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Leadership in Congress has tasked their committees with coming up with details to slash trillions of dollars in federal funding for various programs – including Medicaid. While leadership didn’t define exactly which programs to cut – they gave the various committees the task of ‘finding the money’ to cut among the executive branch agencies that they oversee.
Among the likely early proposals will be one to cut way back on the federal contributions for Medicaid coverage for what’s known as the ‘expansion population’ (in our state that’s ‘childless adults & people between 100 and 138% of poverty).
The current plan to ‘come up’ with the cuts is to reduce the federal contribution for Arizona’s expansion population from 90% to 65%, triggering automatic coverage losses under state law. The result? Approximately 550,000 Arizonans, including low-income adults and individuals earning between 100% & 138% of the federal poverty level would be left uninsured.
Interestingly, the parts of the state that voted for Mr. Trump by the widest margins are in the very areas that stand to lose the most if these cuts happen. Thirty-six percent of working-age Arizona adults who live in rural Arizona are covered by Medicaid versus 17% who live in urban areas, data from Georgetown University’s Center for Children and Families shows.
Medicaid funding cuts could put thousands of Arizonans in peril
Arizona’s existing “trigger law” means any reduction in federal funding automatically cuts coverage for these populations unless the state steps in to fill the financial gap.
And that’s where the problem lies. Arizona’s Hospital Assessment—designed to fund the state’s share of Medicaid expansion—is already at its legal limit of 6% of net patient revenue. To keep coverage, the state would need to find nearly $1 billion annually to replace the lost federal funds.
Given the Republican majority in the Arizona Legislature, which has historically opposed increasing state Medicaid funding, there’s little chance that lawmakers will allocate the necessary resources.
Without a new funding mechanism, Arizona’s Medicaid expansion will collapse, disproportionately affecting rural residents who rely on it for primary and emergency care.
Beyond the direct human cost, these cuts will place strain on Arizona’s healthcare system. Hospitals in rural areas would have a sharp rise in uncompensated care costs as uninsured patients crowd emergency rooms—often their only choice for medical treatment (care that the hospitals won’t get paid for).
This financial pressure could force some hospitals to scale back services or even shut down, further worsening the healthcare crisis in underserved communities.
Politically, the cuts are part of a broader effort to dismantle key ACA provisions, rolling back Medicaid expansion in multiple states. While some states might be able to cushion the blow by reallocating funds, Arizona’s trigger law ensures an immediate impact.
For now, advocacy groups are focusing on convincing Representative Ciscomani to be wary of going along with a change in the federal contribution to support enrollment of the expansion population. Other representatives in a few other ‘trigger’ states like ours are also being targeted for ‘education’.
We’ll see later this year if it makes any difference.
Rep. Juan Ciscomani signals doubt about Republican Medicaid cuts
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Arizona’s public health system has been trying to navigate a storm of uncertainty due to the federal public health grant funding cuts planned by the Trump administration.
Their initiative to halt a broad spectrum of state and local public health grants and cooperative agreements has been temporarily paused by a federal judge, but the looming threat of these essential programs being eliminated remains.
Arizona’s public health system is heavily dependent on federal funding, primarily through grants and cooperative agreements with federal agencies.
Critical areas such as sexually transmitted disease prevention, high-risk perinatal programs, maternal and child health services, overdose and substance use disorder prevention, public health preparedness, SNAP education, Ryan White HIV medications, immigrant and refugee health programs, and adult vaccinations are all at risk.
The situation is further complicated by the funding structure between county health departments and ADHS (the primary grant recipient who passes the money to the counties).
Typically, county health departments run on cost reimbursement contracts, meaning they initially cover the expenses for vital public health initiatives with the expectation of being reimbursed through federal funds. With the potential freeze or reduction in federal funding, these departments face significant financial strain, jeopardizing their ability to maintain essential services.
The Trump Administration’s primary grievance with public health practice appears to be public health’s focus on health disparities and health equity – which are foundational principle of public health practice.
As reported in Governing, the Trump administration has issued orders to freeze disbursement of federal loans and grants, with language suggesting a reevaluation of programs related to diversity, equity, and inclusion.
State Health Departments Prepare for a Period of Uncertainty
The uncertainty surrounding federal funding is causing major disruptions and anxiety at the local health department level. Public health officials, their county managers and supervisors are grappling with the challenge of planning and executing programs without assured financial support.
For Arizona, the stakes are especially high. Our reliance on federal funds means that any disruption can have cascading effects on the health outcomes of Arizonans.
Sadly, despite that advocacy, it may in the end be up to judges to decide whether the administration’s goal of eliminating public health practice is a violation of law and or the constitution.
Challenging times.
Guest blog by AZPHA Member Allan Williams, PhD
In 2018, a paper by Cunningham et al in the New England Journal of Medicine reported that between 1999 and 2016, firearm injuries were the second leading cause of death among children and adolescents (ages 1-19) in the US, trailing only motor vehicle crashes.
A subsequent analysis by Goldstick et al in the same journal using data thru 2020 found that by 2020, firearm deaths became the leading cause of death in that age group, exceeding for the first time motor vehicle deaths. An additional finding was that drug overdose and poisoning deaths surpassed cancer deaths as the third leading cause.
Using the same definitions and methods as those previous reports, the situation in Arizona differed from the US in that three different causes have competed for the leading cause of death since 2020.
As shown in the figure below, drug overdoses and poisoning were the leading cause in 2020, while motor vehicle crashes were again the leading cause in 2021 and 2022.
Then, in 2023 firearm deaths became the leading cause of death.
Firearm injuries have remained the leading cause of death among children and adolescents in the US during 2022-2023. As shown below, among the states with adequate data during that period, firearm injuries were the leading cause of death in 23 states and tied with motor vehicle crash deaths as the leading cause in two states (AZ & KY).
In Arizona, 31% of the firearm deaths among youth were classified as unintentional or suicides while 63% were classified as homicides, all outcomes that could be reduced with secure gun storage legislation and public awareness by households with guns. A 500-page critical systematic review of research by the RAND Corporation (Smart et al, 2024) concluded that:
“We find supportive evidence, our highest evidence rating, that CAP laws, or safe-storage laws, reduce self-inflicted fatal or nonfatal firearm injuries, unintentional firearm injuries and deaths, and firearm homicides among youth.
There is also moderate evidence that CAP laws reduce firearm suicides among young people, and limited evidence that such laws reduce unintentional firearm injuries among adults. The evidence is stronger for negligent-storage laws than for reckless endangerment laws; reckless endangerment laws are sometimes considered a weaker form of CAP law.”
“States without negligent-storage CAP laws should consider adopting them or other safe-storage laws as a strategy to reduce total and firearm suicides, unintentional firearm injuries and deaths, and firearm homicides among youth.”
Several cities and 26 states have such laws. However, as noted in the 2023 AZPHA comprehensive report Gun Violence in Arizona: Data to Inform Prevention Policies, Arizona lacks these and most other gun violence prevention laws and ranks 43rd in the country in 2025 for the overall strength of its gun laws by Everytown Research.
Last week the legislature advanced bills to:
They failed to advance a bill that would have tasked DES with asking USDA to allow them to exclude candy and soda pop from the list of foods SNAP recipients can choose (HB2165).
This week they’ll be considering bills to:
A federal funding freeze would have major impacts on Arizona public health programs
AZ legislator takes aim at ultra-processed food in public schools
Traditional healing is close to being covered by Medicaid in Arizona
Republicans follow lead of RFK Jr. with effort to ban SNAP users from buying soda, candy
Trump administration’s website purge shocks health providers
Rental assistance proposed for people facing short-term hardship | Arizona Capitol Times
The 23rd annual American Lung Association “State of Tobacco Control” report was released this week – which evaluates states and the federal government on the proven-effective tobacco control laws and policies necessary to save lives. The report serves as a blueprint for what state and federal leaders need to do to cut the death and disease caused by tobacco use.
In the report, the Lung Association assigns letter grades, A through F, to the state and federal policies best proven to prevent and reduce tobacco use.
From the report: Arizona Highlights | State of Tobacco Control | American Lung Association
This year’s report highlights tobacco industry aggression at the state and federal level to protect its profits at the expense of the public’s health. These include tobacco industry efforts to stop former President Biden from ending the sale of menthol cigarettes and flavored cigars as well as industry efforts at the state level to stop proven-effective policies to prevent and reduce tobacco use.
The report also shows states’ progress or lack thereof on implementing policies to reduce tobacco use and help people end their addiction to tobacco.
The American Lung Association calls for the following actions to be taken by Arizona’s elected officials:
During the 2024 legislative session, the Lung Association in Arizona worked on legislation to create a statewide tobacco retail licensing system, raise the sales age of tobacco products to 21, and to include electronic smoking devices in the Clean Indoor Air Act. Unfortunately, the bill did not get a hearing.
There were also bills introduced by the tobacco industry. One bill would have created an e-cigarette product registry based on U.S. Food and Drug Administration pre-market tobacco application status that was pushed by the industry in multiple states.
A second bill would have defined heated tobacco products and taxed them at a small rate. The Lung Association opposed both bills, and, thankfully, neither bill ultimately advanced to the Governors’ office.
During the 2025 legislative session, the American Lung Association will again work diligently to educate our lawmakers on the enormous negative economic impacts that tobacco use has on Arizona.
Creating a tobacco retailer licensing system and opposing all forms of statewide preemption on tobacco product sales laws will continue to be a priority.
The rapid growth of AI tools has prompted public health organizations to explore their potential. While some may go ahead too quickly by adopting AI without fully developed rationale, others may hesitate due to uncertainty or challenges in the evolving field.
Addressing these challenges requires a thoughtful, multipronged approach — including well-designed policies — to ensure responsible and effective AI use while mitigating potential drawbacks.
To support these efforts, Developing Artificial Intelligence (AI) Policies for Public Health Organizations: A Template and Guidance offers a comprehensive and adaptable framework to help organizations craft or refine their AI policies.
It was developed by a collaboration between the Kansas Health Institute, Health Resources in Action and the Wichita State University Community Engagement Institute.
As part of this project, three key documents were developed that were used to inform the development of this document, Developing Artificial Intelligence (AI) Policies for Public Health Organizations: A Template and Guidance.
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