Will Humble Public Health Law, Wills Blog

2025 Supreme Court Decisions: A Mixed Bag for Public Health

One of the most important parts of the U.S. Constitution is its system of checks and balances. This system makes sure that no one branch of government—Congress, the President, or the Supreme Court—has too much power.

The Supreme Court plays a critical role by interpreting the law and protecting people’s rights, especially when politics get extreme (like now). In times like these, when big public health challenges are hitting the nation (some of the challenges self-imposed by Secretary Kennedy and the president)… an independent US Supreme Court plays an even more important role than usual.

Did the Court exercise that independence from the executive branch this session? The answer is yes and no. This year’s decisions were a mixed bag for public health.

Some hoped SCOTUS would bring clarity and a cool head. Instead, it delivered a mix of confusing and sometimes conflicting rulings.

The Court said states can block minors with gender dysphoria from getting doctor-prescribed treatments. It also weakened workplace diversity, equity, and inclusion programs, and stopped patients from suing states that refuse to work with health providers who also perform abortions.

Rural hospitals also lost their case for better Medicare payments to cover care for low-income patients.

Still, it wasn’t all bad. In Kennedy v. Braidwood, the Court upheld the U.S. Preventive Services Task Force [more on this in the next blog] keeping (for now) key preventive services like colorectal cancer screenings for adults 45–49, depression screenings for teens, and HIV prevention medications like PrEP. But as we’ll see in the next blog – that relief is likely temporary as Kennedy still has plenty of time to dismantle the Task Force.

The Court also backed federal powers to regulate vaping products that attract kids and “ghost guns” that can’t be traced. And it made it easier for people to challenge federal benefit denials and for students with disabilities to seek protection.

Big thanks to AzPHA member James Hodge, JD, for breaking down these important cases in his article in the Journal of Law, Medicine & Ethics. Read more here.

Will Humble Healthcare, Wills Blog

Arizona Needs to Submit a Rural Health Transformation Plan in 3 Weeks: What’s the Plan?

The clock is ticking for Arizona to submit a plan to use money from the new Rural Health Transformation Program that was created by Congress to blunt the political fallout from cuts to Medicaid enacted under HR1.

When HR1 was signed into law on July 4, 2025, it extended big tax breaks for high income households and corporations while reducing federal funding for Medicaid, SNAP, and other core public health programs.

Those cuts (especially to Medicaid) will eventually have long-term bad impacts on rural hospitals (urban hospitals are less exposed because they have less exposure to Medicaid and a more diverse payer mix).

In the coming years, the HR1 cuts will weaken rural hospital finances. Some will cut or end services like labor and delivery. Others will be forced to close altogether.

To offset those coming effects (or I would argue to provide political cover) Congress set up the Rural Health Transformation Program. The program gives $10B per year for five years across the US (FY 2026–2030). Arizona’s share is $100M per year (for 5 years).

The plans are due soon – on November 5

Governor Hobbs has tasked the Governor’s Office (rather than AHCCCS or ADHS) to develop Arizona’s plan.

CMS released the Notice of Funding Opportunity on September 15  and state plans are due November 5, 2025 — less than three weeks from now. CMS is supposed to approve or deny each proposal by December 31, 2025.

Note: States are prohibited from using RHTP dollars to finance the non-federal share of Medicaid expenditures, and administrative costs can’t exceed 10% of the total state allocation. Annual expenditure reports will be required each federal fiscal year (October 1–September 30).

To support Arizona stakeholders, the UA Center for Rural Health made a Rural Health Transformation Program Toolkit. The site includes a Policy Brief that outlines the program’s structure, funding restrictions, and key considerations for shaping Arizona’s proposal.

See the UA Center for Rural Health 2-Page Policy Brief

With the plan due in less than a month, now is the time for rural health leaders, hospital administrators, and community advocates to review the materials and provide input to the Governor’s Office.

I believe the point person for the Plan in the Gov’s Office is Meaghan Kramer… so that appears to be the person to contact to try to influence how AZ plans to allocate the funds.

 

Will Humble Professional Development, Wills Blog

Public Health Journalism this Week

Nutrition program for women, infants and children to stay afloat through end of month | Arizona Mirror

Federal funding cuts test resilience of AZ HIV care services | Arizona Mirror

The nation’s community health centers face money troubles | Arizona Mirror

Biggs is critical of enhanced tax credits for ACA health insurance

Americans reject RFK Jr.’s health leadership and federal vaccine policies, poll shows | Arizona Mirror

Jeffrey Amos King sentenced to 14 years for $1.2B Medicare fraud

Arizona’s newborn screening program is expanding. Here’s how

Will Humble Wills Blog

Arizona Public Health Association Announces 2025 Public Health Awards

Phoenix, AZ (Oct 15., 2025) — The Arizona Public Health Association (AzPHA) is celebrating the 2025 Public Health Awards on Thursday, October 23, at the vibrant 435 Collective in downtown Phoenix. The annual event recognizes outstanding public health professionals, advocates, and policymakers performing extraordinary services in communities across Arizona.

This year’s honorees represent a diverse and impactful group of leaders:

  • Public Health Research Award: Dr. Megan Jehn (Arizona State University, SORT) and Dr. Kristen Pogreba Brown (University of Arizona, SAFER)
  • Pete Wertheim Public Health Leadership Award: Barbara Lang (Cochise County Health & Social Services) and Jeanne Nizigiyimana (Valleywise Health Center for Refugee and Global Health)
  • Alida Montiel Indigenous Health & Advocacy Award: Frances Villescaz (Gila River Health Care, AIHEC)
  • Rising Public Health Champion Award: Jeffery Hanna (Zeihan ProHealth)
  • Senator Andy Nichols Award: Karen Woodhouse (ADE, Eyes on Learning)
  • Policy Maker of the Year: Arizona Attorney General Kris Mayes

“These awards are more than recognition—they’re a reflection of the deep commitment and innovation happening across Arizona’s public health landscape,” said Will Humble, MPH, Executive Director of AzPHA. “From rural counties to urban centers, our honorees are tackling complex health challenges with compassion, evidence-based strategies, and a relentless drive to improve lives. Their work inspires all of us to keep pushing for a healthier, more equitable Arizona.”

The evening will bring together public health professionals, community leaders, and advocates for a night of celebration, networking, and reflection on the legacy of public health in Arizona—dating back to AzPHA’s founding in 1928.

Tickets are on sale now for $45 and include access to the awards ceremony, networking reception, and light refreshments. Space is limited—reserve your spot today at https://azpha.wildapricot.org/event-6235564

About the Arizona Public Health Association

Founded in 1928, the Arizona Public Health Association (AzPHA) is a nonprofit membership organization dedicated to improving the health and well-being of all Arizonans. AzPHA brings together public health professionals, students, advocates, and community members to advance sound public health policy, promote health equity, and strengthen the public health workforce. Through education, advocacy, and collaboration, AzPHA works to ensure that every community in Arizona has the opportunity to thrive. For more information, visit azpha.org.

Will Humble Health Insurance, Wills Blog

Telehealth Ends for Most Medicare Members

Telehealth has been an efficient way to provide certain kinds of health care services for many people on Medicare – providing easier access to healthcare for patients and better use of time for providers ever since the pandemic.

That’s now changed, and Medicare has largely ended telehealth in certain areas, with new geographic restrictions that affect how and where (and sometimes whether) Medicare members get their care via telehealth.

The expansion of telehealth during the pandemic showed remarkable improvements in access to care as documented in a Kaiser Family Foundation report. Before the pandemic, Medicare’s telehealth coverage was limited. Only patients in rural areas or specific settings had access, and visits had to be conducted via real-time audiovisual technology.

The public health emergency lifted those barriers, letting Medicare members use telehealth for a broad range of services, including behavioral health, chronic disease management, and primary care visits. 

A study published in Health Affairs highlighted how these changes improved care access for members who had struggled to see their doctors regularly. Older adults, those living in rural & underserved areas, and patients managing multiple chronic conditions helped the most.

Geographic Restrictions & Behavioral Health Services

On October 1 the geographic and other limitations on Medicare telehealth came back. Telehealth services (for Medicare members) are now limited to rural areas unless members receive specific services, like monthly visits for home dialysis or certain mental health treatments.

This means that telehealth services will generally be limited to rural areas, and patients will need to receive services at specific originating sites, such as medical facilities, rather than from their homes.

Medicare Telehealth Flexibilities and CMS Operations During Government Shutdown – ASCO

Note: there are still some exceptions to the geography rules for behavioral and mental health services. These services can still be provided via telehealth to Medicare beneficiaries in both rural and urban areas and patients can receive these services in their homes 

Traditional Medicare will still cover telehealth services for some mental and behavioral health care, some substance use disorder treatment, end stage kidney disease assessments and emergency stroke care even in urban areas.

Traditional Medicare will no longer cover telehealth services for routine primary care visits, chronic disease management (e.g. diabetes care, heart disease, arthritis etc.), or follow up visits.

So, if you’re a traditional Medicare member in the Phoenix or Tucson metro areas and require telehealth for general care, chronic disease management, specialist consultations or most follow-up services, you’ll likely need to visit a healthcare facility in person now. Don’t blame your doctor, their staff or your health insurance. You can blame congress and the president. 

Medicare Advantage Plans May Offer More Flexibility

Medicare Advantage plans sometimes offer more flexibility when it comes to telehealth. These private plans sometimes have broader coverage options and may not be as restricted by geographic limitations. If you’re enrolled in a Medicare Advantage plan, check with your plan provider to understand the specific telehealth benefits and flexibility.

What Could Have Been

It didn’t have to be this way. The bipartisan CONNECT for Health Act offered a comprehensive and efficient solution. This bill proposed permanent expansions of telehealth in Medicare (including the removal of geographic site requirements that restrict telehealth to rural areas) and drops in-person visit rules for behavioral health.

Importantly, it also included measures to reduce potential fraud and abuse, something sorely needed to prevent fraud and make telehealth services sustainable over time. Those measures include setting stricter guidelines for billing and ensuring better auditing of services.

The CONNECT Act also addresses concerns about overuse of telehealth by focusing on finding high-value services that are proper for virtual care.

Sadly, it appears that Congress will wait until they hear from mad constituents before they take up the CONNECT Act – or when Congress finally makes a budget deal, maybe they’ll extend the added telehealth flexibility that proved so useful during the pandemic.

Will Humble Professional Development, Wills Blog

France: Their Public Health & Health Care Systems

From Croatia, our travels take us to France, famous for their food, wine, culture and health care system. France often ranks among the healthiest places in the world. I’ll take a crack at explaining why.

Health Care: Universal Insurance with Personal Freedom

France’s health care system is built on national health insurance. Everyone is covered, with funding coming from payroll and general taxes. Patients can choose their own doctors, and fees are regulated to keep care affordable. Most people buy supplemental coverage (mutuelles) to cover co-pays, but the baseline system guarantees care for all.

Hospitals are a mix of public and private, all working under national price controls and quality standards. Unlike the U.S., there’s nobody uninsured.

Public Health Framework

The Ministry of Health provides national policy leadership, while the Agences Régionales de Santé run programs locally. This ensures that immunization campaigns, infectious disease surveillance, and hospital inspections are standardized but responsive to local needs, much like in the US. Santé publique France, the national public health institute, tracks health outcomes, runs surveillance systems, and offers scientific guidance.

Oversight of Facilities

Hospitals, nursing homes, and child care facilities are licensed and regularly inspected by the regional Agences Régionales de Santé using national standards. These inspections cover hygiene, staffing, patient safety, and quality of care. Child care facilities also fall under the Ministry of Education, but health and safety oversight is coordinated through regional Agences Régionales de Santé ARS inspectors.

Food Safety and Restaurant Oversight

France has rigorous food safety rules shaped heavily by the EU. The Ministry of Agriculture and Food Sovereignty manages national policy, while local health authorities inspect restaurants, markets, and producers.

EU rules limit additives, require detailed labeling, and ensure traceability from farm to fork. Restaurant inspections check for hygiene, safe storage, and compliance with these EU standards.

Emergency Services

France’s emergency medical service is unique: ambulances are staffed with physicians or advanced nurses, not EMTs and paramedics like here.

This means hospital-level care often begins at the patient’s doorstep. Epidemiology and outbreak response are centralized through Santé publique France, with regional ARS coordinating local action.

Clinical Workforce

Like in the US, France also suffers from a shortage of physicians. Until 2020, acceptance to France’s medical schools was regulated by the “numerus closus” which set strict limits on how many students could enter the schools annually.

While the annual acceptance number was supposed to account for population growth, the process was highly influenced by the Ordre des Médecins, France’s powerful physicians accreditation board (like the AMA kinda), which wanted to keep access to the profession exclusive.

The 2020 pandemic brought to light the severe shortage of physicians and the numerus closus were eliminated. Today, each medical school works collaboratively with their Agence Régionales de Santé to set their own admission limits, which considers regional population growth and medical desert.

Training physicians takes time and the first cohort of non-numerus closus physicians won’t be ready to practice until 2029 at the earliest  (9 years post highschool). France has been working to create a new level of nurses, similar to the US Nurse Practitioner model, which has been receiving lots of resistance from the Ordre des Médecins.

Nutrition, Physical Activity and Urban Planning

France is designed for walking, even here in Paris. Cities have dense cores with wide sidewalks, bike lanes, and pedestrian-only areas. Public transport systems are robust, reducing reliance on cars. Cycling is encouraged through dedicated bike infrastructure, and Paris in particular has expanded bike lanes dramatically in recent years.

The result is purposeful physical activity, walking to the store, biking to work, and using stairs instead of cars. Walking is a normal part of daily life, one of the reasons why they have way lower obesity rates compared with the U.S.

Farmers Markets are an integral part of a city’s urban planning and French’s way of life. Visit any town in France and you will see a “Place du Marché” where open-air farmers markets still take place to this day (beware of where you park your car the eve of a market-day!). Farmers Markets (open-air or covered) are part of Parisian’s weekly (and in some cases, daily) activities. There is a farmers’ market every day of the week and the Ville de Paris maintains a calendar of events.

There, Parisians access fresh and locally sourced produce, meats and fish that support a healthy diet. Farmers’ markets also support a strong local economy; with the high fixed costs of brick and mortar stores (and uncertainty around folks passing by your location to purchase your goods), many small businesses choose the itinerant modalities of the farmers market and bring their goods directly to their customers around the city.

Mental Health and Substance Use

Mental health services are fully integrated into the national system. Psychiatric hospitals and clinics provide inpatient and outpatient care, while community-based mental health centers are expanding. Treatment for serious mental illness is covered under insurance, ensuring access regardless of income.

Substance abuse services like alcohol and opioid treatment are provided through hospitals and specialized clinics, often with strong links to social services. France has pioneered harm reduction policies, including safe injection sites in major cities.

Alcohol Consumption and Health

Alcohol plays a large cultural role in France, especially wine, but binge drinking is rare even though the drinking age is 18 rather than 21. Per capita consumption is higher than in the U.S., though it has declined in recent decades due to public health campaigns and taxation policies, although I have to say a nice bottle of Burgundy is only like 10 euro.

Reproductive Health

Shortly after the US Supreme Court Dobbs decision, France’s Assemblé National (legislative body) was swift in identifying the need to guarantee women access to their full suite of health care and reproductive health services. The agreement was widely accepted across all political parties (a rarity) and France started the process to amend their constitution.

On March 8, 2024, the following statement was included in Article 34 of the Constitution “ The law determines the conditions under which Women have the guaranteed freedom to access a “Voluntary Interruption of Pregnancy” and France became the first country in the world to guarantee access to abortion services in their constitution.

The Role of the European Union

EU membership shapes much of France’s public health policy. Food ingredient rules are stricter than in the U.S., banning many additives and requiring clear labeling. EU environmental and occupational health directives influence air quality standards and workplace safety. The EU also coordinates cross-border infectious disease surveillance, ensuring France has early warning for outbreaks.

Localities can’t set their own health policies like restricting universal access to care, changing to rules around immunizations requirement to start school or altering a pandemic response set by the central government

Health Outcomes Compared to the U.S.

● Obesity: 17% of adults, compared to over 40% in the U.S.

● Smoking: Higher than the U.S. but declining due to tobacco control.

● Alcohol: Higher than the U.S. but falling steadily.

● Life Expectancy: Around 82 years, several years higher than in the U.S.

Supplemental Material:  Differential Diagnoses | A comparative History of Health Care Problems and Solutions in the United States and France by Paul V. Dutton (brief book review here). Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France (The Culture and Politics of Health Care Work): 9780801445125: Medicine & Health Science Books @ Amazon.com

Will Humble Public Health, Public Health Law, Wills Blog

Federal Government Shuts Down: A Public Health Summary

I’m on the road on vacation so I don’t have the ability to really dive into the public health and healthcare implications of the federal government shutdown – but fortunately the Association of State and Territorial Health Officers (ASTHO) has a decent summary of the implications.

The executive branch posted a shutdown contingency plan document this week outlining the HHS and USDA plans. In short, HHS plans on  retaining approximately 47,257 (59%) of its staff and furloughing 32,460 (41%).

The Office of Management and Budget sent out a memo to federal agencies with directives related to a potential shutdown open_in_new. The memo requested that agencies submit RIF (firing) notices in addition to any furlough notices, which are traditionally issued as part of a shutdown.

Additionally, there is a request that agencies revise their RIF plans when a resolution on continued appropriations is reached to retain the minimum number of employees necessary to carry out statutory functions. It is unclear how this memo intersects with the HHS contingency plans delineated below.

HHS

HHS “will cease all non-exempt and non-excepted activities” like oversight of extramural research contracts and grants, processing FOIA requests and public inquiries, data collection, validation, and analysis.

HHS’s Program Support Center, Financial Management Portfolio, Payment Management Services, and Division of Payment Management will be operational and retain the necessary staffing in an excepted status to ensure delivery of grant payments for excepted programs.

The PMS and DPM will follow specific processes to ensure payment of permissible disbursements. HHS says they’ll maintain the Grants.gov system in an operational status, but with reduced federal support. The Grants.gov Contact Center will remain available and assist callers. HHS will provide the federal grantor community with guidance and updates in the event of a government shutdown.

CDC

CDC will continue to respond to urgent disease outbreaks and continue efforts. CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) will not be available to provide guidance to state and local health departments implementing programs to protect the public’s health, nor will they provide communication to the American public about important health-related information.

Grant funding announcements will not be prepared, resulting in compressed timelines for applicants, such as state and local health departments and universities, to apply for funding.

CMS

CMS Medicare program will continue. CMS has enough Medicaid funding for the first quarter of FY26. CMS will continue Federal Marketplace activities, such as eligibility verification, using Federal Marketplace user fee carryover.

FDA

FDA activities funded through carryover user fee funding and other un-lapsed funding will continue. This includes certain activities related to the regulation of human and animal drugs, biosimilar biological products, and medical devices, and all FDA activities related to the regulation of tobacco products.

FDA activities related to imminent threats to the safety of human life or protection of property would continue. This includes detecting and responding to public health emergencies and continuing to address existing critical public health challenges by managing recalls, mitigating drug shortages, and responding to outbreaks related to foodborne illness and infectious diseases.

The FDA will also reduce food safety efforts within the FDA’s Human Foods Program. Longer-term food safety initiatives, including policy work aimed at preventing foodborne illnesses and diet-related diseases, would be halted, jeopardizing public health.

HRSA

HRSA will continue to oversee activities through mandatory funding, advance appropriations, prior year carry-over funds, and user fees. HRSA will continue to oversee certain direct health services and other activities with carryover balances, such as:

  • Health Centers
  • Ryan White HIV/AIDS program — Parts A and B
  • Ending the HIV Epidemic
  • Teaching Health Center Graduate Medical Education
  • Family to Family Health Information Systems
  • National Health Service Corps

Indian Health Service

IHS received advance appropriations for FY26. The majority of IHS-funded programs will remain funded and operational in the event of a lapse of funding. Advance appropriations, third-party collections, and carryover balances will continue to fund the provision of care by the Indian Health Service, Tribal Health Programs, and Urban Indian Organizations. Facilities construction projects supported with previously appropriated funds will also continue.

SAMHSA

SAMHSA will continue substance use and mental health programs vital to safety and protection. This includes programs that provide critical behavioral health resources in the event of a natural or human-caused disaster, like Disaster Behavioral Health response teams, the 24/7 365-day-a-year Disaster Distress Helpline that provides crisis counseling to people experiencing emotional distress after a disaster, and the 988/Suicide Lifeline to connect people in crisis with life-saving resources.

SAMHSA will continue previously funded operations and utilize available balances to provide essential resources to those seeking help for behavioral health concerns through the Treatment Services Locator program, the Treatment Referral Line, and the Suicide and Crisis Line.

Most SAMHSA grants awarded in the prior year will have funds that remain available to be spent by the grantee, including, for example, the 988 and Behavioral Health Crisis Services program, the State Opioid Response Grant program, and the Mental Health and Substance Use Block Grants.

USDA

As of publication, USDA has not released an updated FY26 contingency plan. Therefore, we do not have official information about the WIC program.

Note: Some of the budget negotiations hinge on whether to extend the enhanced advance premium tax credits for Marketplace plans. For more on that visit:  ACA Premiums Set to Increase in 2026 as Enhanced Marketplace Premium Tax Credits Expire – AZ Public Health Association

Will Humble Professional Development

AZPHA Member Breakfast & Learn Arizona Literacy Plan 2030: Building Student Success and a Stronger Future

Friday, October 10, 2025

9-10am


Literacy is the key to student achievement, a strong workforce, and Arizona’s future. 

Arizona Literacy Plan 2030 is the product of over a yearlong process of gathering input from partners and stakeholders from across the state and is endorsed with their commitments to take meaningful steps in support of it.

Learn more about the plan and how it outlines the key drivers, proven strategies, and actions required to improve school readiness and third-grade reading outcomes.  


Our Speaker: Lori Masseur,

Early Learning Director at Read On Arizona

Lori’s Bio: As director of early learning, Lori Masseur guides Read On Arizona’s collaborative work on several strategic priorities related to improving school readiness, early literacy, and systems-building efforts in our state, including data integration, expanding effective literacy practices, and building educator capacity for early learning professionals.

Lori has more than 20 years of experience in early childhood education, most recently as part of the Arizona Department of Education’s early childhood education team, supporting the work of teachers and administrators in providing high-quality educational opportunities for children from birth to age 8. She served in various capacities over her eight years at ADE, including deputy associate superintendent of early childhood education and director of the Arizona Head Start State Collaboration Office.

Her experience includes overseeing the revision of Arizona’s Infant Toddler Developmental Guidelines as well as Arizona’s Early Learning Standards and early childhood funding manual. Lori also helped develop Arizona’s successful Comprehensive Literacy State Development Grant application and served on the advisory committee for Child Care in 35 States: What We Know and Don’t Know from the Bipartisan Policy Center.

Lori has a bachelor’s degree in elementary education from the University of Arizona and a master’s in reading and curriculum instruction from Grand Canyon University.

Register Here – Free for AZPHA Members

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