As we transition into the 2020s next week, I thought I’d put on my 10- year public health thinking cap and reminisce about some of the top public health policy topics of the 2010s in Arizona. Here you go…
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The Recession. I still have PTSD from being responsible for a state agency during the recession. We made so many horrible budget cuts those years including a childless adult enrollment freeze in the behavioral health medicaid system. That was gut wrenching and it had untold bad outcomes for so many.
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The 1 cent 3-year sales tax. Remember the special election for the one cent sales tax? I can’t imagine what would have happened to vulnerable Arizonans if that hadn’t been pushed by Governor Brewer and put on the ballot. It passed with a yes vote of something like 64% to 36%. Who says Arizonans are a bunch of stingy tightwads?
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Medicaid restoration and expansion. A bipartisan group of legislators and hard work by a host of Stakeholders (including AzPHA) and leadership from Governor Brewer pushed Medicaid restoration and expansion over the line. Critical to the passage was consent by the hospital industry to pay an annual assessment that captures the state funding portion that was needed to make this a reality. It was perhaps among the most significant and long lasting health care achievements of the 10’s in Arizona.
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AZ Supreme Court upholds the hospital assessment funds that pay for Medicaid restoration and expansion. The careful writing of the statutory language that funded Medicaid expansion pays off- and the fees charged by AHCCCS to hospitals stands.
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Medical Marijuana. Voters narrowly approved medical marijuana and the ADHS did the best they could to build a responsible system. As we transition to the 20’s we’re poised to have retail marijuana stores. Conservatives could potentially head off such a move if they would approve meaningful criminal justice reform of our marijuana laws. Odds are that we’ll have retail marijuana stores by the early 2020s.
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Senator McCain stands with Senate Democrats voting against
a bill that would have repealed the Affordable Care Act with the “skinny repeal” which would have radically jeopardized access
to care. -
Behavioral health system interventions were implemented for Medicaid members needing behavioral health services. The decade began with interventions that resulted in a settlement of the Arnold v Sarn suit by tying performance measures to evidence-based SAMHSA fidelity models and additional financial investments in the system. Later in the decade, Medicaid managed care contracts are overhauled integrating physical and behavioral care for most Medicaid members in AZ.
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The roots of the Opioid Epidemic lie in the 2000s decade, but the epidemic really accelerates in the 2010s- with opioid deaths passing the number from car crashes in AZ early in the decade. Various interventions happen through the mid part of the decade, culminating in the bipartisan Arizona Opioid Epidemic Act at the end of the decade.
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CPS Carved out of ADES to be the new DCS. The “NI” discoveries and a deep dive into ADES reveals that the CPS system needs and overhaul and the new agency is created with a more specific mission. No doubt the 2020s will continue to have stories about bad outcomes. The root of many of the core issues go back to dramatic cuts to preventive service programs that happened in the Recession and decisions made by elected officials to use federal prevention funds for other purposes (see Morrison Institute work on this) as well as not pay a small match for federal child care subsidy funds that were easily available.
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Social Determinants increasingly recognized as drivers of outcomes during the decade. Policy makers and agency directors increasingly look toward interventions that address social determinants. The 2020s will likely build on those successes.
