The Value of Prevention: The Prevention & Public Health Fund in Action

The U.S. spends far more on medical care than any other nation, yet ranks 26th in life expectancy.  That’s partly because we tend to focus on treating illnesses rather than preventing them in the first place.  Basically, we’re not adhering to wise advice that “a stitch in time saves nine”.

More than 85% of the health care costs in the U.S. are from preventable chronic conditions, yet only 3% of our health care spending is focused on prevention and public health - the key factors that prevent chronic medical conditions before they start. It’s essential that we do a more effective job preventing costly chronic medical conditions to reduce health care costs.

The Affordable Care Act included several initiatives designed to reduce health care costs. One important component was the creation of the Prevention and Public Health Fund, which provides federal, state and local public health resources to reduce long-term health costs. The fund focuses on preventing expensive chronic medical conditions by providing expanded and sustained national investment in public health programs that improve health and restrain the rate of growth in health care costs.

This investment in public health infrastructure to reduce costs is evidence-based. Research suggests that funding for community-based public health has a 5.6 to 1 return on investment. In other words, every dollar invested in evidence-based prevention programs results in a $5.6 in savings in overall health care costs.

Over the last several years, the fund has been used to support an array of evidence-based community prevention and clinical prevention programs that bolster public health infrastructure and workforce and expand public health research and tracking efforts that reduce health care costs. Resources go to programs at the local, state and federal levels to: a) better detect and respond to disease threats; b) increase vaccination rates; c) fight obesity; d) curb tobacco use; and e) increase access to preventive care services.

The fund also provides state and local resources to fight numerous health threats. Vaccination programs supported by the fund ensure access to vaccines that protect the most vulnerable among us from routine diseases like influenza and provide community-based immunity to prevent the widespread circulation of diseases like mumps and measles. The fund supports the ability to track emerging infectious disease outbreaks like Zika or Ebola, as well as foodborne illnesses.

Arizona public health jurisdictions have received more than $52.6 million through the Prevention & Public Health Fund since 2010. This $9.3 million annual investment is at work in Arizona, providing critical resources that support evidence-based, community prevention activities tailored to meet community health needs and preferences.

Evidence-based PPHF investments in Arizona include:

• Prescription painkiller (Opiate) and heroin use prevention;

• Health security funds for bioterrorism, disease outbreaks, and disasters;

• Building immunization services to prevent serious infectious disease outbreaks;

• Promoting better detection and response to disease threats;

• Lead poisoning prevention;

• Reducing tobacco use; and

• Reducing diabetes, heart disease, and obesity.

Astonishingly, the US House of Representative’s “American Health Care Act”, all introduced versions of the US Senate’s “Better Care Reconciliation Act” (and Amendments), and the President’s proposed budget would eliminate the Prevention and Public Health Fund.  

We’re urging our elected representatives in congress and their staff to reflect on the impact that Prevention and Public Health Fund resources are having in Arizona as they consider options for reforming the U.S healthcare system.  Arizona’s public health infrastructure is already stretched thin because of limited state and local investment in public health. Further reductions in capacity by reducing or eliminating the Prevention and Public Health Fund would impair Arizona’s ability to bend the health care cost curve as well as impair its ability to respond to infectious diseases, the opioid crisis, and preventable diseases and chronic conditions.

The Arizona Public Health Association partnered with the Vitalyst Foundation to develop a report that outlines the progress that Arizona is making using existing prevention and Public Health Fund resources. 

The report, entitled The Value of Prevention: How the Prevention and Public Health Fund Invests in Arizona’s Health is geared to inform policy makers and other stakeholders of the potential implications related to eliminating or restructuring the Prevention and Public Health Fund.  The report is also posted on our AzPHA home page at www.azpha.org.

Please take a gander and forward the report to folks that might be interested- especially people and organizations that you know that may be able to influence the outcome of this enormously important national debate about the future of health care and public health in our country.

_____________________________________________________

"Our Lives on the Line”, Arizona" Rally and Press Event

More than a dozen groups have joined forces to lead a national “day of action” against the plan to drastically cut back Medicaid and public health resources as part of the repeal of the Affordable Care Act. The rally and press event in Arizona is one of many being held simultaneously in numerous other cities around the country that day.

“Our Lives On the Line, Arizona” event — including a flagship rally in Washington — will set the tone for several weeks of action to persuade key lawmakers to focus on evidence-based solutions that will improve health outcomes as they debate changes to the Affordable Care Act  Here’s where you can register for the Arizona event    

 

Time:

Saturday, July 29, 2017 11:00 AM - 12:00 PM AZ Time

Host:

Our Lives on the Line

Location:

Parsons’s Center for Health and Wellness – Southwest Center for HIV/AIDs (Phoenix, AZ)

1101 N. Central Avenue
Phoenix, AZ 85004

    Senate Releases 3rd Crack at the "Better Care Reconciliation Act"

    There were 2 important actions this week regarding public health & access to care.  The U.S. Senate released their 3rd version of the Better Care Reconciliation Act (BCRA) and House released their Health and Human Services and Appropriations bill for next fiscal year

    Let's start with BCRA.

    The Senate released it's new version of BCRA this week (PDF) but it still hasn't been evaluated by the non-partisan Congressional Budget Office...  so we won't know the particulars of what the new version would likely do to insurance coverage and premiums until that evaluation is complete (probably next week). 

    We do know that many things are the same as the previous version of the bill- especially when it comes to the troubling changes that would be made to Medicaid:  

    • Like the previous version of BCRA, the new bill would still convert federal Medicaid funding to a per capita allotment (or a block grant) and limit growth in federal Medicaid spending beginning in 2020. Medicaid funding per person would go up with the Medical Consumer Price Index from 2020 – 2024 and by just the regular Consumer Price Index after that- which will likely serve to dramatically cut back Medicaid funding.

    • Phases out the enhanced federal contribution for the expansion population in states like AZ from 90% in 2020 to regular state match in 2024.  That means that somewhere between 2020 and 2024 Arizona would drop the expansion population from Medicaid coverage (people from 100% to 138% of FPL).

    • Marketplace plan premium tax credits would be available down to 100% of FPL in 2020 (because those folks between 100 and 138% of poverty won't be enrolled in Medicaid anymore).

    • Eliminates the individual mandate for everybody to have health insurance.

    • Eliminates the requirement that larger employers provide health insurance.

    • Would let insurers sell currently "non-compliant" insurance plans - meaning insurance plans with very high deductibles and limited benefits (people that buy these catastrophic plans would be eligible for a tax credit). This would serve to reduce premiums (and benefits) for people that elect these plans- but it would shrink the risk pool for people that want more robust (compliant) plans- meaning that premiums for the more comprehensive plans will go up alot.

    • Repeals the mandate to have health insurance and eliminates cost sharing subsidies in 2020.

    • Completely eliminates the Prevention and Public Health Fund in FY19, which is used by every state to support vital public health programs that promote health, prevent disease, and allow for rapid response to emerging public health threats.

    _________________

    The House Labor, Health and Human Services and Education Subcommittee released their FY18 appropriations bill this week too. Here's a summary of the funding proposals included in the bill:

    The bill decreases the US Department of Health and Human Services' budget by $542M below last year's level.  It reduces CDC's budget by almost $200M , which includes $840M in transfers from the Prevention and Public Health Fund (eliminating the fund).  Many if not most of these budget cuts would roll down to state and local health departments.

    The bill reduces HRSA funding by about $400M (to $5.8B) including a complete elimination of all Title X Family Planning Funds ($300M).

    _____________

    We're encouraging AzPHA members to send messages to our Senators urging them to focus on supporting a Senate bill that: 1) protects future funding for Medicaid; 2) allows folks with pre-existing conditions to be able to continue to have access to affordable health insurance; and 3) protects the Prevention and Public Health Fund.

    Senator Jeff Flake
    Russell Office Building 413
    Washington, D.C. 20510
    (202) 224-4521
    Twitter: @JeffFlake

    Senator John McCain
    Russell Office Building 218
    Washington, DC 20510
    (202) 224-2235
    Twitter: @SenJohnMcCain

    At Last... a Very Short Reprieve in our Fight for Access to Care

    This week the U.S. Senate had a goal of voting on the “Better Care Reconciliation Act of 2017” - the earlier version of the bill that was passed in the House of Representatives this year.  Fortunately, the Senate decided to chill and not to take the vote this week or next.  Hopefully they'll reflect over the July 4 break and come back with a more productive approach to improving on the ACA.

    The nonpartisan Congressional Budget Office released it's analysis of the Senate Bill (https://www.cbo.gov/publication/52849), which seems to have had a profound impact on the negotiations.  The report found that the proposal would have increased the number of people who are uninsured. It is estimated that 15 million more people would be uninsured by next year. The increase in the number of uninsured people would reach 19 million in 2020 and 22 million in 2026.

    In later years, lower spending on Medicaid and substantially smaller average subsidies for coverage would lead to even more increases in the number of people without health insurance. By 2026, enrollment in Medicaid would fall by about 16% and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under the ACA.

    Another interesting development this week was a new analysis released by AHCCCS concluding that the proposal would cost our state at least $7.1 billion through 2026. Download the full report from the AHCCCS website.            

    The analysis shows that the Bill increases costs for Arizona by $2.9 billion between FY 2018 and FY 2026.  It would make changes to the enhanced federal funding provided for the 320,000 Medicaid members that are childless adults with incomes up to 100% of federal poverty, as well as 82,000 adult members with incomes between 100-133% of federal poverty.   

    We're encouraging AzPHA members to send messages to our Senators urging them to focus on supporting a Senate bill that decouples the issues related to the individual health care insurance market from these dramatic changes to federal and state Medicaid programs.

    Senator Jeff Flake
    Russell Office Building 413
    Washington, D.C. 20510
    (202) 224-4521
    Twitter:
    @JeffFlake

    Senator John McCain
    Russell Office Building 218
    Washington, DC 20510
    (202) 224-2235
    Twitter:
    @SenJohnMcCain

    Medicaid in the Crosshairs: Senate Releases Proposal to Repeal & Replace the ACA

    This morning the U.S. Senate released draft healthcare legislation entitled the “Better Care Reconciliation Act of 2017”.  Note that it has a different name than the House version that passed a few weeks ago (American Health Care Act).  In many respects, the two bills are very similar.

    They're calling this a "discussion draft", implying that it's possible that the language of the bill could morph before it hits the Senate floor next week.

    The non-partisan Congressional Budget Office is still working on an evaluation of the Senate version.  That evaluation will provide a better picture of the practical impacts that the bill would have if enacted, however, here's what we know from the initial reading of the discussion draft: 

    • Like the House version, BCRA would give states either a per capita cap for federal Medicaid contributions or a block grant of funds beginning in 2020. It appears that, unlike the House version, federal funds for kids the elderly and people with disabilities could not be "block granted" (an improvement).  On the down side, the inflation rate used to calculate future per capita contributions would be even lower than the inflation rate in AHCA which will result in less Medicaid spending in 2025.

    • Rolls back the Medicaid expansion (to 138% of poverty), but more slowly than the House version. Would creates some kind of state innovation fund for states that didn't expand Medicaid.

    • Eliminates the individual mandate for everybody to have health insurance.

    • Eliminates the requirement that larger employers provide health insurance to their employees.

    • Insurance companies would still not be allowed to increase premiums or deny coverage based on preexisting conditions.

    • States would be allowed to change what qualifies as an essential health benefit for Marketplace plans.

    • Completely eliminates the Prevention and Public Health Fund (PPHF) in FY18, which is used by every state to support vital public health programs that promote health, prevent disease, and allow for rapid response to emerging public health threats.

    The Century Foundation has a good comparison of the House and Senate Versions as well as the current law under the Affordable Care Act on their website here:  https://tcf.org/content/commentary/heart-comparison-house-senate-health-bills/   ;

    ___________

    We're encouraging AzPHA members to send messages to our Senators urging them to focus on supporting a Senate bill that: 1)  protects futue funding for Medicaid; 2) allows folks with pre-existing conditions to be able to continue to have access to affordable health insurance; and 3) protects the Prevention and Public Health Fund.

    Senator John McCain

    Washington, DC Office:       202.224.2235

    Phoenix Office:                    602.952.2410

    Senator Jeff Flake

    Washington, DC Office:       202.224.4521

    Phoenix Office:                    602.840.1891

    Opioid Epidemic Public Health Interventions Ramping Up

    There’s been a promising increase in public health policy focus in recent weeks regarding Arizona’s ongoing opioid epidemic. 

    A few weeks ago the Arizona Department of Health Services (ADHS) released the 2016 Arizona Opioid Report which found that there were 790 deaths in 2016 in Arizona from opioids, a 16% increase from 2015 and a 74% increase since 2012.  More than half of the increase in the last two years have been heroin deaths (heroin increased from 11% of opioid deaths in 2007 to 39% in 2016).

    Shortly after the report was released, the Governor declared a Public Health State of Emergency charging the ADHS with developing: 1) an enhanced opioid surveillance protocol; 2) new emergency regulations for prescribing opioids among licensed healthcare institutions; 3) additional provider practice guidelines; 4) Naloxone use guidelines for law enforcement; and 5) a report of findings that include possible additional legislative action by September 5, 2017.

    Last week the ADHS launched an opioid website at www.azhealth.gov/opioid which houses information about the opioid epidemic including information for those required to report data, and resources for law enforcement and EMS and  clinicians as well as standing orders for naloxone dispensing.

    These latest administrative actions are just the latest in a string of interventions in Arizona regarding the opioid epidemic.  In October 2016 the Governor issued an Executive Order charging AHCCCS with limiting  Initial Opioid prescriptions to 7 days.  On January 9, 2017 he signed an Executive Order that establishes a substance abuse program for people leaving prison at risk for opiate abuse.

    Last legislative session, the Legislature passed HB 2493, which will set 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 that will:

    • 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, recommend policies to decrease drug overdose fatalities; and
    • Educate the public regarding drug overdose fatalities.

    In addition to all of these interventions, AHCCCS has received a  State Targeted Response Grant ($24M over the course of 2 years) from the Substance Abuse and Mental Health Services Association to increase access to medication assisted treatment, care coordination for high risk individuals, recovery support services and prevention activities to reduce opioid use disorders and deaths.  The project will also develop and support state, regional, and local level collaborations, build capacity and infrastructure and service enhancements in high need areas.

    The proposed activities within the Arizona Opioid State Targeted Response project will: 1) create a new streamlined data-driven decision-making process to target and tailor treatment and prevention resources where they are most needed in the state; 2) expand training for prevention and treatment providers; 3) expand law enforcement access to Naloxone kits; 4) expand access to MAT and integrated treatment; and 5) expand peer support services, recovery homes and recovery supports to pregnant and parenting women. 

    We’ll continue to track the policy interventions that are underway and update our AzPHA members on the latest surveillance and intervention activities.

    Could the Pathway to Repealing & Replacing the ACA Run through Medicaid? Yes.

    Last week the Nevada State Legislature handed Governor Sandoval an opportunity to provide the U.S. Senate a template for modifying the Affordable Care Act.

    The Nevada Legislature approved a bill and sent it to the Governor's desk that would allow any Nevadan to "buy in" to their state's Medicaid program.   If the Governor signs the bill (and if the Centers for Medicare and Medicaid Services - or CMS -  approves the plan) any Nevadan would be allowed to buy managed care health insurance through their state Medicaid program.  The bill would allow the purchase regardless of income. Nevada residents that qualify for their current Medicaid program would continue to receive services as-is.                  

    The actual Bill is called Assembly Bill 374.  If it's signed, the new law would direct the Nevada Department of Health and Human Services to ask CMS for a Waiver allowing their Medicaid agency let Nevadans buy health insurance through their Medicaid managed care program.  If the law is signed by their Governor (and if the approach is approved by CMS) the Medicaid insurance would be available for purchase on the "Silver State Health Insurance Exchange".  The plan calls for folks who qualify for tax credits under the Affordable Care Act to be able to use their credits to help pay for the coverage. 

    Nevadans would need to pay an annual premium "... representing 150% of the median expenditure paid on behalf of a Medicaid recipient during the immediately preceding fiscal year".   The coverage would be the same as the coverage for NV Medicaid recipients except it wouldn't cover emergency medical transportation (e.g. ambulance rides).  The measure is written to ensure that no federal funds would be used.

    The plan has several advantages that cover many of the consensus areas that most Americans agree with... that folks should have access to reasonably priced health insurance regardless of whether or not they have a pre-existing condition. This relatively simple plan would accomplish that without a complicated overhaul of the healthcare system since all states have existing Medicaid programs. 

    I often hear people arguing that a solution to the healthcare debate is to adopt a "Medicare for All" plan...  and I've wondered why there's never been much discussion of a Medicaid buy-in option.  It solves a lot of the issues that the exchanges struggle with because the risk pool is larger and the rate negotiation much bigger than in the individual market today.  That means lower costs and less volatility.

    Arizona would be in a good position to lead the way with such a plan.  Our state Medicaid program (called AHCCCS) is widely recognized as an efficient and cost-effective model for providing Medicaid coverage. In addition, AHCCCS' legislation already provides the enabling statutory language to allow state employees to buy into Medicaid- so the buy-in concept isn't entirely foreign. 

    To make it work, the actuarial rates would need to be calculated in order to set the premium levels for buying in to AHCCCS.  With ACA tax subsidies and cost sharing reductions, the out of pocket costs per person would be competitive or less expensive than plans currently offered in Arizona’s Marketplace, with less year-to-year volatility in pricing.

    Sometimes solutions to complicated problems are staring you right in the face.

    Weekly AzPHA Public Health Policy Update

    A couple of weeks ago he nonpartisan Congressional Budget Office (CBO) released its final analysis of the House Republican’s American Health Care Act (AHCA) which was passed by the US House of Representatives by a vote of 217-213 on May 4.  The Vote in the House came before the CBO evaluation of the Bill.

    CBO’s new analysis of AHCA estimates that 14 million Americans would lose health insurance in 2018.  By 2026 they estimate that 23 million would lose health insurance under the House version of AHCA. 

    The measure would convert federal Medicaid (AHCCCS) funding to a per capita allotment and limit growth beginning in 2020 (using 2016 as a base year).  States could also choose to receive Medicaid funds as a block grant instead of the per-capita allotment. These are troublesome provisions that shift financial risk to AZ from the federal government ...  setting up an environment that increases the likelihood that we would have future reductions in eligibility and covered services for Arizonans that get their health insurance through Medicaid (including vulnerable populations).

    The Bill would also shift more of the cost of care to consumers through higher out-of-pocket expenses. Premiums could go down for some people, but premiums for low-income Americans and seniors would increase.  Subsidies would shift from income-based to age-based, with subsidies increasing with age.

    It would also eliminate the Prevention and Public Health Fund beginning in 2019, block Planned Parenthood from receiving Medicaid reimbursements for services (for one year).

    The Kaiser Family Foundation has a very helpful set of resources on their website that helps explain the differences between the current health care law and what would happen if the AHCA were enacted as passed by the US House of Representatives.

    The Bill as passed by the US House of Representatives would:

    • Convert federal Medicaid (AHCCCS) funding to a per capita allotment and limit growth beginning in 2020 using 2016 as a base year and provide states the option to get a block grant instead of the per-capita allotment. 
    • Editorial comment: this provision (in my opinion) the most problematic proposal in AHCA as it would shift financial risk to AZ from the federal government and set in motion a sequence of events that would likely result in reductions in eligibility and covered services for vulnerable Arizonans. 
    • Sunset the federal funds that paid for Medicaid expansion (to 133% of federal poverty) on January 1, 2020 except for people enrolled in the expansion population on 12/31/19 and who don’t have a break in eligibility of more than 1 month.
    • Replace the current income-based tax credits with flat tax credits adjusted for age. Eligibility for new tax credits phases out at income levels between $75,000 and $115,000.
    • Impose late enrollment penalty for people who don’t stay continuously covered.
    • Repeal the Prevention and Public Health Fund at the end of Fiscal Year 2018.
    • Encourage use of Health Savings Accounts by increasing annual tax- free contribution limit and through other changes.
    • Establish a fund ($115 billion over 9 years available to all states), and additional funding of $8 billion over 5 years for states that elect community rating waivers (let insurance companies charge more for people with pre-existing conditions). States could use the money to provide financial help to high-risk individuals, promote access to preventive services, provide cost sharing subsidies, and for other purposes.

    Our parent organization, the American Public Health Association,issued a statement highlighting the CBO’s findings and urging the Senate to work in a bipartisan manner that builds on the strengths of the Affordable Care Act.

    We're encouraging AzPHA members to send messages to our Senators urging them to focus on supporting a Senate bill that, first and foremost, protects Medicaid and that also allows folks with pre-existing conditions to be able to continue to have access to affordable health insurance.

    Senator John McCain

    Washington, DC Office:        202.224.2235

    Phoenix Office:                    602.952.2410

    Senator Jeff Flake

    Washington, DC Office:        202.224.4521

    Phoenix Office:                    602.840.1891

    What Would the President's Proposed Budget do to AZ Public Health?

    Last week the President released the Executive Branch's FY18 proposed budget... called“A New Foundation for American Greatness.” The proposal outlines the administration’s funding priorities for the upcoming fiscal year... but it's Congress that has the authority to actually set the budget.  

    In a nutshell, the President's budget requests an additional $54B in military spending next federal fiscal year (about a 9% increase) and proposes paying for the increase with cuts to other domestic discretionary programs (including core public health programs) by the same amount ($54B). 

    Obviously, if it were to be enacted by congress as proposed, it would mean pretty substantial reductions in public health spending at the national, state and local level as the cuts would significantly impact public health grant funds to state (and local) health departments here in Arizona. 

    Below is a breakdown of the proposed cuts to the CDC & HRSA and here's a link to the President's proposed budget:

    https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/budget.pdf 

    Centers for Disease Control & Prevention

    The executive budget proposes cutting the CDC's budget by 17% (from $7.2B to $5.9B) with large specific cuts to several programs.  I've broken down the proposal by public health service category below.

    Chronic Disease Prevention and Health Promotion

    The proposal completely eliminates several line items in the CDC's budget including:

    • tobacco prevention and cessation ($204M cut);
    • nutrition, physical activity and obesity ($50M cut);
    • heart disease ($103M cut);
    • diabetes ($140M cut); and many other line items.

    The proposed budget reduces the CDC's Immunization and Respiratory Disease program by 10%; from the current $782M to $701M.

    The proposal calls for cut by 17% funding for HIV/AIDS, Viral Hepatitis, STIs and TB Prevention programs; from the current $1.1B to $934M. In addition, the budget calls for decreases HIV/AIDS Prevention and Research Program by $147M.

    A cut of 11% is proposed for Emerging and Zoonic Infectious Diseases; going from $579M to $514M.

    The Executive budget completely eliminates the Preventive Health and Health Services Block Grant. Arizona currently over $1.85 million in FY16 from this Block grant, which allows AZ to address our unique public health needs in innovative and locally defined ways.

    The budget does propose the creation of a $500M fund called the America’s Health Block Grant to provide flexibility for each state to implement specific interventions to address its population’s unique public health issues. States could theoretically use this funding to support interventions such as tobacco prevention and control; diabetes; heart disease and stroke; nutrition, physical activity and obesity and arthritis.  However, this new Block Grant is slated to be funded via the Prevention and Public Health Fund, which is completely eliminated by the American Health Care Act as passed by the House of Representatives.

    Birth Defects, Developmental Disabilities, Disability and Health

    The proposed budget eliminates 18 current categorical programs in the birth defects center and directs the CDC to focus its birth defects and developmental disabilities portfolio on core public health activities that "align with CDC’s mission and have proven interventions to make an impact on America’s health.”  It calls for 26% cut to the total programs in this category going down from the $135M to $100M.

    Public Health Scientific Services are slated to be cut by $30M to $460M from the current $491M; Occupational Safety and Health is slated for a dramatic 41% cut to $200M from the current $338M.  Public Health Preparedness and Response is slated for a 9% cut ($136M), bringing preparedness funding down to $1.2B including a cut of $107M to the Public Health Emergency Preparedness Cooperative Agreement.

    Environmental Health

    The budget proposes eliminating the Amyotrophic Lateral Sclerosis Registry and reducing the Environmental and Health Outcome Tracking Network by $9M.  Environmental programs are slated to be cut to $157M, a decrease of $59 million from the current $217M.    

    Injury Prevention and Control

    Eliminates the elderly falls program and the injury research control centers. It does plan for level funds for opioid abuse and overdose prevention at $74M but cuts total injury prevention by 8% going from to $216 million from the current $235M.

    Health Resources & Services Administration (HRSA)              

    The executive budget proposes cutting HRSA's budget to $5.5B from the current $6.15B with large specific cuts to several programs among rural health and primary care.  I've broken down the proposal by public health service category below.

    Primary Health Care

    The budget proposes the elimination of HRSA primary care programs for area health education centers; training diversity; training in primary care medicine; oral health training; public health and preventive medicine programs and other workforce programs.

    HRSA workforce programs would be cut by 33% from $1.15B to $771M. I couldn't tell from the line item whether this represents the match funding for state loan repayment programs for primary care incentives in rural areas or not.

    Overall, this category of the HRSA budget would be $5B. There are proposed increases in mandatory funding for Community Health Centers by $89M.

    Rural Health

    The proposed budget eliminates the rural hospital flexibility (FLEX) grants and the state offices of rural health grants (like our Arizona Center for Rural Health). The Rural Hospital Flexibility Grants and State Offices of Rural Health are discontinued "to prioritize programs that provide direct services". 

    The total HRSA rural health budget would be cut by 50% with whatever funding remaining targeted toward the Rural Health Outreach Network and Quality Improvement Grants, Rural Health Policy Development, and Telehealth.

    Maternal and Child Health Bureau

    The proposed budget envisions cutting this Bureau within HRSA by $35M to $1.2B. It increases funding for the Title V Maternal and Child Health Block Grant by $30M and increases funding for the Healthy Start program by $10M but eliminates the sickle cell demonstration program; autism and other developmental disorders; heritable disorders; universal newborn hearing screening and emergency medical services for children.

    Ryan White HIV/AIDS Program is slated for a $59M cut from the current $2.3B; eliminating the AIDS Education and Training Centers Part F and the "special projects of national significance"

    ________________________

    Remember, these proposed FFY 18 budget cuts by the President are just that, proposed.  Congress is the branch of government that's authorized to set spending levels, so it'll be important for us to continue to follow the budget conversations over the coming months and add our voices to others that will be advocating for the protection of important public health programs.

    ______________________

    There's has never been a better time to join or renew your membership in AzPHA!

    Membership Renewal

    Individual Membership

    Organizational Membership


     

     

     

     

    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

    _________________________________________________________________________________

    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.

    _________________________________________________________________________________

    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.