2026 - AZ Public Health Association

May 19, 2026May 10, 2026

Will Humble Public Health Law, State Legislature, Wills Blog

Potential 2026 Ballot Measures: A Public Health Perspective

Once the budget deal is done, expect a fast-moving wave of ballot referrals. These measures don’t go to the Governor. If they pass both chambers, they go straight to voters. That makes them one of the Legislature’s most powerful tools to shape policy without the risk of a veto.

Here are the key referrals with public health or civic health implications that have already cleared at least one chamber:

Potential Legislative Ballot Referrals

HCR2056 – medical mandates; right to refuse
Status: Passed the House; waiting for Senate floor vote
This would put a sweeping constitutional “right to refuse” medical mandates before voters. While framed as personal liberty, the practical effect would be to significantly weaken the state’s ability to respond to infectious disease threats and future public health emergencies and make vaccination rates plummet.

If this makes it to the ballot AZPHA will definitely oppose it.

SCR1004 – photo enforcement systems; voter approval
Status: Passed the Senate; waiting for House floor vote
This asks voters to prevent cities not already using photo enforcement from ever using it. Cities currently using it would need to get voters to approve continuing to use it. While there’s little evidence that photo radar saves lives and prevents injuries – photo red light enforcement (when properly placed) definitely saves many lives and prevents injuries.

If this makes it to the ballot AZPHA would likely oppose it.

HCR2058 – AHCCCS; comprehensive claims audit
Status: Passed the House; moving through the Senate.
This referral would require a comprehensive audit of AHCCCS. AZPHA has not taken a position on this measure; its impact will depend heavily on how the audit is structured and implemented, including potential effects on access to care and administrative burden.

I’m not sure whether AZPHA would oppose this or not if it makes it to the ballot.

SCR1001 – citizenship; identification; contributions; early voting
Status: Passed the Senate; waiting for House floor vote.
This is a far-reaching election overhaul that would tighten rules around early and mail-in voting, including shortening early voting timelines and adding new requirements. Taken together, these changes would make voting less accessible with downstream effects on representation and the policy decisions that influence community health.

AZPHA will oppose this if it makes it to the ballot

SCR1005 – elections; foreign contributions; prohibition
Status: Passed the Senate; advancing in the House.
This proposal would constitutionally restrict foreign national contributions tied to ballot measures. AZPHA has not taken a position; it falls into the broader civic infrastructure category that shapes policy and resource decisions affecting health.

I’m not sure whether AZPHA would oppose this or not if it makes it to the ballot.

See the PowerPoint Summary

Potential Voter Initiatives

The following are the voter initiatives that are in the field gathering signatures – which may make the ballot if enough good signatures are filed and if they survive legal challenges:

Free, Fair and Secure Elections Act

Status: Gathering Signatures

This measure would add a fundamental right to vote in the Arizona Constitution. It guarantees the ability to vote in person on Election Day at any voting center in your county, early in person through the Monday before the election, and early by mail for any election.

It prevents the Legislature from shortening the early voting period and requires any voting restrictions to be narrowly tailored and justified by a compelling state interest.

The measure also allows voters to sign up to automatically receive mail ballots, sets rules for when they can be removed from that list, and requires ID for in-person voting. Voters without ID can cast a provisional ballot and verify their identity later. The state must provide free ID cards to those who need them.

AZPHA will likely support this measure if it makes it to the ballot.

Protect Education Act

Status: Gathering signatures

This measure adds stronger oversight to Arizona’s Empowerment Scholarship Account (voucher) program while keeping access for students with disabilities and others who qualified before 2022. It limits newer eligibility (from the 2022 expansion) to families earning $150,000 or less (adjusted each year).

It tightens how ESA funds can be used, banning things like luxury purchases. Schools, tutors, and service providers must register annually, pass fingerprint clearance, and meet state standards. Schools must be accredited or give state tests (with exceptions for students with disabilities).

It also allows the Legislature to add more ESA rules, provides funding through fees and recovered funds, and increases state oversight of private schools receiving ESA money.

AZPHA will likely support this measure if it makes the ballot

Already on the Ballot

HCR2021 (Food tax cap)
Status: On the November 2026 ballot

This measure would cap city and town taxes on groceries at 2% and require voter approval for any increase above that level. It preserves some local control but limits how much municipalities can rely on food taxes for revenue.

Unsure whether AZPHA will take a position on this one

HCR2055 (Cartels as terrorist organizations)
Status: On the November 2026 ballot

This measure would require Arizona to designate drug cartels as terrorist organizations and direct state agencies to respond using available enforcement tools. It’s largely a policy statement with unclear practical impact, since terrorism designations are typically handled at the federal level.

AZPHA unlikely to take a position on this one

SCR1004 (Ban on mileage tracking/taxes)
Status: On the November 2026 ballot

This measure would prohibit the state from tracking vehicle miles traveled or imposing taxes or fees based on mileage without a driver’s consent. It effectively blocks future road-funding models tied to mileage, including those sometimes discussed for electric vehicles.

AZPHA unlikely to take a position on this one even though it comes to us via Sen Hoffman

May 19, 2026May 10, 2026

Will Humble Public Health, Wills Blog

Hantavirus on a Cruise Ship: Serious, But Not a Pandemic in the Making

There’s been a lot of hype over the last couple weeks about hantavirus cases linked to a cruise ship that left Argentina on April 1 and later reported several severe illnesses and deaths linked to a hantavirus.

It’s good to take this seriously. Hantavirus can be dangerous for the people who get sick. But let’s keep this in perspective: this is not the beginning of a pandemic.

The strain is Andes virus strain of the hantavirus, a type of hantavirus found in parts of South America. The Andes strain is different from the hantavirus strain most Arizonans remember from the 1993 Four Corners outbreak in Indian Country. That outbreak was linked to Sin Nombre virus, which is mainly spread when people breathe in dust contaminated by infected deer mouse urine, droppings, or saliva.

The Andes version is unusual because it can spread from person to person. But that doesn’t mean it spreads easily. Transmission generally requires sustained close contact with someone who is sick, more like the kind of prolonged close-quarters exposure we worry about with tuberculosis, not the casual, highly efficient spread we saw with COVID-19.

It is not something that will sweep through airports, schools, workplaces, or grocery stores.

That is why the public health response is focused and practical: find passengers, figure out who had meaningful exposure, watch them for symptoms, and act quickly if someone gets sick.

That is also what is happening locally. Maricopa County Public Health is following an Arizona resident who was on the ship. They’re asymptomatic right now but being checked by public health for 42 days.

Maricopa County Public Health’s follow-up is exactly the kind of quiet, routine work that keeps small events small. Monitoring one exposed person doesn’t mean the community is at risk. It means the system is doing its job.

There is one federal angle worth calling out. Kennedy fired the CDC’s Vessel Sanitation Program staff last year – including the epidemiologists who led CDC’s cruise-ship outbreak response.

Bottom line: the hantavirus cases on the cruise ship are serious for the people affected and worth investigating carefully. But, for the general public in Arizona, the risk is extraordinarily low.

Maricopa County’s follow-up is prudent public health practice, not a sign of danger. This is a contained outbreak investigation, not the next pandemic.

May 18, 2026May 12, 2026

Will Humble Suicide Prevention, Wills Blog

Suicide: A Public Health Crisis Behind Bars

Guest blog from AzPHA member Andy Hall, MS, PhD

Many are aware of the class-action litigation over healthcare in Arizona’s prisons that began in 2012, and many know that the system’s healthcare program was recently placed in receivership after years of failure to meet Constitutional standards. Meanwhile, a healthcare crisis in the Maricopa County Sheriff’s Office (MCSO) jails has gone largely unnoticed.

I paid the jails no attention until the Arizona Republic ran a piece in August 2024 by Jimmy Jenkins titled “Dying in the Dark.” Jenkins looked at the numbers, identities and causes of death for everyone who died in MCSO custody from 2019 to 2023. He found that although the average daily population (ADP) in the jails had declined, deaths had risen dramatically over that five-year period.

Investigation finds ‘astronomical’ death rate in Maricopa County jails

Indeed, the number of deaths in the jails had nearly quadrupled in the most recent three years. Office of Medical Examiner (OME) autopsies showed that 43 people (most awaiting trial) died in MCSO custody in both 2022 and 2023, far higher than the 2019 total of eleven.

Moreover, the numbers from those two years led to the finding that Maricopa’s rate of jail deaths was four times higher than the national average. And, astonishingly, drug overdoses, withdrawals and suicides were found to account for the majority of those deaths.

Jenkins’ findings were so eye-opening that I began tracking the Sheriff’s monthly inmate deaths listings and requesting autopsies from OME. While numbers of jail-attributable deaths have been a tad lower since 2023, the autopsies continue to tell a very troubling story.

In 2024, MCSO listed 27 deaths. Knowing that might not be the whole picture, I asked OME for a review. That review found seven jail-attributable deaths not counted by MCSO, for a total of 34 jail deaths that year. For 2025, MCSO’s listing showed 39 deaths. OME added two cases, for a total of 41 deaths last year, 75 over the two years.

Behind the totals, OME autopsies continue to show extremely high numbers of “accidental” drug intoxication deaths, accounting for 46% (16 of 34) of 2024 deaths and 51% (21 of 41) of 2025 deaths. One-third of 75 deaths over the 2024-25 period were determined “natural” by OME examiners. This means that the remaining two-thirds, whether accidental, suicide or homicide, were preventable.

While the accidental death numbers are extremely troubling, close reading of the autopsies reveals an even more distressing aspect — the number of people who die very shortly after booking, some within hours.

In both 2024 and 2025, many accidental drug deaths occurred within the first 48 to 72 hours after people entered the jail system, raising urgent questions about intake screening, withdrawal management, monitoring, and emergency response.

In 2024, ten of the sixteen drug deaths happened within 72 hours of admission. Likewise, ten of twenty-one 2025 accidental deaths occurred very shortly after booking, several within 48 hours. The OME reports are terribly disturbing to say the least. What’s going on?

Maricopa County Corrections Annual Report

In a recent interview on jail overdose deaths, Sheriff Jerry Sheridan stated that in his 40+ years at MCSO, he knew of only two cases of staff bringing drugs into the jails. He said, “..there are drugs in the jail system and that’s just the way it is in every jail and in every prison in this country.” Since, in his view, drug deaths simply can’t be blamed on MCSO staff, the Sheriff has removed the scanners used by his predecessor to screen employees.

County jail overdose deaths are up as sheriff defends removing employee scanners

Amid all these deaths (161 from 2022 through 2025, with the overwhelming majority accidental and otherwise preventable), Correctional Health Services (CHS) is responsible for providing a full continuum of care from intake through release in the County’s jails.

In the CHS 2025 Annual Report, Director Lisa Struble boasts of three 2025 National Association of Counties Achievement Awards, claims the CHS Opioid Treatment Program serves as a national model, and states CHS will continue to “set the standard for excellence in correctional healthcare.”

And yet, Struble’s report makes absolutely no mention of deaths occurring in the Maricopa County jail system! With a death rate found two years ago to be far higher than other large metro jail systems, such LA County, New York’s Rikers Island, Cook County, Illinois, and Harris County, Texas, CHS simply cannot credibly claim to set any kind of “standard for excellence” in jail healthcare. Ignoring the problem won’t make it go away.

140 Dead in Los Angeles Jails Since Start of 2023 | Vera Institute

Sheriff Sheridan and Ms. Struble are in denial. Meanwhile, a hell of a lot of people are dying. Immediate investigation is needed to understand why accidental deaths and suicides in our jails are so high and to figure out what must be done to address this true public health crisis.

– Andy Hall, MS, PhD, is retired after a varied career in progressive criminal justice advocacy, voting rights, prisoners’ rights, death penalty mitigation, academia, and technical support for homeless and domestic abuse services. He lives in Tempe. Email j.andyhall@gmail.com.

May 17, 2026May 10, 2026

Will Humble Public Health, Wills Blog

Maricopa County Activates Heat Relief Network

May 1^st launched the 2026 Heat Relief Network season for Maricopa County. The heat relief season runs from May 1-September 30^th, with countless organizations opening their doors to anyone in need of a place to cool off. This year, more than 200 sites have already begun welcoming folks, including offering water. Some sites welcome pets, while others provide respite 24 hours.

This year, Maricopa County Department of Public Health is making two notable changes to their work in heat to hopefully continue to improve the decrease in heat-related deaths seen last year. Six sites this year will distribute naloxone. Individuals who are substance using are more vulnerable to heat-related illness and death. Further, after collaborating with colleagues at the City of Phoenix, MCDPH staff heard of the need to create specific heat sites for families looking for relief during the summer. Our partner Arizona Faith Network, in coordination with Trinity United Methodist Church in Phoenix, has set up a family heat relief site for those in need.

How can you help? Know your risk. Protect yourself. Protect Others. In other words — be heat aware. Get out of the sun before you feel unwell and check on your neighbors. Did you know you can call 2-11 for a ride to the closest heat relief site to you?

Last year, we saw a 30% decrease in heat related deaths in Maricopa County because we worked together to get the word out and help those most in need. We need your help again this year! Check out https://www.maricopa.gov/1871/Extreme-Heat for more information.

May 12, 2026May 10, 2026

Will Humble Behavioral Health, Wills Blog

Secure Behavioral Health Facilities Are Finally Back on the Table – with an AHCCCS RFP

Arizona is facing, and has faced for a long time, a major gap in our mental health care system: the lack of secure residential treatment settings (ABHRFs) for folks with serious mental illness resistant to treatment.

These are sometimes folks with conditions like schizophrenia or bipolar disorder who, because of their illness, won’t engage in voluntary treatment. Their families are left watching loved one’s cycle through emergency rooms, jails, and homelessness without access to the long-term, structured care they need.

In 2019, families and advocates achieved a significant milestone when legislation was passed to authorize SBHRFs in Arizona. The idea was that these facilities would offer a secure, therapeutic environment where individuals with SMI could receive intensive treatment while also being protected—and protecting others—from the consequences of untreated illness.

But despite our work not a single SBHRF has opened because of sabotage from the ACLU of Arizona (who appears to have a hotline to the Governor’s Office) and the Arizona Center for Disability Law.

The absence of secure residential treatment has real human consequences. It leaves Arizona’s most vulnerable residents (and their families) without hope for recovery and puts their families in a position of helplessness. It also means there’s a huge gap in discharge opportunities from the Arizona State Hospital, Valleywise and other inpatient hospital systems – impacting the entire system.

As we’ve written before, Arizona’s behavioral health system has a missing middle. People who are too ill for an open setting often end up in the wrong place like ERs, jails, or staying longer than needed at the state hospital.

SBHRFs are meant to help with that fix that. They’re small, secure, treatment-focused secure residential facilities for people under court order who need structure and supervision to stabilize.

Read the 3-Part Series

Helping Loved Ones Get the Care They Need: Navigating Arizona’s Court-Ordered Treatment Process for Persons with Mental Illness (Part I of III)

Helping Loved Ones Get the Care they Need: Secure Environments Can Enhance Care for People with Serious Mental Illness (Part II of III)

Helping Loved Ones Get the Care they Need – Secure Residential Treatment: A Crucial (and Scarce) Resource for Supporting Mental Health Treatment (Part III of III)

After years of post-bill-passage advocacy, there’s finally hope we might actually get them built and staffed.

AHCCCS released a Request for Proposals this week to develop SBHRFs:
https://azpha.org/wp-content/uploads/2026/05/AHCCCS-SBHRF-RFP-May-2026.pdf

This is the first step in several years that could turn the statute into actual service.

The RFP (open until 1/1/27) asks for providers to step up and run these facilities. That means figuring out staffing, security, clinical models, and how to run within AHCCCS contracts.

The RFP lays out the basic expectations for providers that want to build and run these facilities. SBHRFs are expected to be small, secure settings (generally up to 16 beds) with 24/7 staffing and supervision. They’re designed specifically for people under court-ordered treatment, so the facilities need both a clinical model and the ability to safely manage restricted movement.

On the clinical side, the contractor will need to provide behavioral health treatment, medication management, and structured daily programming aimed at stabilization and step-down to a less restrictive setting. There’s a clear expectation that these aren’t just “places to stay”—they’re treatment environments with defined care plans and discharge goals.

Security is a core feature. The RFP calls for controlled access, secure perimeters, and policies that balance safety with patient rights. That includes coordination with courts, guardians, and treatment teams.

There’s also a strong emphasis on care coordination. Operators will need to work closely with AHCCCS health plans, the courts, and other parts of the system to manage admissions, transitions, and length of stay.

Finally, the RFP gets into the operational nuts and bolts—staffing ratios, qualifications, reporting requirements, and performance expectations tied to AHCCCS contracts.

May 11, 2026May 10, 2026

Will Humble Healthcare, Social Determinants, Wills Blog

Phoenix Prohibiting Humanitarian Aid in City Parks

Last week the Phoenix City Council did exactly what we expected they’d do. Rubber stamp Parks Department director Cynthia Aguilar and City Manager Ed Zuercher’s proposal to dramatically restrict (essentially eliminate) humanitarian aid in city parks.

By a 6-3 vote, the Council approved the ordinance despite hours of testimony from healthcare providers, outreach workers, harm reduction advocates, and community members warning that the policy will make life even harder for people experiencing homelessness.

Phoenix OKs punitive limits on feeding, treating homeless people in parks

Zuercher’s press release spins the ordinance as a simple “time, place and manner” regulation designed to keep parks “safe and welcoming.” But the actual policy is really just a way to almost completely shut down humanitarian aid in city parks.

It sharply limits food distribution and medical outreach unless organizations get (an ungettable) permit from the Parks Department. If they can get a permit (limited to two per park per month total) it restricts activities to tightly controlled settings, bans syringe exchange services in parks altogether and puts up other huge barriers.

Councilmember Anna Hernandez was one of only three “no” votes and the Council’s most compassionate voice opposing the measure. In her recent op-ed, she argued that Phoenix “shouldn’t criminalize caring,” warning that the ordinance punishes the very groups trying to fill gaps in the city’s behavioral health, housing, and healthcare systems. That argument was echoed repeatedly during public testimony this week by organizations that actually work on the streets every day.

Phoenix shouldn’t criminalize caring for people | Opinion

This outcome was totally predictable. Once something makes it to the city council agenda it’s almost always a slam dunk no matter what people from the public say. The Parks Department leadership under Cynthia Aguilar pushed the proposal aggressively, tightening the screws with each revision- with an end result of essentially ending all aid.

City Manager Ed Zuercher also fully backed it. Most Council members seemed primarily interested in finding a politically safer way to package the ordinance rather than reconsidering whether it was good policy.

Starting June 5, humanitarian groups that have long provided sandwiches, wound care, hygiene supplies, overdose prevention services, and basic medical outreach in parks will face enormous red tape to provide even sporadic basic services.

Op-ed: Phoenix Parks Department treating homeless like biohazards instead of people

Those who disobey the man face arrest and sure prosecution from County Attorney Mitchell for a Class 1 Misdemeanor (the worst kind).

Fortunately, I gotta believe that a brave soul may exercise nonviolent civil disobedience and provide services without the ungettable permit. I also gotta believe a jury is unlikely to convict the person – but if they do – they’d become a public health martyr.

Criminalizing aid to the unsheltered so parks workers can look at magazines in the shade doesn’t solve homelessness. It just makes their job easier (which is the goal).

May 10, 2026May 10, 2026

Will Humble State Legislature, Wills Blog

Suspended Animation at the Capitol

We’re still in the suspended animation at the state capitol.

The House and Senate passed their (party line) budget last week. Hobbs has already vetoed it. The governor argued the proposal didn’t include executive branch priorities, cut too much from safety net services, and didn’t fund things needed to implement the red tape provisions in HR1.

Then the House took a one-month paid vacation until June 1. As far as I can tell the Senate is still technically conducting business.

Arizona legislature heads home for a month with budget shutdown clock ticking | Arizona Mirror

Hobbs vetoes ‘unbalanced and reckless’ Republican budget | Arizona Capitol Times

In the meantime, regular bills are frozen. Many healthcare and public health bills that are still technically alive are now sitting in purgatory waiting for budget negotiations to move forward. Until there’s a bipartisan budget the regular bills will remain frozen.

Next week I’ll cover the list of potential ballot propositions that could affect public health either directly or indirectly (and which ones we’ve taken positions on).

May 9, 2026May 10, 2026

Will Humble Professional Development, Wills Blog

Remembering ADHS Director Jim Schamadan

Dr. James (Jim) Schamadan passed away on April 19 at the age of 98. He was the ADHS director twice.

He was a physician, an engineer, and a healthcare executive who helped build Scottsdale Memorial Healthcare and served as its CEO through the mid-1990s. From there, he was appointed ADHS Director. He served twice including a later stint as an interim director in the late 1990s.

The exact dates are unclear because he was a pre-internet director.

James Louis Schamadan Obituary – The Arizona Republic

Schamadan’s background in building and running healthcare organizations likely shaped how he approached the job (I’m reading between the lines here). He came from the provider side, with experience in operations and infrastructure, and stepped into a department dealing with complex system changes and ongoing legal requirements.

I met Dr. Schamadan once, around 1999, when he was serving in his second stint as director in an interim capacity. I was working in environmental health at ADHS, and we were dealing with a situation in New River involving a house packed with dangerous explosives. The question was how to remove the hazard without putting the surrounding community at risk.

He struck me as extremely direct. In the end the team decided to carefully remove the explosives rather than burn the building down – a good call I think (that was during the Hull Administration).

Because his service came during a transitional period and because one of his stints as Director was interim there isn’t a deep public record of his tenure at least that I could find.

But that doesn’t mean the work wasn’t important. Arizona’s health system was in the middle of significant change, and ADHS needed steady leadership to navigate it.

Rest in peace Dr. Schamadan and thank you for your service.

May 8, 2026May 10, 2026