Our Legislative Session Advocacy Approach

This week marks the beginning of the 2020 legislative session.  The kickoff will be the Governor’s address to the legislature where he’ll outline what he sees as priorities.

Our Advocacy Approach

AzPHA will follow the session closely and express our support or opposition to bills based on a simple core principle…  we support bills that will have a positive impact on public health especially when they are evidence-based or evidence-informed.  We will oppose bills that are likely to have a negative impact on public health.  Our support or opposition to bills is located on the https://www.azleg.gov/ site under RTS Current Bill Positions (a summary of the system went out in last week’s update).

We have a host of Resolutions that also guide our advocacy which are posted on the members only website.  The fact that we have Resolutions on so many core public health priorities make it easy for us to be swift with our support or opposition. Our Resolutions go all the way back to the 1930s.  They are initiated by either the Board or our members and all resolutions have been voted on and approved by our members.

Our Public Health Policy Committee has a discussion board on Basecamp and that’s also where we post information, research and documents related to public health policy.  Let me know if you’d like to sign up for that Basecamp site at willhumble@azpha.org. Our policy committee also has conference calls every other Monday starting tomorrow at 11 am.  The call-in number is 641.715.3580 and the Code is 389388.

Harmful Reproductive Health Education Bill

We haven’t started our full review of bills as most have not yet been proposed.  We have, however, signed up in opposition to SB1082 which would make it more difficult for schools to provide evidence-based and age appropriate reproductive health education. The bill proposes to prohibit age appropriate reproductive health education before 8th grade and would place additional administrative barriers on schools that will discourage them providing this important curriculum topic.

Here’s our statement in the RTS system on the Bill:

Teen births are the number one cause of inter-generational poverty resulting in poor health outcomes and avoidable reliance on public benefits. Evidence-based and age appropriate reproductive health education in schools reduces teen births- and is an important tool to reduce teen births and inter-generational poverty. 

This bill includes burdensome administrative requirements that will discourage school districts from providing reproductive health education and will increase teen births and the resulting poverty, poor health outcomes and reliance on public benefits.  

For example, Texas has a very restrictive reproductive health school requirement (similar to those in this Bill) and also has among the country’s highest teen birth rate.

US Preventive Health Services Task Force Accepting Applications to Serve

In the last 10 years a prevention model of health has woven its way into the fabric of traditional models of care. With the passage of the Affordable Care Act, the role preventive services has expanded significantly in the US health care delivery system.  Preventive health care services prevent diseases and illnesses from happening in the first place rather than treating them after they happen.

Category A & B” preventive services recommended by the US Preventive Services Task Force are now included (at no cost to consumers) in all Qualified Health Plans offered on the marketplace. In addition, many employer-based and government-sponsored health plans have included Category A & B preventive services in the health insurance plans they offer to their respective members.

Currently, the United States Preventive Services Task Force recommends more than 50 Category A or B preventive health services.  Category A services are those that “…  there is high certainty that the net benefit is substantial”.  Category B services are those that: “… the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial”.

The Task Force operates within the Agency for Healthcare Research and Quality.  The Task Force consists of a panel of experts representing public health, primary care, family medicine, and academia.  They update the list of recommended services by reviewing best practices research conducted across a wide range of disciplines.

The Preventive Health Services Task Force is currently accepting applications to serve on the Task Force.

This is a terrific opportunity for a mid to late career public health professional to serve the public health community, improve outcomes in the US, develop further professionally, and to increase your professional network connections.

DATES:

Nominations must be received in writing or electronically by March 15th to be considered for appointment (to begin in January 2021).

NOMINATION SUBMISSIONS:

Nominations must be submitted electronically or in writing, and should include:

  • The applicant’s current curriculum vitae and contact information, including mailing address, and email address; and

  • A letter explaining how this individual meets the qualification requirements and how he or she would contribute to the USPSTF. The letter should also attest to the nominee’s willingness to serve as a member of the USPSTF.

AHRQ will later ask people under serious consideration for USPSTF membership to provide detailed information that will permit evaluation of possible significant conflicts of interest. 

Interested individuals can nominate themselves. Organizations and individuals may nominate one or more people qualified for membership on the USPSTF at any time. 

ADDRESSES:

Submit your responses either electronically or in writing to: https://uspstfnominations.ahrq.gov/register, Lydia Hill, ATTN: USPSTF Nominations, Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Mailstop: 06E53A, Rockville, Maryland 20857.

SUPPLEMENTAL INFORMATION:

USPSTF members currently meet three times a year for two days in the Washington, DC area. A significant portion of the USPSTF’s work occurs between meetings during conference calls and via email discussions.

Member duties include prioritizing topics, designing research plans, reviewing and commenting on systematic evidence reviews of evidence, discussing and making recommendations on preventive services, reviewing stakeholder comments, drafting final recommendation documents, and participating in workgroups on specific topics and methods.

Members can expect to receive frequent emails, can expect to participate in multiple conference calls each month, and can expect to have periodic interaction with stakeholders. AHRQ estimates that members devote approximately 200 hours a year outside of in-person meetings to their USPSTF duties. The members are all volunteers and do not receive any compensation beyond support for travel to in person meetings.

FOR FURTHER INFORMATION CONTACT:Lydia Hill at coordinator@uspstf.net.

For more information, including nominee selection, qualification requirements, and additional background information: https://www.federalregister.gov/documents/2020/01/07/2020-00019/solicitation-for-nominations-for-members-of-the-us-preventive-services-task-force-uspstf

Lots Happening on the Tobacco Control Front

There has been a lot of action to better regulate tobacco products in the last couple of weeks.  Here’s my summary of what’s been happening.  Keep in mind that the FDA’s statements have sometimes in flux and statements sometimes contradict themselves within hours – but here’s where we are as of today:

Tobacco 21

  • Congress passed and the president signed a budget bill that has raised the federal age of sale of all tobacco products to 21 years old. 

  • The 21 buy-age applies as of now in Arizona.  No further legislative action (at the state level) is required in order to implement the law.

  • The law is being implemented immediately.  The FDA could have taken several months to activate the 21 buy age provision.  Astonishingly (at least to me) they elected to activate the provision immediately.

  • The tobacco 21 provision is accomplished by amending the Tobacco Control Act of 2009, which established at that time a federal age of sale of 18. 

  • FDA’s existing enforcement authorities apply, called the Synar provisions. If states don’t comply with Synar then funding from SAMHSA’s Substance Abuse Prevention and Treatment Block Grant is supposed to be withheld (that grant is $20M+ in AZ.

  • Synar was amended in last week’s budget to remove the existing requirement that states have minimum age of sales laws (in other words AZ doesn’t need to pass a T-21 law to keep the SAMHSA Block Grant).  

  • Funding was included in the bill for states to do the Synar compliance and enforcement activities.

Electronic Cigarettes

Last week the FDA also announced a few policy decisions related to electronic cigarettes.  Here’s that stuff:

  • The Tobacco 21 provisions apply to all tobacco products including electronic cigarettes.

  • The FDA is banning the sale of fruit, candy, mint, and dessert flavored small cartridge electronic cigarettes.  Menthol flavors will still be allowed.  The flavor ban exempts large (tank based) refilling cartridges.  Right now small cartridges are 60% of the market and the big refillable cartridges are 40%.

  • Companies that don’t cease manufacturing, distributing and selling  unauthorized flavored cartridge-based e-cigarettes (other than tobacco or menthol) within 30 days risk FDA enforcement actions.

  • All e-cigarettes will be going through an FDA review beginning in May and only those products that demonstrate “benefit for U.S. public health” will be allowed to stay in the retail market.

  • The FDA intends to prioritize enforcement by focusing on:

    • Any flavored, cartridge-based product (other than a tobacco- or menthol-flavored e-cigarettes;

    • Other e-cigarettes for which the manufacturer has failed to take (or is failing to take) adequate measures to prevent minors’ access; and

    • E-cigarettes that are targeted to minors (under 21).

Stay tuned.  As we’ve seen, federal agencies can change their minds quickly and without notice these days.

Note: These provisions don’t impact the Smoke Free Arizona Act.  We still need to get a super-majority of the legislature to approve a bill that amends that voter initiative to include e-cigarettes in order to get e-cigs out of our bars, restaurants and other places of employment.

Voice Your Opinion this Legislative Session

As the leading public health professionals in the state, it’s important that you engage in public health policy development. After all, we’re the people that have first hand knowledge about the public health implications of the decisions that our elected officials make.

The good news is that it’s easier than ever to voice your opinion. Our state legislature has a transparent way to track bills through their www.azleg.gov website. The site allows you to track when bills are being heard in committee and provides an opportunity for you to express your support, opposition, or neutrality from your home or office.  

The main URL to bookmark in your computer is http://www.azleg.gov – which is the State Legislature’s official website.  It got an overhaul last year making it easier to work with.

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

The dark blue tabs provide more detailed info about the bill.  For example, the “Documents” tab displays the actual language of the bill including the most recent versions.

You’ll see that bills have committee assignments on the Bill Status pages. You can easily check the committee agendas each week on the website too.  Go to the “Committee Agenda” and pull up the agenda for the committee you’re interested in.  

Most of the bills we’ve been following and advocating for or against have been assigned to either the House Health Committee or the Senate Health and Human Services Committee.  This year the House Health Committee meets on Thursdays at 9 am. The Senate Health & Human Services Committee meets Wednesdays at 9 am.

I’m encouraging all of you to weigh in for and against bills when you believe that it’s in the best interests of public health to do so. It’s straightforward.

First you need to create an account with an e-mail address and a password. You’ll need to go down to one of the kiosks in the House or Senate to set up your account and password- but after that you’ll be able to sign in for or against bills from your home or office. If you don’t want to use your work email address you can use a personal e-mail.

Once your account is set up, you can sign in support or against any bill at the Azleg’s My Bill Positons site at https://apps.azleg.gov/RequestToSpeak/MyBillPositions 

Even if you don’t have an account, you can click on each bill and find out who has signed in for or against or neutral on the bill.  Just go to the tab over each bill that says “RTS Current Bill Positions” and you’ll see who has signed in support or against each bill. Sometimes you’ll see our name up there (AzPHA).

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