overdose review team at the ADHS (much like the child fatality review team) was assigned to the Senate Health & Human Services Committee.  No hearing date set yet.

    Traffic Safety Cameras

    HB2525 passed the House last week.  It would ban traffic safety cameras in AZ.  We're against this one. It was assigned to the Senate Transportation and Technology Committee.  No hearing set yet. 

    Teenage Texting & Driving

    SB 1080 which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license if they're under 18) passed on a Senate and was assigned to the House Transportation and Infrastructure Committee.  It was approved on Wednesday, March 1st. 

    Newborn Screening

    SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests passed through the Senate and has been assigned to the House Health Committee.  It's on the House Health Committee agenda this Thursday morning.  This one is looking good.

    Voter Initiative Stuff
    Perhaps some of the most troubling bills and resolutions in terms of public health have to do with the voter initiative process.  Many of the real big achievements in public health have been voter initiatives (e.g. Smoke Free Arizona Act).  A couple of the bills that would change how voter initiatives work would require voter approval, but a couple could be approved by the Legislature (with the Governor’s signature).  We're not alone in our opposition to these proposals- lots of people are concerned about them. Here's a quick summary:

    •  HCR2002 & HCR2007 (which would need to be approved by voters to become effective) passed the House have been assigned to the Senate Judiciary Committee.  No hearing dates set yet. 
    • HCR2029 passed the house yet but would require signature gatherers to get a certain number of signatures in each of the 30 legislative districts.  This one would ultimately need to be approved voters.  Sent to the Senate but it's not assigned to a committee yet.
    • HB 2404 passed through the House (as amended) and would prevent signature gatherers from getting paid by the signature (for voter initiatives- not for candidate signatures).  This one could become law without voter approval nd was assigned to the Senate Judiciary Committee.

    If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org and she’ll get you on our list.  We have a weekly call every Monday at 11 am and someone from the committee is always down at the Legislature for key hearings.

    Let’s Get Ahead of the Family Planning Curve in Arizona

    Unintended pregnancies, especially teen pregnancy and its social consequences, are a significant cause of inter-generational poverty and poor health outcomes. Teen mothers are less likely to finish high school or college, meaning they’re less likely to find well-paying jobs. Unintended pregnancies  also can result in depression, diabetes and obesity in the mother and affect the physical and mental health of the child.

    The bottom line is that the physical, social and economic consequences of unintended teen pregnancies can perpetuate across generations. The Arizona teen pregnancy rate is almost 50% higher than the national value and the need to lower the unintended pregnancy rate is compelling. The question is, what can we do about it?

    Increasing access to Long Acting Reversible Contraceptives (LARCs) is increasingly  recognized as a key tool to reducing unintended teen pregnancies. LARC includes birth control methods like intrauterine devices and implants that last three to 10 years and don’t require user effort daily, weekly or monthly. In fact, LARC is nine times more effective at preventing unintended pregnancies compared to the pill and 18 times more effective than male condoms.

    Despite the effectiveness, LARC utilization remains low in the United States (about 11%) compared with the pill (25%).   Some states, however, have made great strides toward increasing use of this more effective family planning tool.

    Colorado was one of the early adopters of LARC, which were provided at no cost to the low-income population through the state’s Title X-funded family planning clinics.  The Initiative was tremendously successful, resulting in lower-than-expected fertility rates, lower abortion rates, reduced unintended teen pregnancies and decreased high-risk births. The state’s Medicaid program has avoided $79 million in birth-related costs between 2010 and 2012 due to reduced fertility rates, resulting in a return on investment of $5.85 per dollar spent.

    There are other tools Arizona could use to replicate the successes seen in Colorado, including the Medicaid Family Planning Waiver and the Centers for Disease Control and Prevention’s 6|18 Initiative: Accelerating Evidence into Action. 

    Real-world evidence-based stories like Colorado provide a template for strategies that could be used in Arizona. Decreasing teen pregnancy rates will have a significant impact on reducing inter-generational poverty. It’s time for us to work together to overcome the barriers to LARC usage in Arizona. Visit the Center for Population Science and Discovery’s Long Acting Reversible Contraceptives (LARCs): Efficacy & Cost Effectiveness issue brief for all the details!

    Weekly AzPHA Public Health Policy Committee Update

    Good news for the most part on the public health policy front last week.  Many of the bills that we like passed out of the House or Senate on floor votes- and will be getting committee assignments in the other house this week.  Some of the bills we like died in their committee, but you can't win 'em all.  A couple bills that look problematic survived last week. Committee agendas will be lighter this week as bills come over from the opposite house of the legislature to be read and then assigned to committee by the President of the Senate and the Speaker of the House.    

    Health-related Bills 

    Good news on several bills that we supported last week, with most of them getting approved by their house of origin. A couple of bills that would be bad for public health progressed despite our efforts last week,  Here’s a quick summary:

    Community Health Workers

    HB 2426 made it through the full House of Representatives last week by a score of 41-17-2 and will now head to the Senate.  If it makes it all the way, it'll set up a pathway for Community Health Workers in AZ to voluntarily become certified which would be a big step forward for this important health profession...  expanding the use of CHWs in Arizona’s healthcare system in part by making it easier to get reimbursement for their services.  We should find out its committee assignment in the Senate this week.

    Oral Health

    Bad news on the oral health front last week. HB 2442 which would add some dental services for pregnant women enrolled in AHCCCS never made it to the House floor for a vote, so it's effectively dead. Gotta hand it to Rep. Kelli Butler for giving it the old college try.  

    Asthma Management

    HB 2208 which would (under certain circumstances) let school staff administer or help a student self-administer an inhaler for things like asthma episodes got through the House by a vote of 50-8-2.  On to the Senate.   

    Vaccines

    HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months got through the full House 58-0-2.  On to the Senate.   

    Sunscreen & Tanning Beds

    HB 2134 which would make it clear that kids can take sunscreen to school and camps... and that school and camp staff can help them put it on passed through the House 46-12-2.  

    HB 2194 - which prohibits kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free passed through the House 39-19-2. Both will get Senate committee assignments this week. 

    Physical Activity

    HB 2082 which would require all schools to have 50 minutes of unstructured recess per day from K through 5th grade got through the House 39-20-1.  On to the Senate.  Good news for physical activity!  

    Tribal Courts and Involuntary Commitment 

    HB2084 is a new one for our list.  Basically it would allow a mental treatment facility to admit a patient for involuntary treatment pending the filing of a tribal courts involuntary commitment order.  This is good (and we support it) because it will provide better treatment logistics for patients.  It passed through the House 60-0.  

    Nurse Anesthetists

    SB 1336 passed the Senate last week.  It would basically let nurse anesthetists issue a medication order in the scope of his or her practice.  We're for it because it would help improve access to care in rural areas by adjusting the prescribing authority for nurse anesthetists (helping fill a care gap).  This passed through the Senate floor 25-5-0, so it's on to the House for this one.

    Drug Overdose Review Team

    HB 2493 which would set up a drug overdose review team at the ADHS (much like the child fatality review team) passed the House 52-6-2.   

    Traffic Safety Cameras

    Let's face it. Getting a ticket in the mail for speeding or running a red light is no fun.  But evidence suggests that photo enforcement of red lights and speeding is an effective public health intervention, which is why we don't like HB2525.  It would ban traffic safety cameras in AZ.  Unfortunately, this passed on a House floor vote 32-28-0.  A close call, but it did pass.  We'll be trying to inform the debate over in the Senate regarding how traffic safety cameras prevent injuries and save lives.

    Teenage Texting & Driving

    SB 1080 which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license if they're under 18) passed on a Senate floor vote 24-6-0.  Not exactly a robust prohibition on texting and driving because it only applies to new teenage drivers for 6 months, but at least it's a start.  The only other AZ state law that prohibits texting and driving applies to school bus drivers.  AZ is behind the national curve in this area. Next stop is a Senate committee.

    Newborn Screening

    SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests passed through the Senate 28-1-1.  

    Tobacco

    A couple of weeks ago we signed up in support of and testified for HB 2335 which (if it had passed) would have moved the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  It passed in th House Health Committee 7-2, but was never heard in the Commerce committee and it effectively died last week because it didn't get a floor vote.   

    Voter Initiative Stuff

    Perhaps some of the most troubling bills and resolutions in terms of public health have to do with the voter initiative process.  Many of the real big achievements in public health have been voter initiatives (e.g. Smoke Free Arizona Act).  A couple of the bills that would change how voter initiatives work would require voter approval, but a couple could be approved by the Legislature (with the Governor’s signature).  We're not alone in our opposition to these proposals- lots of people are concerned about them. Here's a quick summary:

    • HCR2002 & HCR2007 (which would need to be approved by voters to become effective) passed the House and would repeal the Voter Protection Act - which stops the Legislature from altering voter initiatives except under strict circumstances.
    • HCR2029 hasn't passed the house yet but would require signature gatherers to get a certain number of signatures in each of the 30 legislative districts.  This one would ultimately need to be approved voters.
    • HB 2404 passed through the House (as amended) and would prevent signature gatherers from getting paid by the signature (for voter initiatives- not for candidate signatures).  This one could become law without voter approval.

    AHCCCS Waiver

    AzPHA submitted comments on the current AHCCCS 1115 Waiver application.  Here’s a link to the waiver application and our response letter.    We encourage all AzPHA members to look at our response letter and use what you think is useful to turn in your own comment letter to AHCCCS via e-mail topublicinput@azahcccs.gov by February 28.


    If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org and she’ll get you on our list.  We have a weekly call every Monday at11 am and someone from the committee is always down at the Legislature for key hearings.

    Weekly AzPHA Public Health Policy Committee Update

    We're at about the halfway point in this year's legislative session now. The only committees meeting next week are the Appropriations Committees in the House and Senate.  There’ll be lots of Rules, caucus, Committee of the Whole & 3rd reading this week.  It’s harder for the public to be involved in the process this week, but you can always contact your legislator (remember to use your NON-work computer & e-mail) to share your views, concerns & suggestions.

    Congress is on break this week which means some of them might be organizing town hall type forums in the coming days.  There isn’t much scheduled yet- but we have our eyes peeled- and we’ll do an update blog when and if they end up being scheduled in the next couple of weeks.  

    Active Health-related Bills

    Good news on several bills that we supported last week. The bills below made it through their respective committees and are likely all on their way to floor votes this week.  Last week was the deadline for hearing bills in their chamber of origin- which is why many of the committees had such robust agendas.  Here’s a quick summary:

    Community Health Workers

    HB 2426 ,which would set up a pathway for Community Health Workers in AZ to voluntarily become certified passed the House Health Committee 9-0.  Yea!  We signed up in support of the bill and testified on its behalf as well.   Voluntary certification would be a big step forward for this important health profession because it would expand the use of CHWs in Arizona’s healthcare system in part by making it easier to get reimbursement for their services.  This bill is on the House Rules Committee Agenda on Monday morning (2/20).  Looking good for a floor vote this week.

    Oral Health

    Good & bad news on the oral health front last week.   HB 2442 which would add some dental services for pregnant women enrolled in AHCCCS, passed the House Health Committee 9-0.  There are a host of public health reasons why this is a good idea- you can read about them in this Issue Brief from the UA's Center for Population Science & Discovery.  The bad news is that the bill was also assigned to the House Appropriations committee (because it would cost a little money) but it’s not listed on the House Appropriations Committee Agenda this week.   If it doesn’t get added, it would be a real setback- but it would still be possible for it to be ultimately included in the budget bills.

     Asthma Management

    HB 2208 which would (under certain circumstances) let school staff administer or help a student self-administer an inhaler for things like asthma episodes also sailed through House Health 9–0.  This bill is on the Rules Committee agenda for Monday (2/20). Still looking good for a floor vote this week.

    Vaccines

    HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months is alive and well- passing through the House Health Committee 9-0 a couple of weeks ago and passing through the Rules committee this week.  Still on track for a floor vote this week.

    Sunscreen

    HB 2134 which would make it clear that kids can take sunscreen to school also got a favorable recommendation from House Health 9-0 a couple of weeks ago and also passed through the Rules committee last week.  Lookin’ good for a floor vote this week.

    Physical Activity

    HB 2082 sponsored by Jesus Rubalcava and, which would require all schools to have 50 minutes of recess per day from K through 5th grade is still looking good.  That bill passed 11-0 in the House Education Committee a couple of weeks ago and got through the Rules Committee last week.  Ready for a floor vote now.

    Newborn Screening

    Meanwhile, over in the Senate, SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests, passed through the Senate Health and Human Services Committee a couple weeks ago and is looking good for a senate floor vote this week.

    Tobacco

    A couple of weeks ago we signed up in support of and testified for HB 2335 which if it passes would move the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  It passed in the House Health Committee 7-2, but was never heard in the Commerce committee- meaning it’s probably finished this year unless it can somehow be unassigned to Commerce. 

    New AzPHA Policy Positions

    After viewing bills in the various committees over the last couple of weeks, the AzPHA Health Policy Committee came to the Board asking for approval to take positions on the bills below.  Here’s a quick summary:

    Nurse Anesthetists

    We’ll be supporting SB 1336 moving forward.  It’s complicated, but basically it would help improve access to care in rural areas by adjusting the prescribing authority for nurse anesthetists.

    Drug Overdose Review Team

    We’ll also be supporting HB 2493 which would set up a drug overdose review team at the ADHS much like the child fatality review team.

    Photo Traffic Enforcement

    Let's face it. Getting a ticket in the mail for speeding or running a red light is no fun.  But the evidence suggests that photo enforcement of red lights and speed is an effective public health intervention, which is why we’re weighing in against HB2525 this upcoming week in the House Appropriations Committee (Wed. at 2 pm).  It would prohibit any jurisdiction from using photo enforcement technology to enforce red light running etc.  If you scroll back, you’ll see a separate blog on this topic.

    AHCCCS Waiver

    The AzPHA’s Board reviewed and approved our comments on the current AHCCCS 1115 Waiver application.  Here’s a link to the waiver application and our response letter.    We encourage all AzPHA members to look at our response letter and use what you think is useful to turn in your own comment letter to AHCCCS via e-mail to publicinput@azahcccs.gov by February 28.

     

    Should the State Prevent Cities from Using photo Traffic Enforcement?

    Let's face it. Getting a ticket in the mail for speeding or running a red light is no fun.  But the evidence suggests that photo enforcement of red lights and speed is an effective public health intervention, which is why we’re weighing in against HB2525 this upcoming week.  It would prohibit any jurisdiction from using photo enforcement technology to enforce speeding or red light running. 

    Many state and local governments in AZ have turned to photo enforcement of speeding and running red lights promote public safety (and some would say to raise revenue). The theory is that drivers will pay more attention to their speed and red lights when they know they’re at risk for getting a ticket. It stands to reason that cameras would keep drivers’ speeds in check and prevent serious injuries from high-speed crashes. But do they?

    A landmark study for photo enforcement was done by Retting et.al. and published in the American Journal of Public Health examining the impact that photo enforcement had in Oxnard CA after they implemented their photo enforcement program.  The researchers found that intersections that had red light cameras installed had a 29% reduction in injury crashes.  Right-angle crashes (which often happen because of red light running) were reduced by 32% and right-angle crashes involving injuries were reduced by 68%.  Overall accidents at the intersections were reduced by 7%.

    In 2008, an Arizona established a statewide photo speed enforcement program on interstate highways. DPS contracted with a private company to install the cameras (along with signage to alert drivers), and they began operating that fall. Vehicles that were clocked going 11 miles per hour or more over the speed limit got tickets in the mail.  The system was in use until 2010 when the contract expired and the cameras were removed.  Did their presence have an effect on public safety?

    Last year, a research team that included Dr. Chengcheng Hu, director of biostatistics for the Phoenix campus of the UA Mel and Enid Zuckerman College of Public Health, Dr. Steven Vanhoy, a recent graduate of the UA College of Medicine – Phoenix, and several colleagues from Banner – University Medical Center Phoenix, published a paper that offers some insight.

    The researchers examined crash data along a 26-mile segment of Interstate-10 in Phoenix where speed cameras had been placed every 2 miles as well as a 14-mile control segment where no cameras had been deployed. They compared crash data from Jan. 1 to Dec. 31, 2009 (when cameras were in place) to data from Jan. 1 to Dec. 31, 2011 (after the cameras had been removed).  They found that the removal of the photo radar cameras was associated with a two-fold increase in admissions to Level 1 Trauma Centers from car crashes in the areas where the cameras were removed.

    Nobody likes getting a traffic ticket, but we believe that photo enforcement of reasonable traffic laws can significantly reduce severe injuries.   That’s why we’re weighing in against HB2525 this week in the House Appropriations Committee on Wednesday, February 22 at 2pm in House Hearing Room 1. 

    Believe me, I'm no evangelist for every single speed limit in my part of town nor the placement of some of the cameras and vans- but moving to eliminate this option for local communities would cause public health harm.  I for one  am happy that AzPHA is mobilizing against HB2525 this week. 

    Weekly AzPHA Public Health Committee Update

    Our Public Health Policy Committee continues to be busy following bills making their way through the state legislature and preparing comments on AHCCCS’ 1115 Waiver application.  Here’s a snapshot of AzPHAs activities over the last couple weeks and what's up this week.  There’s good and bad news this week.

    Active Health-related Bills

    We'll be signing up in support of 3 bills in the House Health Committee this week.  We're enthusiastically supporting HB 2426 which would set up a pathway for Community Health Workers in AZ to voluntarily become certified. Voluntary certification would be a big step forward for this important health profession because it would make it easier to get reimbursement for their services- and expand the use of CHWs.  Good news! 

    We'll also be enthusiastically supporting HB 2442 this week in House Health- which would provide for preventive dental services for pregnant women enrolled in AHCCCS.  There are a host of public health reasons why this is a good idea- you can read about them in this Issue Brief from the UA's Center for Population Science & Discovery.

    We're also supporting HB 2208 this week, which would, under certain circumstances, let school staff administer or help a student self-administer an inhaler for things like asthma episodes.  There was a late breaking amendment to this bill this week which we think makes the bill more likely to move forward.

    Meanwhile, last week:

    HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months is alive and well- passing through the House Health Committee 9-0 last week. 

    HB 2134 which would make it clear that kids can take sunscreen to school also got a favorable recommendation from House Health 9-0. 

    HB 2190 which would ask ADHS to compile stroke statistics was held in committee, meaning it’ll need to be approved this week or it’s probably toast this year. O

    Last week AzPHA signed up in support of and testified for HB 2335 which if it passes would move the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  There’s good evidence that when a person starts smoking before they’re 21 they’re far more likely to be a life-long smoker (because people that start in their teens are more highly addicted as a result of changes in the brain).   HB 2335 passed in the House Health Committee 7-2, but still needs to get through the House Commerce Committee and then of course get a full House floor vote.  It didn’t get a hearing in the House’s Commerce Committee this week, and the committee chair has said he won’t hear the bill in his committee-  which would effectively kill it.  Sad!

    No news this week about House Bill 2082 sponsored by Jesus Rubalcava and, which would require all schools to have 50 minutes of recess per day from K through 5th grade. That bill passed 11-0, but there’s still a ways to go and plenty of hurdles to overcome before this would become law.

    Meanwhile, over in the Senate,  SB 1368 passed through the Senate Health and Human Services Committee.  If it passes, it would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests. This one is looking good.

    We’re watching the Legislature’s hearing calendar closely and will offer our support and/or information.  If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org and she’ll get you on our list.  We have a weekly call every Monday at 11 am and someone from the committee is always down at the Legislature for key hearings.

    AHCCCS Waiver

    The AzPHA’s Public Policy Committee is finishing up our comments on AHCCCS’ 1115 Medicaid waiver application (as required by a state laws that passed in 2015).  AzPHA will be submitting comments on the Waiver application focusing on 4 key areas: 

    • The proposed requirement for all “able-bodied” adults to become employed or actively seeking employment or attend school or a job training program.
    • The proposed requirement for able-bodied adults to verify on a monthly basis compliance with the work requirements and any changes in family income.
    • The authority for AHCCCS to ban an eligible person from enrollment for one year if the eligible person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements.
    • The authority for AHCCCS to limit lifetime coverage for all able-bodied adults to five years except for certain circumstances. 

    Our Committee will present our proposed letter to the AzPHA Board on Friday and we’ll share the final letter here on the blog right after it’s approved.  If you’d like to participate in the editing process you can always contact tiffany@azpha.org and she’ll get you on our Public Health Policy Committee list.

    Adios

    What would Repealing the Affordable Care Act do to Arizona’s Economy?

    Good question.  Often those of us in public health tend to focus on the importance that access to care has in public health outcomes.  But we also know that having a robust economy that provides opportunities is a key driver in the social determinants of health that dramatically impact health status of populations.

    The Children’s Action Alliance commissioned the W.P. Carey School of Business at ASU to study the economic impact of removing the federal funds that are coming into Arizona as a result of the Affordable Care Act.  Among the report’s conclusions is that if all federal and state ACA-related funding including tax credits were eliminated, the Gross State Product in AZ would decline by $5 billion with a loss of $3.5 billion in personal income. Employment losses in all sectors would be about 62,000 with the health care sector losing 29,000. 

    The 25-page report has a host of results that demonstrate repealing the ACA’s healthcare funding provisions would do more than just reduce access to care, it would result in impacts to Arizona’s economy that would affect those social determinants that are so important to maintaining population health.

    Some members of the U.S House of Representatives and the U.S. Senate have vowed to repeal and replace the Affordable Care Act.  A key public health question is “what does replace mean and what does it look like”.  If you’d like to have your voice heard, you can take action now by using this APHA tool to send your message to Senators McCain and Flake and your Representative (based on the address you use). 

    The time to voice your opinion is now!