2025 - AZ Public Health Association

Kennedy & Oz announced the grant awards for the Rural Health Transformation program last week… funds allocated by Congress as political cover for the deep Medicaid cuts enacted in HR 1, which will hit rural hospitals and providers hard beginning in 2027.

While Arizona was awarded $167M (out of the $200M we applied for), this short-term grant funding is nowhere close to offsetting the big financial losses rural hospitals will experience once HR 1’s Medicaid changes take effect.

Feds shortchanged state on rural health, Gov. Hobbs says

NOTE: Kennedy and Oz’s grant award formula greatly favored deep red states, with Alaska receiving $368 per person. Next are WY at $353 per person. By contrast, Arizona is getting just $22 per capita. California gets a paltry $6 per person.

Arizona Submits Rural Health Transformation Grant Application to Feds – AZ Public Health Association

RHT Program State Project Abstracts

Arizona’s original application emphasized two priorities that matter deeply to rural communities: building a durable rural health workforce and improving access to care. That focus is still sound even as the overall funding level doesn’t.

CMS Announces $50B in Awards to Strengthen Rural Health Focusing Mostly on Red States

Workforce Development

The most important and most lasting part of Arizona’s proposal is our emphasis on workforce development. The state requested $57M per year for 5 years to support education, training, recruitment, and retention strategies for rural health professionals.

According to our application, the Rural Health Workforce Development and Training Program is designed to recruit and keep clinicians and allied health professionals through:

High school and Career and Technical Education pathways
Expanded rural clinical rotations and residency programs
Financial incentives such as stipends, commuting aid, and relocation support
Training and upskilling tied to rural service commitments

The proposal also recognizes a critical reality: retention matters just as much as recruitment. Long commutes, housing shortages, professional isolation, and burnout regularly drive clinicians out of rural practice.

Arizona got $167 million of the $200 million requested and it’s unclear which elements of the application were cut. One can only hope that the workforce development components were preserved. They’re the most strategic part of the plan and the piece most likely to deliver long-term value beyond the life of the grant.

Stabilizing Fragile Systems

Beyond workforce development, Arizona’s plan includes a Priority Health Initiative focused on behavioral health and substance use disorder treatment, chronic disease prevention and management, and maternal, fetal, and infant health.

The proposal also aims to expand telehealth infrastructure, support mobile and satellite care models, and reduce administrative strain on rural providers through subsidized electronic health record licenses and shared back-office support services that many small rural clinics can’t afford on their own.

Funds will flow through subawards and cooperative agreements to rural hospitals and clinics, local governments, educational institutions, and community-based organizations. The state also plans to invest in secure data systems, dashboards, and fiscal tracking tools to meet federal accountability requirements.

Grants Can’t Replace Medicaid

Sadly, workforce planning or telehealth investment can compensate for deep, structural Medicaid cuts. HR 1 will reduce coverage and reimbursement in ways that directly threaten rural hospital solvency. RHT grants may smooth the edges temporarily, but they’re not a substitute for stable, predictable Medicaid financing.

Ideology Permeates the Program

Oz said this week these grants may come with strings that go way beyond rural health transformation. Oz said he and Kennedy intend to reassess state funding annually and “claw back” RHT dollars if states fail to fully embrace the administration’s broader agenda, including anti-vaccine positions and nutrition initiatives like restricting what foods can be purchased with SNAP benefits.

Oz and Kennedy basically are saying that the RHT funds are a compliance tool to force states to risk having to pay back RHT money they’ve already invested if they don’t adopt Kennedy’s politically driven (and non-evidence based) policies that have nothing to do with rural care delivery.

Oz’s threat to claw back funds already spent if he thinks the state’s governor isn’t enthusiastically adopting Kennedy’s agenda is sabotage, but maybe the courts will intervene if Oz and Kennedy follow through with their threats.

Oversight?

Implementation matters. Oversight of Arizona’s RHT funds will rest with the Arizona Office of Economic Opportunity, a small, roughly 10-person office housed in the Governor’s Office rather than a state agency.

While the grant application says there will be coordination with agencies that already manage workforce and Medicaid programs, capacity is a real concern for me.

Given the scale and complexity of these funds, it would make sense to give direct responsibility to AHCCCS and ADHS which have more mature procurement, compliance, and accountability infrastructure.

Hopefully the Office of Economic Opportunity has more capacity than meets the eye. Time will tell.

Note: Revised RHT Grant 2026

Revised RHT Grant Budget Chart

December 29, 2025December 28, 2025

Will Humble Social Determinants, Wills Blog

How Arizona’s Medical Debt Proposition (209) is Helping Families’ Health

In November 2022, Arizona voters overwhelmingly approved Proposition 209, the Predatory Debt Collection Protection Act which protect families from spiraling medical debt and aggressive collection practices.

Prop 209 passed by a remarkable 72 % to 28 % margin, showing strong bipartisan support across the state.

AzPHA vocally supported the measure and went up against debt buyers and sellers during the campaign.

What Prop 209 Did

Prop 209 put in place common-sense reforms that matter for health and economic stability:

Capped the interest rate on medical debt at the lesser of 3 % per year or the weekly average one-year Treasury yield, significantly how fast medical debt grows.
Expanded exemptions from debt collection including higher protections for home equity, vehicles, bank accounts, and household goods so that families are less likely to lose those when a medical emergency strikes.
Reduced wage garnishment exposure so that only up to 10 % of disposable earnings can be taken to pay unsecured debts, leaving more income available for rent, food, and care.

Hobbs’ Action: Cancelling Medical Debt Using Federal Funds

Last week Governor Katie Hobbs recently announced a medical debt cancellation initiative that brings real relief to nearly 500,000 Arizonans with medical debt. The creative plan used federal pandemic relief funds to buy up and cancel medical debt at one penny on the dollar.

Because medical debt portfolios can be bought for a fraction of their face value, state dollars go far often buying down hundreds of dollars of debt for every dollar spent… which is why the debt could be bought for so cheap.

Debt cancellation through this initiative offers real, measurable gains:

Improved access to care: Without overwhelming debt hanging over them, families are more likely to seek preventive care and fill prescriptions lowering long-term health risks.
Reduced stress: Financial strain is a well-documented risk factor for poorer mental and physical health. Eliminating medical debt can lessen chronic stress and its associated harm.
Greater economic stability: With wage garnishment reduced and debt erased, families keep more income for essentials such as housing, utilities, and food — all critical social determinants of health.
Preservation of assets: Prop 209’s exemptions, paired with debt cancellation, mean families are less likely to lose a car, home, or savings due to an emergency health event.

Proposition 209 and the Hobbs’ debt-buyout program represent a two-pronged strategy: one prevention-oriented (through reforming debt collection law) and one relief-oriented (through targeted cancellation).

Editorial Note: The timing of Hobbs debt buyout comes just as people who get their health insurance via the Marketplace are making decisions about their plans. Because the enhanced advanced premium tax credits are now gone – many will be buying high-deductible bronze plans – which are often the source of medical debt… people who buy high-deductible plans to reduce their premium.

December 28, 2025December 28, 2025

Will Humble Public Health, Wills Blog

Who Did More Harm to Public Health in 2025 Kennedy or Rubio?

For much of 2025, public-health debates in the United States have focused on the damage being caused by Health Secretary Robert F. Kennedy Jr. with his reckless vaccine policy decisions, deep funding cuts, the wholesale firing of experienced public-health professionals across HHS agencies, and the loss of trust in public health institutions like the CDC.

His actions weakened domestic health protections and further eroded trust in science, evidence-based decision-making, and the scientific method itself.

But even accounting for all of Kennedy’s harm, the most destructive public-health decision of 2025 didn’t come from his agency. It came from the Secretary of State Rubio via elimination of the U.S. Agency for International Development.

That decision will cost more lives, undermine more health systems, and increase global health risk more than any other public health policy choice made this year. It also delivered a severe blow to America’s ability to lead through diplomacy.

USAID Provided Key Global Public Health Infrastructure

For decades, USAID was one of the most important public-health institutions on the planet, arguably more consequential than the World Health Organization or the Gates Foundation. It served as a core pillar of global disease prevention and health-system stability. Today, it’s gone.

USAID funded (and held partners accountable for) infectious-disease surveillance, HIV treatment, tuberculosis, malaria prevention, maternal and child health services, clean water and sanitation systems, nutrition programs for mothers and infants, vaccine delivery infrastructure, and health workforce training in developing nations.

USAID’s work stopped outbreaks before they became pandemics. It reduced mass displacement. It stabilized regions where collapsing health systems fuel hunger, conflict, and migration. It improved women’s health, helped families plan their futures, and helped entire populations escape poverty.

USAID focused on upstream prevention on a global scale. It was also one of our most effective tools for building diplomatic influence.

Hard Power, Soft Power & Why USAID Mattered

In international affairs, countries project power in two ways. Hard power relies on forces like military strength, sanctions and the threat of punishment. Soft power relies on trust, humanitarian aid, scientific cooperation, and being seen as a reliable partner acting in good faith.

USAID was a key to U.S. soft power. When we helped countries prevent disease, strengthen health systems and keep children alive and families out of poverty, it built credibility. We earned cooperation and trust. It made our leadership legitimate.

Rubio’s elimination of USAID dismantled global public health infrastructure and dramatically weakened our soft power… broadcasting that the U.S. is transactional, unreliable, and disinterested in shared global responsibility.

That erosion of trust will obviously make cooperation during future emergencies more difficult. It will even make collaboration more difficult when a future administration wants to restore the U.S.’ role as an international force for good.

The Damage Is Underway

Thanks to Secretary Rubio disease surveillance is collapsing, meaning outbreaks are detected later or not at all. Interruptions in HIV and tuberculosis treatment are fueling drug resistance, which will inevitably reach us as well.

Gaps in maternal and child health services are translating into preventable deaths. Weakening vaccine infrastructure invites the return of diseases that were on the decline.

Who Owns This Decision

Responsibility for the decision is clear. As Secretary of State, Rubio presided over, defended, and even trumpeted the dismantling of USAID. President Trump supported it. Elon Musk helped drive the ideological thrust that made it possible.

Together, they reframed global public health as expendable “foreign aid” rather than what it is: a frontline defense against disease, instability, humanitarian catastrophe… and a key source of U.S. soft power.

What History Will Remember

Kennedy has done plenty of damage to public health in 2025. But history will judge the elimination of USAID as something worse: an abdication of public health responsibility trading several decades of disease prevention and diplomacy in exchange for personal ambition and professional survival.

History will remember Rubio’s decision as an abandonment of global public health and soft power, not dollars “saved.”

December 24, 2025December 22, 2025

Will Humble Health Insurance, Healthcare, Wills Blog

Congress Fails to Extend Enhanced Health Insurance Tax Credits

The clock has run out for folks hoping Congress will help make their Marketplace health insurance more affordable.

Even though a small number of Republicans in the US House recently joined Democrats to support a discharge petition to force a vote on extending the enhanced premium tax credits (none from AZ including Ciscomani), it came too late to matter for next year.

Speaker Mike Johnson has refused to bring the bill to the floor, and under House rules, any vote wouldn’t happen until January.

Health plans that start January 1, 2026 are already priced and no longer include the former enhanced advance premium tax credits.

Even if the House acts in January, it’s doubtful the Senate would follow. The practical result is straightforward: the enhanced premium tax credits are almost certainly gone.

As a result, Marketplace premiums will rise a lot for most of the 350,000 or so Arizonans who buy Marketplace health insurance.

Those former enhanced subsidies mainly helped people earning between 138% and 400% of the federal poverty level, working adults who don’t qualify for Medicaid and don’t get insurance through a job.

The impact will be different depending on how much the person or family makes.

People closer to 138% of poverty will see the largest percentage increases in premiums.
People between 300% and 400% of poverty will face large dollar increases — often hundreds of dollars more per month.

Folks will now be making various choices depending on their values and family circumstances. I can think of 4 different ways this will affect Marketplace customers:

They’ll drop coverage altogether, gambling that they won’t get sick or injured. Healthier and younger people will disproportionately choose this option – further damaging the risk pool and making premiums go up in the long run.
They’ll downgrade plans, moving from Gold or Silver to Bronze plans with lower premiums but sky-high deductibles.
They’ll pay more and cut back elsewhere, staying in the same plan category but sacrificing other household needs.
They’ll change jobs for insurance, giving up freelance work or small businesses to find employer-sponsored coverage.

ACA Premiums Set to Increase in 2026 as Enhanced Marketplace Premium Tax Credits Expire – AZ Public Health Association

The former enhanced premium tax credits have worked exactly as intended. KFF data show they helped drive record marketplace enrollment and made coverage affordable for middle-income families who were previously priced out.

This was a policy choice. Congress has chosen higher premiums, fewer insured people, a weakening of the risk pool leading to higher long term premiums, more medical debt and uncompensated emergency department care.

Remember that in November.

How to handle Obamacare uncertainty

December 23, 2025December 22, 2025

Will Humble Maternal Health, Public Health, Wills Blog

Evidence-Based Advocacy Comes at a Price: Kennedy Punishes the American Academy of Pediatrics for Disagreeing with the New Hepatitis B Vaccine Guidance

Last week Kennedy canceled numerous federal grants previously awarded to the American Academy of Pediatrics. The decision came right after the Academy publicly criticized a new Advisory Committee on Immunization Practices recommendation to delay the Hepatitis B vaccine for some newborns.

Kennedy’s message: Criticize my agency policies and you’ll lose your funding.

The grants that were cut supported work the AAP has done for years like educating pediatricians & parents about vaccines, improving maternal & child health care, preventing injuries, strengthening clinical guidance, and helping doctors reach families with evidence-based health information.

Kennedy’s action highlights a fact that many nonprofits face (including AZPHA): Advocacy that stays true to your mission caries a financial risk.

It happens at the state and local level too. AzPHA learned this years ago, when we lost our largest organizational member and sponsor over our support for evidence-based firearm safety legislation. A couple of years ago we lost a county health department organizational membership for the same reason.

Every nonprofit receiving government funding faces this same calculation. Do we speak authentically and vocally when policies supported (or opposed) by an organizational member or sponsor threaten public health, or do we stay quiet to protect revenue?

That’s why diversified funding matters so much. Nonprofits that rely too heavily on a single government agency whether federal, state, or local are more exposed when their priorities differ from those of their funder.

A broad mix of funding sources provides a buffer. It allows organizations (like us) to tell the truth, even when it makes politicians and appointees mad.

That’s what we’ve been striving for at AZPHA over the last few years… a broader base of member organizations to diversify our funding and provide a financial buffer so we’re able to do evidence-based advocacy and buffering revenue risk.

Advocacy grounded in evidence and mission will sometimes upset funders. But if nonprofits stop advocating for what they believe in they’ll stop being who they are.

Public health depends on organizations willing to speak up like the American Academy of Pediatrics and AZPHA even when it costs them.

December 22, 2025December 22, 2025

Will Humble Public Health, Wills Blog

Phoenix Imposes Criminal Penalties for Providing ‘Street Medicine’ in Parks without the Parks Director’s Permission

Last week the Phoenix City Council voted 8–1 to pass a sweeping new ordinance banning volunteer street-medicine services in city parks unless providers first get a permit from the city’s Parks and Recreation Department Cynthia Aguilar (who wrote the ordinance).

Phoenix bans syringe access, limits medical events in city parks

Beginning in April it will be a criminal Class 1 misdemeanor for volunteers to provide medical services in parks without a permit from Aguilar. Disobey by providing health related humanitarian aid without a permit & you’ll face 6 months in jail, big fines and a permanent criminal record.

View Aguilar’s Ordinance

The new ordinance squarely targets the services provided by Phoenix Street Medicine to persons experiencing homelessness. Phoenix Street Medicine is a program coordinated by the UA Mel & Enid Zuckerman College of Public Health with collaboration from UA College of Medicine, ASU, NAU, Midwestern University, and Creighton University. One of the co-founders is AZPHA Board Member Jeffery Hanna.

Their mission is simple and evidence based: meet people where they are, rather than expecting them to navigate a system that often shuts them out. The program hosts about 12 outreach events each month, mostly at Hance Park in downtown Phoenix.

The humanitarian services they provided were wide-ranging and practical, including:

Blood pressure, blood sugar, cholesterol, and A1c screening
Physical exams, wound care, foot care, and other urgent needs
Flu, COVID-19, and Hepatitis A vaccines
Mental health screening and education
Narcan distribution to prevent overdose deaths
Vision screening and prescription glasses
Help with medications, daily living needs, and referrals to clinics and community resources

The program was also an important professional-development resource. Medical, nursing, and public-health students gain real-world experience working with high-need populations under the supervision of licensed clinicians.

That training helped build a workforce that understands trauma-informed care, harm reduction, and the realities of homelessness in Arizona.

The 8-1 council vote came despite hours of public testimony from dozens of physicians, nurses, public-health professionals, service providers, students, and community members.

Many of them (including Arizona Public Health Association members) urged the council to slow down, reconsider, or narrow the ordinance. They warned that criminalizing basic medical care would make people sicker, not safer. The council approved it anyway.

The authority to issue or deny Phoenix Street Medicine permits rests Aguilar, who will have unilateral power to approve or deny permits.

Judicial review may not matter because there are no clear standards, timelines, or appeals process laid out in the ordinance. Or maybe judicial review will work because of the lack of those criteria?

My biggest concern is that Aguilar will simply refuse to issue permits to Phoenix Street Medicine, effectively shutting down the services. If (when) that happens people experiencing homelessness will lose access to basic care, and the city will see more preventable crises spill into emergency rooms and jails.

Phoenix has chosen enforcement over compassion and people experiencing homelessness will pay the price if (when) permits become a tool to block care rather than enable it.

Time will tell.

December 20, 2025December 22, 2025

Will Humble Professional Development, Wills Blog

Public Health Upcoming Events

AZPHA Member Breakfast & Learn

American Indian Health Education Center (AHEC) Workforce Development

Friday, January 9, 2026

9am – 10am

Our Speakers: Brooke Rector & Angel Sanchez

Brooke Rector
Brooke Rector is the Youth Program Coordinator for AIH-AHEC, where she works to expand health career opportunities for Native students, address the underrepresentation of Native professionals in healthcare, and help alleviate workforce shortages. She leads the Youth Career Pathways Program, collaborating with tribal leaders, elders, and healthcare institutions to ensure that training is grounded in traditional knowledge while incorporating modern medical practices.

Brooke also coordinates summer programs, health clubs, and student resources that provide youth with hands-on exposure to careers in medicine, nursing, public health, and allied health fields. She is passionate about promoting health across Arizona, particularly among youth and underserved communities.

Angel Sanchez
Angel Sanchez is the Academic Pathways Coordinator for AIH-AHEC. He holds a Bachelor of Public Health from Arizona State University and a Master of Public Health from the University of Arizona. Angel previously worked as a Student Support Specialist at ASU’s College of Health Solutions.

In his current role, he supports high school and college students pursuing careers in healthcare and public health, applying his knowledge of healthcare policy and administration to strengthen Tribal communities and address workforce needs across Arizona.

Register Here

The Hertel Report Winter State of the State Conference

Join The Hertel Report’s Winter State of the State on Friday, February 13, 2026, featuring our bi-annual Arizona healthcare market update hosted and moderated by Publisher Jim Hammond.

$15 Discount for AZPHA Members: Use Code AZPHA2026

WINTER STATE OF THE STATE

Friday, February 13, 2026

Networking & Breakfast Begins 7am

Program: 8am to 10:30 am

Orange Tree Golf Resort, Scottsdale

Virtual Attendees Welcome!

The Hertel Report’s 2026 Winter State of the State Conference features a morning of networking, a full breakfast, and timely insights on Arizona’s healthcare market. Get the latest updates on Medicaid, Medicare Advantage, Marketplace, ACOs, and commercial market trends, and explore how the Trump administration’s priorities are shaping health policy, public health, and the strategies Arizona’s healthcare leaders are using to navigate the evolving landscape.

December 19, 2025December 22, 2025

Will Humble Professional Development, Wills Blog

Public Health Journalism this Week

Who’s Who in Arizona Healthcare for 2026 – AZ Big Media

Arizona advises providers continue giving Hep B vaccine

Arizona lawmaker wants to ban fluoride from drinking water

Will Humble fears RFK Jr.’s vaccine policies will make them unavailable for everyone. Here’s how

Phoenix bans syringe access, limits medical events in city parks

Arizona group tracks untreated mental illness in violent crimes

December 18, 2025December 18, 2025

Will Humble Medicaid, Social Determinants, Wills Blog

UPDATED: Where Does Arizona’s Medicaid Work Requirement Planning Stand? A Summary

Arizona has been working on Medicaid work requirements for several years. AHCCCS (our state Medicaid agency) even received federal approval for a waiver to start work requirements in 2024 due to a law signed by Ducey in 2015.

AHCCCS Asks Permission to Implement Work Requirements & Five-Year Benefit Limit – AZ Public Health Association

But before the program could launch Congress passed HR1, which set new, national work requirements for every state.

Because of that change, Arizona will now begin work requirements on the same timeline as the rest of the country. Right now, that start date is expected to be January 2027.

AHCCCS says they don’t plan to start work requirements early using the old waiver. Instead, they’ll move forward under the new rules in HR1.

What HR1 Means for Arizona

HR1 makes work requirements part of federal law. It also limits the federal government’s ability to change or weaken those rules. Even though Mehmet Oz is in charge of CMS, HR1 doesn’t give him the power to create new, nationwide policy. Congress wrote HR1 so states (not CMS) decide the details of who’s exempt, as long as states stay within the boundaries of the law.

But- if a state proposes exemptions that Oz thinks are too broad he can argue that the state is outside the HR1 guardrails and can decide not to approve their state plan.

This means Arizona should have the flexibility to define things like:

Who’s “medically frail” (e.g. able bodied)
Who counts as a caregiver
What counts as a temporary illness
What hardship or “good cause” exemptions look like
What documentation people need to show
How work hours will be checked

Oz can review a state’s choices, but he can’t rewrite the rules or add new exempt groups. His job (via HR1) is to make sure Arizona’s following HR1, not to micromanage the program.

UPDATE: View CMS Guidance for Work & Community Engagement Requirements

UPDATE: View the American Hospital Association’s Take on the Work/Community Engagement Requirements

What AHCCCS Has Done So Far

Think of what AHCCCS is doing right now as grading a road before construction begins. They know the path they need to take, but they’re still waiting for instructions about the exact “route and materials” required. CMS says more guidance will come by June 2026.

Much of the planning AHCCCS has already completed for its earlier waiver can now be reused. I expect them to use many of the same definitions and processes they developed last year. This helps keep the work moving while they wait for more federal direction.

See: AHCCCS Asks Permission to Implement Work Requirements & Five-Year Benefit Limit – AZ Public Health Association

AHCCCS is also looking at how people will report their work activities. They haven’t yet decided whether this tool will be inside Health-e-Arizona Plus or linked to it, but the goal is to make the process as simple as possible for members.

CMS has also encouraged states to reuse systems they already have, such as the work-verification tools used for SNAP. This could make it easier for members who already report work information for other programs.

Costs and Planning

AHCCCS has estimated the costs of getting ready for the 2027 start date. You can find these on pages 7 and 195 of their FY 2027 budget request: : FY2027 AHCCCS Budget.

These numbers may change as Arizona learns more from CMS and moves further down the implementation road.

Editorial Note: In my experience rewriting code on a legacy computer program to bolt on a new set of circumstances is fraught with challenges. Usually, the person that wrote the initial code is long gone and often the code documentation is lost or never existed – making it super hard for the programmers.

Add to that government agencies often don’t have the funds to get started writing the code and or don’t have the parameters they need to make the changes in time. This often leads to the deployment of untested programs that have all kinds of glitches. In this case – the glitches will end up with persons who meet the work requirements being unable to prove it to the agency that they do and then losing all health insurance.

Time is a critical factor. Let’s hope AHCCCS has things sufficiently lined up to be able to execute this effectively in 13 months.

1 2 3 … 28