U of A Study Examines Emergency Department Use During the Recession

AzPHA member Patrick Wightman from the UA Center for Population Science and Discovery recently published an Issue Brief examining the impact that the freeze on “childless adult” enrollment in AHCCCS during the Great Recession had on the use of hospital and emergency department services. 

Because Arizona conducted a natural experiment by freezing Medicaid enrollment among childless adult, and the fact that data are available to measure the effect of those policy changes, Patrick was able to compare people’s behavior with health insurance to their behavior without it.  The fact that the freeze lasted years allowed him to examine any impact of pent-up demand following the lifting of enrollment freeze.

Here’s a link to the entire Issue Brief , which includes the entire results including several useful graphs, but here’s the Summary from the Issue Brief.

“While the trends presented here are descriptive, they occur in the framework of two significant “natural experiments”, the first drastically restricting low-income individuals’ access to public health insurance, and the second once again expanding that access.  Because these policy changes happen at the state and federal levels, beyond the control of beneficiaries, it can be inferred that, in large part, they are the cause of the beneficiaries’ behavior, in this case their health care utilization.

In this context, the patterns shown here provide strong evidence that health care utilization, at least in the form of ED visits and hospitalizations, follows the availability of health care, in the form of health insurance.  While this finding is not unanticipated in the case of hospital visits, in the case of ED visits it is perhaps somewhat surprising, at least to the extent that ED visits represent “legitimate” medical emergencies.”

In the News

Opioid Use Disorder Treatment Medications

Earlier this week AHCCCS announced that they’ve accepted the recommendations of their Pharmacy and Therapeutics Committee and will be adding an additional buprenorphine medication (sublingual) to their preferred formulary list and a streamlined prior authorization process for a long acting injectable medication (effective 10/1). Here’s the story from the Republic and the Cap Times.

Hacienda Healthcare Enforcement Action

The ADHS issued a Notice of Intent to Revoke the license of a Hacienda Healthcare on Friday (here’s the story from the Republic). Apparently, a patient at the facility had larvae on a stoma, prompting the investigation. As you’ll recall, the facility previously had not been required to have a license – until SB1211 was passed and signed. The Governor signed the law with an emergency implementation clause (making it immediately effective) on 4/24/19.

A survey was conducted on 4/23 & 4/24 (that found no deficiencies) and the facility was apparently issued a license on 4/26. According to the news report staff from 3 state agencies (ADHS, AHCCCS, and ADES) are monitoring the facility and working on an investigation.

WHO Declines to Call Ebola Outbreak a Global Public Health Emergency

The now months-long Ebola outbreak in the Democratic Republic of the Congo (which spread to Uganda this week) is an emergency for the DRC and its neighbors, but according to the WHO this week, it doesn’t constitute a global health emergency.

The core of the decision was that the additional powers that come with an emergency declaration aren’t needed and, if used, may cause more harm than good.  One of those powers would allow the WHO to disclose information about a disease event to other countries without the consent of the outbreak country.  Emergency powers also give the WHO director-general authority to issue temporary recommendations regarding trade and travel.  However, the WHO’s recommendations on travel and trade have sometimes been ignored during other declarations.

On the other hand, declaring an emergency can be quite helpful in raising cash to fund public health and treatment interventions, and not declaring an emergency may miss opportunities to get additional resources to the outbreak areas.

More than 2,100 cases and 1,400 deaths have been reported in the DRC, making this the second largest Ebola outbreak on record.  It’s still 10% the size of the 2014-2016 West African outbreak, but has been difficult to control because of political and civil unrest in the DRC -despite the fact that there is now a vaccine that wasn’t available until the end of the 2016 outbreak.

Merck is making an additional 450,000 doses of the experimental Ebola vaccine for the DRC- but it takes a year from start to finish to make the vaccine. More than 130,000 DRC people have been vaccinated so far.

Legislative Session Session PowerPoint

Here’s a Summary of the 2019 Legislative Session (PPT) and the Summary of the Legislative Session as a (PDF). It’s been updated a bit since last week as the Governor signed the medical marijuana bill this week (which will require testing of medical marijuana, gives the ADHS additional dispensary enforcement authority, allows MM data to be used for research purposes, and makes the MM cards good for 2 years (effectively reducing the card fees by half).

Many States Using State Earned Income Tax Credits as a Prevention Strategy for ACEs

Is it Arizona’s Turn?

It’s no secret that exposure during childhood to negative events called adverse childhood experiences increase a person’s likelihood of having long-term chronic or behavioral health issues like heart disease, violence, suicide, and substance use.  ACEs like child abuse, neglect, parent incarceration, substance use, or separation are often clustered.

Policymakers in many states are looking for ways to prevent ACEs… which includes strategies to strengthen protective factors like social connectedness, access to healthcare and community resources, enhancing parental skills to promote healthy child development, and providing quality care and early education, and reduce risk factors before they occur. Arizona took a step forward this year by passing a budget bill that will draw down more than $60M in additional funds to support affordable childcare in Arizona.

Leading evidence-based policies to prevent ACEs before they occur are usually linked in some way to strengthening economic supports to help working families out of poverty and reduce parental stress. One well known economic support is the federal Earned Income Tax Credit

Many states are recognizing that they can also play a role through their state-based tax codes – and implementing Earned Income Tax Credits at the state level. Arizona hasn’t done so yet.

Here’s how they work. The Earned Income Tax Credit is a refundable income tax credit that can be used to reduce the tax burden for low- to moderate-income working people.  The federal government along with 29 states have established them at the local level. Arizona doesn’t.

Economic support from Earned Income Tax Credits is associated with improved infant and maternal health, better school performance for children, and increased college enrollment. Research suggests they reduce risk factors for child abuse and neglect ACEs by offsetting the costs of raising a child among working families.

This webpage from the National Conference of State Legislatures has a host of information about which states have state based Earned Income Tax Credits and how they work. They’re usually based on a reference to the federal EITC.

State Earned Income Tax Credits are a promising economic support for working families that help to raise more than six million people—half of them children—above the poverty line each year.

Arizona lawmakers have long had a zeal for reducing taxes.  Perhaps next year they should look at taxes from a new angle- using tax policy to support an evidence-based policy a state based earned income tax credit- that will that prevent negative childhood events and bad public health outcomes.

Report Suggests Paternal Parental Work Flexibility Improves Maternal Outcomes

A new report published this week from the National Bureau of Economic Research found increasing a father’s work flexibility after a baby is born reduces the risk of the mother having physical postpartum health complications and also improves her mental health.

Workplace flexibility has long been key factor in improving postpartum outcomes but less has been known about how a father’s work hours flexibility influences outcomes.  The paper this week examined father’s work flexibility and the affect that it has on intra-household responsibilities and the effect that that flexibility has on maternal outcomes. 

The paper examined the effect that work flexibility has in the months immediately following childbirth. The authors found that a dad’s access to workplace flexibility improves maternal health. They modeled household demand for paternal presence at home in the context of a Swedish reform that granted new fathers more flexibility to take intermittent parental leave during the postpartum period.  

Increasing the father’s work hours flexibility reduces the risk of the mother experiencing physical postpartum health complications and improved her mental health. The abstract concludes that “Our results suggest that mothers bear the burden from a lack of workplace flexibility–not only directly through greater career costs of family formation, as previously documented–but also indirectly, as fathers’ inability to respond to domestic shocks exacerbates the maternal health costs of childbearing.”

Interesting research in the context of what kinds of public health policy interventions are effective at improving maternal postpartum health, don’t you think?

Title X Family Planning Article

Andrew Howard from the Arizona Capitol Times wrote this informative story about the outcome of a 2017 state budget provision requiring the ADHS to apply for Title X family planning grant.  Many people believe that the requirement was included in the budget in hopes that the ADHS would get Title X funds (as they’re prohibited from contracting with Planned Parenthood).

I won’t say anymore about the story…  except that it’s a quick informative read about the outcome of a key public health policy decision here in AZ.  

What Can You Do this Summer RE Public Health Advocacy?

Send your elected officials a short note thanking them for their service.  The last few days were long and stressful for all.  

  • Invite them to tour your facilities over the interim.  

  • “Like” your elected officials on social media and follow them.  

  • Attend any events they are holding over the summer.  

  • Monthly send them a short note with interesting information about their district and those they serve (who you also serve!)

  • Use this time during the interim to build relationships with your home and work district elected officials so they know who are when session starts January 13, 2020.

This spreadsheet has legislator contact information and committee assignments.  Targeting legislators who serve on committees of interest to us is a good strategy to start with.  This spreadsheet has our member facilities by legislative and congressional district.  

Yuma County Captures 2019 Spotlight Award

Blue Cross Blue Shield of Arizona and fitness icon Jake “Body by Jake” Steinfeld have teamed up to shine a light on people and programs that are making Arizona healthier. The 2019 Spotlight Awards honor leaders across our state who are inspiring health and wellness in their communities, where it matters most.

WINNERS:

Business of the Year: Chicanos Por La Causa
City of the Year: City of Phoenix
County of the Year: Yuma County
Tribal Nation of the Year: Tohono O’odham
School District of the Year: Tempe Elementary School District #3
School of the Year:  Brunson-Lee Elementary