Will Humble Public Health Law, Wills Blog

Arizona Public Health at Risk: Join AZPHA in Defending Health and Healthcare

AZPHA stands with health professionals across the country in sounding the alarm about the damaging impact current and proposed federal policies are having on public health and healthcare infrastructure.

We’re calling on our members—and all health professionals and organizations in Arizona—to sign this national open letter opposing these destructive changes and protecting the future of public health.

This isn’t politics—it’s about protecting lives and the systems we all rely on for clean air and water, safe food and medication, access to care, and research that advances medicine.

We urge all AZPHA members and colleagues across Arizona’s health and medical communities to sign the national open letter today and encourage your peers to do the same.

Click here to sign the open letter

Each day these federal policies continue, our public health infrastructure deteriorates further. If the proposed 2026 federal budget is enacted, Arizona will see:

  • Cuts to Medicaid, threatening coverage for children, seniors, people with disabilities, and rural hospitals already on the edge of closure.
  • Decimating agencies like SAMHSA and AHRQ, which are critical to addressing the opioid crisis, mental health needs, and the safety of our healthcare systems.
  • A 50% budget cut to the CDC, impacting state and local health departments and undermining efforts to combat chronic diseases, injuries, and emerging health threats.
  • Closure of research centers and slashed NIH funding, halting Arizona-based medical research and training programs.
  • Reduced funding for maternal and child health programs, impacting vulnerable populations statewide.
  • Threats to environmental health, education, and housing—all major determinants of health.

This is not just about numbers—it’s about people, families, communities, and our collective future.

Will Humble Federal Public Health Bud, Wills Blog

Standing Up for Public Health: How We’re Helping APHA Fight Back

AZPHA recognizes the challenges we face as Trump, Kennedy and Musk continue to make decisions that are devastating our public health system….  actions that are damaging public health systems, outcomes, prevention efforts, health equity, and critical research resources.

While we know we have no ability to influence Trump or Kennedy – we can support those challenging these damaging policies using the judicial branch. APHA has taken a proactive stance by taking part as a plaintiff in several lawsuits aimed at halting harmful policy decisions. For instance:

  • APHA joined a coalition to file a lawsuit against the OMB to block a policy that paused all agency grants and loans, arguing it violated the First Amendment and the Administrative Procedure Act. See: APHA v OMB
  • In another case, APHA and other organizations challenged the secret operations of DOGE, asserting violations of the Federal Advisory Committee Act. See APHA v DOGE
  • APHA also took part in a lawsuit contesting the abrupt cancellation of research grants by the NIH, emphasizing the importance of continued support for biomedical research. APHA v Kennedy

Beyond litigation, APHA actively engages in advocacy to protect public health at the national level – just as we do at the state and local level. They’re issuing action alerts urging members and the public to contact Congress on critical issues, like opposing efforts to cut the nation’s public health workforce and advocating for strong public health funding in federal appropriations.

Recognizing the importance of these national efforts by APHA, the AZPHA Board of Directors last week decided to become the first state affiliate member of the APHA 1872 Society to support APHA’s legal actions (the name honors the year 1872 APHA was established).

By supporting APHA’s efforts, we stand united in defending public health and promoting fair health outcomes for all.

As an early member of the Society (we might be the 1st) we’ll in a position to encourage other affiliates to do the same via our Affiliate Representative on the Governing Board (Rebecca Nevadale is the lead ARGC for the country).

For more information on APHA’s initiatives and how you can get involved, visit their Public Health Under Threat page.

Will Humble Affordable Care Act, Federal Budget, Medicaid

Delayed Cuts, Immediate Costs: Budget Bill Front-Loads Tax Breaks, Defers Social Program Reductions

The US House of Representatives passed a large budget reconciliation bill last week with large tax cuts for the wealthy and anticipated spending cuts in areas like Medicaid, premium subsidies on the healthcare insurance marketplace, SNAP and WIC.

I’ve been on vacation and haven’t had much time to delve into the details of the bill (which still needs to get through the Senate), but here are the basics:

  • Medicaid Reductions
    • Introduction of stricter eligibility requirements and work requirements for certain populations.
    • Estimated to begin FY 2027, with full implementation phased in by FY 2029.
    • Cuts estimated to reduce federal Medicaid spending by hundreds of billions over ten years.
  • ACA Healthcare Marketplace Subsidy Reductions
    • Reduction or phase-out of enhanced subsidies provided under the American Rescue Plan.
    • Implementation expected to begin in 2026, after the next presidential election cycle.
  • Supplemental Nutrition Assistance Program (SNAP) Cuts
    • Tighter eligibility verification and proposed caps on benefit levels for certain recipients.
    • Changes scheduled to take effect starting in 2026, fully phased in by 2028.
  • Women, Infants, and Children (WIC)
    • Funding reduced from current levels; states expected to impose stricter enrollment caps.
    • Budgetary impact begins FY 2026, with reductions expanding through 2029.
Cooking the Books

While the tax cuts are implemented immediately (boosting after-tax income for the highest earners) the “savings” from cuts to Medicaid, SNAP and WIC are averaged over a 10-year window. 

I think it’s probable that future Congresses or administrations will modify or cancel the cuts to Medicaid and SNAP once folks understand what they will actually do to their constituents – but leave the tax cuts in place.

The Most Important Staffer in Congress You’ve Probably Never Heard Of: The Senate Parlamentarian

All this creates a fiscal illusion. Spending appears to be reduced on paper, but real-world impacts of the benefit cuts may be negligible if (when) the cuts are reversed… further exploding the deficit.

All this poses real and huge financial risks due to exploding borrowing costs. Markets are already reacting — 20-year U.S. Treasury yields are above 5%, signaling investor concern about rising long-term deficits and U.S. creditworthiness and making servicing the US debt untenable.

Let’s see what the Senate does.

Will Humble State Legislature, Wills Blog

Legislative Update: Memorial Day 2025

The AZ State Legislature remains on break for another week as they prepare to come back in June and hammer out the state budget. The majority of public health related bills have been thru the system and either passed and were signed or died a quiet death by not even having a hearing.

There are a few bills still in limbo – bulls that have made it most of the way through the system but not all the way.

Here’s a new PowerPoint with the latest on the session – from the good bills that were passed and signed, the one bad public health bill that Hobbs signed, the missed opportunities and those bills that are still languishing.

The presentation doesn’t include the budget obviously – which can have big public health implications both because appropriations (or lack thereof) and budget reconciliation bills that change PH policy.

Here’s a link to that PPT – and it’s basically what it’ll be presenting at the Rural Health Conference in early June up in Flag: 

Legislative Session Update: May 25, 2025

Will Humble Healthcare, Public Health, Wills Blog

Happy Birthday Social Security  – Guest Blog from Leonard Kirschner MD, MPH

Americans love anniversaries whether it is the birth of our nation on July 4th, our parents 50th, Pearl Harbor or 9/11. The year 2025 has a number of significant anniversaries of laws that have changed American society in uncountable ways. 

On August 14, 1935, in the height of the Great Depression, President Franklin Delano Roosevelt signed Social Security into law. Opponents fought long and hard to stop passage calling it “Socialism.” Ida May Fuller received the first Social Security check for the grand sum of $22.45.

July 30, 2025, is the 60th anniversary of the historic signing of Medicare and Medicaid into law by President Lyndon Johnson. The ceremony took place at the Truman Library in Independence, Missouri, and Harry Truman got Medicare card #1.

His premium for Part B was $3.00 per month. LBJ spoke only about Medicare and declared it a memorial to the slain JFK. Medicaid was an afterthought, added at the last moment before the law was passed by a divided Congress, and was intended to be a modest program with minimal financial impact.

Congressional opposition was fierce calling it, once again, “Socialism”.  The Arizona Health Care Cost Containment System (AHCCCS) is Arizona’s unique and successful Medicaid program.

It was July 26, 1990, President George H. W. Bush signed the Americans with Disabilities Act into law. The event took place on the South Lawn of the White House and the President considered it an extension of the Civil Rights Act of 1965.

He said, “Let the shameful wall of exclusion finally come tumbling down.” The signing was the culmination of a quarter century of advocacy by and for the members of our society with disabilities. Some opponents called it “Socialism.”

Can you believe it has been fifteen years since President Barack Obama signed the Affordable Care Act into law on March 23, 2010. I don’t believe I need to recount the battles leading up to the passage and later battles to “Repeal and Replace”. Opponents, when not talking about “Death Panels”, even called it “Socialism.” Rejecting the call to repeal was one of Senator John McCain’s finest hours. 

As we celebrate the 90th anniversary of Social Security, the 60th anniversary of Medicare and Medicaid, the 35th anniversary of the ADA, and the 15th anniversary of the ACA, remember that the passage of these five laws took years of effort, advocacy, and politics to achieve the end result of passage. 

Don’t forget that once the laws were signed, the political battles did not end.  Stay tuned for the 2025 political battles and the repeated use of that 90-year-old pejorative, “Socialism”.  The debate has not ended and will not end in our lifetime.

Leonard Kirschner MD, MPH

AHCCCS Director (1987-1993)

Past President AARP Arizona 

Will Humble Nutrition, Wills Blog

US House Agriculture Committee Advances Proposal Requiring States to Pay for Part of SNAP – Measure could end SNAP benefits if Legislature doesn’t pay up

This week, the House Agriculture Committee advanced a big (bad) change to the Supplemental Nutrition Assistance Program by approving a provision that would require states to contribute to the cost of SNAP benefits — a departure from the program’s longstanding federal funding model.

For the last few decades, the federal government has covered 100% of SNAP benefits – with administrative costs shared between federal and state governments. Under the new proposal, states with higher payment error rates could be required to cover up to 25% of benefit costs, while those with lower error rates might pay as little as 5%.

Note: the USDA hasn’t publicly released state-specific SNAP payment error rates (including Arizona’s – or at least I couldn’t find it.

The proposal is designed to cut the federal budget to place more of the cost burden for SNAP on to states. If states don’t pay up they could lose all SNAP benefits (depending on how USDA interprets the law if it passes and is signed.

I don’t need to write about how ending this benefit would harm the social determinants of health, health equity and food insecurity –  a likely scenario if Arizona’s legislature doesn’t appropriate the funds to cover the state portion as I would expect.

Will Humble Vaccination, Wills Blog

Kennedy’s War on Vaccination: FDA to Suspend Approval of Updated COVID Boosters Except for Seniors & Folks w/ High Risk Factors

In a major and dangerous policy shift, the FDA announced in a New England Journal of Medicine article that updated COVID-19 vaccines will now require randomized, controlled trials for approval in healthy individuals aged 6 months to 64 years.

This marks a departure from previous decades long practice where annual updates were approved based on immune response data, similar to the approach for influenza vaccines.

Under the new guidelines, only older adults and people with high-risk medical conditions will have access to updated COVID-19 vaccines – a change that will affect vaccine for more than 100 million Americans.

Kennedy’s Not-So-Silent War On Vaccination – AZ Public Health Association

This new dangerous policy shift is 100% in line with Kennedy’s longstanding anti vaccine outlook.

Requiring full-scale clinical trials for each updated vaccine variant is logistically impossible, not financially feasible (ROI) and will lead to preventable deaths and hospitalizations. Furthermore, conducting placebo-controlled trials when effective vaccines already exist is ethically questionable.

The FDA’s new policy is likely the first major assault in a long war that Kennedy will be undertaking over the next few years to reduce vaccine accessibility and public health preparedness.

For now, I really don’t have a call to action to stop this harmful decision – although I’ll keep thinking about it.

Note: The CDC’s advisory panel (ACIP) will be voting on this policy shift in June – and may rubber stamp of the FDA’s policy article – which will lead to the CDC no longer recommending the booster to those under 65. Health plans would then stop paying for the vaccine for those populations. ACIP members who vote against the new recommendations will likely be dismissed by Kennedy.

In Below is an excerpt from the NEJM article from this week:

“Moving forward, the FDA will adopt the following Covid-19 vaccination regulatory framework: On the basis of immunogenicity — proof that a vaccine can generate antibody titers in people — the FDA anticipates that it will be able to make favorable benefit–risk findings for adults over the age of 65 years and for all persons above the age of 6 months with one or more risk factors that put them at high risk for severe Covid-19 outcomes, as described by the CDC.”

“For all healthy persons — those with no risk factors for severe Covid-19 — between the ages of 6 months and 64 years, the FDA anticipates the need for randomized, controlled trial data evaluating clinical outcomes before Biologics License Applications can be granted. Insofar as possible, when approving a Covid-19 vaccine for high-risk groups, the FDA will encourage manufacturers to conduct randomized, controlled trials in the population of healthy adults as part of their post marketing commitment.”

Will Humble Federal Budget, Social Determinants, Wills Blog

A Familiar Idea Returns: Will ‘Most Favored Nation’ Drug Pricing Survive This Time?

Americans continue to pay more for prescription drugs than anyone else in the world. This has been a long-standing and well-documented problem. A key driver isn’t just what patients pay out of pocket—it’s the actual list prices of the drugs themselves. These prices inflate private insurance premiums, drain the Medicare trust fund, and strain household budgets across the country – damaging the social determinants of health.

One of the key reasons for this price disparity has been Medicare’s historic inability to negotiate prices directly with drug manufacturers. This changed modestly with the 2022 Inflation Reduction Act, which gave Medicare limited authority to negotiate the prices of a small number of high-cost drugs.

It was a step forward, but really a C-. By contrast, a more aggressive bill—H.R. 3, the Lower Drug Costs Now Act—would have required the Medicare to negotiate prices for hundreds of drugs. That bill did not pass in large part because Senator Sinema cut a deal with big pharma to sabotage HR3.

‘Inflation Reduction Act of 2022’ Gets a C- for Cutting Prescription Drug Prices – AZ Public Health Association

This week the Trump administration block, copied, and pasted the executive order from his first term to use ‘international reference pricing’ to cap what Medicare pays for some Part B (physician administered) drugs.

This “Most Favored Nation” approach would tie Medicare payments for physician-administered drugs (Part B Drugs) to the lowest price paid by similar wealthy nations. On paper, it’s an appealing proposal. After all, why do we pay two to four times what other countries pay for the same meds?

Note: The EO only applies to Part B Drugs administered by physicians – not Part D drugs (the lion’s share of medications). Medicare spends about $150B on Part D drugs vs. just $50B on Part B drugs – so this proposal doesn’t include the majority of meds and none of the drugs one gets at the pharmacy.

During Trump’s first term his HHS Secretary finished a rule to apply MFN pricing to 50 high-cost drugs, but the rule was blocked by the courts before it could take effect.

Pharma’s Big Con: Keep the Scam Going by Confusing Prescription Drug Prices with Out-of-Pocket Costs – AZ Public Health Association

Fast forward to the 2.0 drug EO this week: The administration has issued a new executive order trying the same thing again. The language and structure are almost identical to the earlier version that was struck down. And so, the question looms—will the courts allow it this time?

Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients – The White House

There’s reason to be skeptical. If the new version doesn’t address the legal shortcomings of the earlier rule it’s likely to also crash and burn.

Still, it’s not meaningless. It keeps the conversation alive and signals – for the first time – bipartisan frustration with drug pricing in the U.S.

Whether through MFN pricing, more aggressive negotiation powers for Medicare, or robust patent reform, meaningful change is still both necessary but elusive because of the chokehold big pharma has on Congress.

For now, the new executive order is worth a try—but don’t hold your breath. And remember, HR3 would have been an ironclad solution.

‘Inflation Reduction Act of 2022’ Gets a C- for Cutting Prescription Drug Prices – AZ Public Health Association

Will Humble Public Health, Wills Blog

A Breath of Fresh Air: Sheila Sjolander Named Interim ADHS Director

We’re delighted to share that Sheila Sjolander has been appointed as the interim director of ADHS! This is good news for public health in Arizona—and a breath of fresh air for county health departments across the state.

Sheila is no stranger to public health and ADHS. She’s been shaping public health policy and strategy in Arizona for more than two decades. Most recently, she served as Deputy Director for Public Health Services, overseeing a team of over 700 public health professionals across the divisions of Prevention, Preparedness, and Licensing.

Before stepping into the deputy director role, Sheila worked for more than 10 years as Assistant Director for Prevention Services – including areas like maternal and child health, WIC, physical activity and nutrition etc.

She’s also been on the front lines of health improvement, strategic planning. Her efforts have earned her well-deserved recognition, including the Outstanding Achievement in Rural Women’s Health award in 2016 and the CHW Champion Award in 2017.

Sheila’s commitment to helping Arizona’s county health departments is steadfast and consistent. 

Sheila earned a Master of Social Work from Temple University, and brings a unique blend of compassion, experience, and strategic vision to her new role.

As ADHS enters this new chapter, Sheila’s appointment feels like the good fit. We look forward to seeing how her leadership uplifts ADHS’ mission.

P.S. I’ve been trying to confirm who is the interim director at AHCCCS but haven’t been able to independently identify who it is – all I have right now is grapevine stuff.

Will Humble Public Health, Wills Blog

The Science & Community Impacts Mapping Project

Science transforms our world but doing science and the impacts of scientific research are often hidden from view. Not anymore.

That’s because the Science & Community Impacts Mapping Project now allows folks to explore how science and health fuels the economy, supports jobs and improves health outcomes.

The White House and Secretary Kennedy have ordered large cuts to federal funding for scientific research. These changes include a proposal to reduce support for all health-related research nationwide, and cancellations of many grants for specific research projects.

We encourage you to contact your local elected officials and representatives in Congress to share your opinion and call attention to these funding cuts. Click here to find contact information for your representatives. Here are some facts to keep in mind:

  • Less than 1% of the federal budget goes to NIH, but this investment has a big impact.
  • Federally funded scientific and medical research improves health, drives innovation, creates jobs, and grows the economy.
  • Every dollar invested in scientific research through NIH produces, on average, $2.56 of economic activity in return – over 250% gain.
  • NIH research supports over 400,000 jobs across the U.S.
  • Reducing indirect cost rates to 15% would undermine the ability of universities, hospitals, and research institutes to conduct lifesaving, medical research.
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