Author: Jeri Royce

We’re at about the halfway point in this year’s legislative session now. The only committees meeting next week are the Appropriations Committees in the House and Senate.  There’ll be lots of Rules, caucus, Committee of the Whole & 3rd reading this week.  It’s harder for the public to be involved in the process this week, but you can always contact your legislator (remember to use your NON-work computer & e-mail) to share your views, concerns & suggestions.

Congress is on break this week which means some of them might be organizing town hall type forums in the coming days.  There isn’t much scheduled yet- but we have our eyes peeled- and we’ll do an update blog when and if they end up being scheduled in the next couple of weeks.  

Active Health-related Bills

Good news on several bills that we supported last week. The bills below made it through their respective committees and are likely all on their way to floor votes this week.  Last week was the deadline for hearing bills in their chamber of origin- which is why many of the committees had such robust agendas.  Here’s a quick summary:

Community Health Workers

HB 2426 ,which would set up a pathway for Community Health Workers in AZ to voluntarily become certified passed the House Health Committee 9-0.  Yea!  We signed up in support of the bill and testified on its behalf as well.   Voluntary certification would be a big step forward for this important health profession because it would expand the use of CHWs in Arizona’s healthcare system in part by making it easier to get reimbursement for their services.  This bill is on the House Rules Committee Agenda on Monday morning (2/20).  Looking good for a floor vote this week.

Oral Health

Good & bad news on the oral health front last week.   HB 2442 which would add some dental services for pregnant women enrolled in AHCCCS, passed the House Health Committee 9-0.  There are a host of public health reasons why this is a good idea- you can read about them in this Issue Brief from the UA’s Center for Population Science & Discovery.  The bad news is that the bill was also assigned to the House Appropriations committee (because it would cost a little money) but it’s not listed on the House Appropriations Committee Agenda this week.   If it doesn’t get added, it would be a real setback- but it would still be possible for it to be ultimately included in the budget bills.

 Asthma Management

HB 2208 which would (under certain circumstances) let school staff administer or help a student self-administer an inhaler for things like asthma episodes also sailed through House Health 9–0.  This bill is on the Rules Committee agenda for Monday (2/20). Still looking good for a floor vote this week.

Vaccines

HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months is alive and well- passing through the House Health Committee 9-0 a couple of weeks ago and passing through the Rules committee this week.  Still on track for a floor vote this week.

Sunscreen

HB 2134 which would make it clear that kids can take sunscreen to school also got a favorable recommendation from House Health 9-0 a couple of weeks ago and also passed through the Rules committee last week.  Lookin’ good for a floor vote this week.

Physical Activity

HB 2082 sponsored by Jesus Rubalcava and, which would require all schools to have 50 minutes of recess per day from K through 5th grade is still looking good.  That bill passed 11-0 in the House Education Committee a couple of weeks ago and got through the Rules Committee last week.  Ready for a floor vote now.

Newborn Screening

Meanwhile, over in the Senate, SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests, passed through the Senate Health and Human Services Committee a couple weeks ago and is looking good for a senate floor vote this week.

Tobacco

A couple of weeks ago we signed up in support of and testified for HB 2335 which if it passes would move the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  It passed in the House Health Committee 7-2, but was never heard in the Commerce committee- meaning it’s probably finished this year unless it can somehow be unassigned to Commerce. 

New AzPHA Policy Positions

After viewing bills in the various committees over the last couple of weeks, the AzPHA Health Policy Committee came to the Board asking for approval to take positions on the bills below.  Here’s a quick summary:

Nurse Anesthetists

We’ll be supporting SB 1336 moving forward.  It’s complicated, but basically it would help improve access to care in rural areas by adjusting the prescribing authority for nurse anesthetists.

Drug Overdose Review Team

We’ll also be supporting HB 2493 which would set up a drug overdose review team at the ADHS much like the child fatality review team.

Photo Traffic Enforcement

Let’s face it. Getting a ticket in the mail for speeding or running a red light is no fun.  But the evidence suggests that photo enforcement of red lights and speed is an effective public health intervention, which is why we’re weighing in against HB2525 this upcoming week in the House Appropriations Committee (Wed. at 2 pm).  It would prohibit any jurisdiction from using photo enforcement technology to enforce red light running etc.  If you scroll back, you’ll see a separate blog on this topic.

AHCCCS Waiver

The AzPHA’s Board reviewed and approved our comments on the current AHCCCS 1115 Waiver application.  Here’s a link to the waiver application and our response letter.    We encourage all AzPHA members to look at our response letter and use what you think is useful to turn in your own comment letter to AHCCCS via e-mail to [email protected] by February 28.

 

Let’s face it. Getting a ticket in the mail for speeding or running a red light is no fun.  But the evidence suggests that photo enforcement of red lights and speed is an effective public health intervention, which is why we’re weighing in against HB2525 this upcoming week.  It would prohibit any jurisdiction from using photo enforcement technology to enforce speeding or red light running. 

Many state and local governments in AZ have turned to photo enforcement of speeding and running red lights promote public safety (and some would say to raise revenue). The theory is that drivers will pay more attention to their speed and red lights when they know they’re at risk for getting a ticket. It stands to reason that cameras would keep drivers’ speeds in check and prevent serious injuries from high-speed crashes. But do they?

A landmark study for photo enforcement was done by Retting et.al. and published in the American Journal of Public Health examining the impact that photo enforcement had in Oxnard CA after they implemented their photo enforcement program.  The researchers found that intersections that had red light cameras installed had a 29% reduction in injury crashes.  Right-angle crashes (which often happen because of red light running) were reduced by 32% and right-angle crashes involving injuries were reduced by 68%.  Overall accidents at the intersections were reduced by 7%.

In 2008, an Arizona established a statewide photo speed enforcement program on interstate highways. DPS contracted with a private company to install the cameras (along with signage to alert drivers), and they began operating that fall. Vehicles that were clocked going 11 miles per hour or more over the speed limit got tickets in the mail.  The system was in use until 2010 when the contract expired and the cameras were removed.  Did their presence have an effect on public safety?

Last year, a research team that included Dr. Chengcheng Hu, director of biostatistics for the Phoenix campus of the UA Mel and Enid Zuckerman College of Public Health, Dr. Steven Vanhoy, a recent graduate of the UA College of Medicine – Phoenix, and several colleagues from Banner – University Medical Center Phoenix, published a paper that offers some insight.

The researchers examined crash data along a 26-mile segment of Interstate-10 in Phoenix where speed cameras had been placed every 2 miles as well as a 14-mile control segment where no cameras had been deployed. They compared crash data from Jan. 1 to Dec. 31, 2009 (when cameras were in place) to data from Jan. 1 to Dec. 31, 2011 (after the cameras had been removed).  They found that the removal of the photo radar cameras was associated with a two-fold increase in admissions to Level 1 Trauma Centers from car crashes in the areas where the cameras were removed.

Nobody likes getting a traffic ticket, but we believe that photo enforcement of reasonable traffic laws can significantly reduce severe injuries.   That’s why we’re weighing in against HB2525 this week in the House Appropriations Committee on Wednesday, February 22 at 2pm in House Hearing Room 1. 

Believe me, I’m no evangelist for every single speed limit in my part of town nor the placement of some of the cameras and vans- but moving to eliminate this option for local communities would cause public health harm.  I for one  am happy that AzPHA is mobilizing against HB2525 this week. 

Our Public Health Policy Committee continues to be busy following bills making their way through the state legislature and preparing comments on AHCCCS’ 1115 Waiver application.  Here’s a snapshot of AzPHAs activities over the last couple weeks and what’s up this week.  There’s good and bad news this week.

Active Health-related Bills

We’ll be signing up in support of 3 bills in the House Health Committee this week.  We’re enthusiastically supporting HB 2426 which would set up a pathway for Community Health Workers in AZ to voluntarily become certified. Voluntary certification would be a big step forward for this important health profession because it would make it easier to get reimbursement for their services- and expand the use of CHWs.  Good news! 

We’ll also be enthusiastically supporting HB 2442 this week in House Health- which would provide for preventive dental services for pregnant women enrolled in AHCCCS.  There are a host of public health reasons why this is a good idea- you can read about them in this Issue Brief from the UA’s Center for Population Science & Discovery.

We’re also supporting HB 2208 this week, which would, under certain circumstances, let school staff administer or help a student self-administer an inhaler for things like asthma episodes.  There was a late breaking amendment to this bill this week which we think makes the bill more likely to move forward.

Meanwhile, last week:

HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months is alive and well- passing through the House Health Committee 9-0 last week. 

HB 2134 which would make it clear that kids can take sunscreen to school also got a favorable recommendation from House Health 9-0. 

HB 2190 which would ask ADHS to compile stroke statistics was held in committee, meaning it’ll need to be approved this week or it’s probably toast this year. O

Last week AzPHA signed up in support of and testified for HB 2335 which if it passes would move the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  There’s good evidence that when a person starts smoking before they’re 21 they’re far more likely to be a life-long smoker (because people that start in their teens are more highly addicted as a result of changes in the brain).   HB 2335 passed in the House Health Committee 7-2, but still needs to get through the House Commerce Committee and then of course get a full House floor vote.  It didn’t get a hearing in the House’s Commerce Committee this week, and the committee chair has said he won’t hear the bill in his committee-  which would effectively kill it.  Sad!

No news this week about House Bill 2082 sponsored by Jesus Rubalcava and, which would require all schools to have 50 minutes of recess per day from K through 5th grade. That bill passed 11-0, but there’s still a ways to go and plenty of hurdles to overcome before this would become law.

Meanwhile, over in the Senate,  SB 1368 passed through the Senate Health and Human Services Committee.  If it passes, it would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests. This one is looking good.

We’re watching the Legislature’s hearing calendar closely and will offer our support and/or information.  If you’re interested in joining our Public Policy Committee, you can contact [email protected] and she’ll get you on our list.  We have a weekly call every Monday at 11 am and someone from the committee is always down at the Legislature for key hearings.

AHCCCS Waiver

The AzPHA’s Public Policy Committee is finishing up our comments on AHCCCS’ 1115 Medicaid waiver application (as required by a state laws that passed in 2015).  AzPHA will be submitting comments on the Waiver application focusing on 4 key areas: 

• The proposed requirement for all “able-bodied” adults to become employed or actively seeking employment or attend school or a job training program.

• The proposed requirement for able-bodied adults to verify on a monthly basis compliance with the work requirements and any changes in family income.

• The authority for AHCCCS to ban an eligible person from enrollment for one year if the eligible person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements.

• The authority for AHCCCS to limit lifetime coverage for all able-bodied adults to five years except for certain circumstances. 

Our Committee will present our proposed letter to the AzPHA Board on Friday and we’ll share the final letter here on the blog right after it’s approved.  If you’d like to participate in the editing process you can always contact [email protected] and she’ll get you on our Public Health Policy Committee list.

Adios

A couple of weeks ago AzPHA signed up in support of and testified for HB 2335 which, if it passes, would move the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  There’s good evidence that when a person starts smoking before they’re 21 they’re far more likely to be a life-long smoker (because people that start in their teens are more highly addicted as a result of changes in the brain).   

HB 2335 passed in the House Health Committee 7-2, but still needs to get through the House Commerce Committee and then of course get a full House floor vote.   It didn’t get a hearing in the House’s Commerce Committee this week, and the committee chair has said he won’t hear the bill in his committee-  which would effectively kill it.

How come AzPHA feels so strongly, you ask?  Pretty simple.  Cigarette sales to people under 21 account for only 2 % of total sales but because 90% of smokers start before they’re 21, under-21 sales hook 90% of new smokers.  Here’s another way to look at it.  Only 10% of lifetime smokers started after they were already 21.  That means 90% started before they were 21.  It’s easy to see why upping the age to 21 is an effective public health intervention that could pay huge dividends in the future.

Perhaps this Abstract from this 2014 Study from the Journal of the American Public Health Association says it best: The majority of tobacco use emerges in individuals before they reach 21 years of age, and many adult distributors of tobacco to youths are young adults aged between 18 and 20 years. Raising the tobacco sales minimum age to 21 years across the United States would decrease tobacco retailer and industry sales by approximately 2% but could contribute to a substantial reduction in the prevalence of youths’ tobacco use and dependency by limiting access.

Let’s cross our fingers that evidence and an interest in improving public health in Arizona eventually wins out!

One of the initiatives that we’re enthusiastic about during this year’s legislative session is the possibility that Severe Combined Immune Deficiency syndrome could be added to the state’s newborn screening panel.  We at AzPHA hope it happens!

Arizona began screening newborns for phenylketonuria (PKU) in the late 60s and early 70s. Samples were sent to the State Laboratory or were tested in hospital labs. In 1979 Arizona began testing for phenylketonuria, congenital hypothyroidism, homocystinuria, maple syrup urine disease, hemoglobin diseases.  Galactosemia and biotinidase were added in 1981.  In 1993 the Office of Newborn Screening was born and the Arizona State Lab began screening for the seven disorders in late 1994. In the 2000’s we expanded the number of screenings further to include 29 disorders in the Uniform Screening Panel. 

The goals of newborn screening are to find babies with certain, rare disorders at birth and help families and the infants get fast treatment to prevent or delay serious medical problems.  Babies born with these conditions appear to be normal at birth but without interventions the disorder may have a devastating or lethal effect on the baby’s health and development.  The good news is that early screening, detection and treatment often results in normal growth and development.  Another goal is to find possible hearing loss before one month of age and link families with appropriate assessment and intervention. 

We’re pleased that the Governor has proposed in his budget to add Severe Combined Immune Deficiency (SCID) to the AZ panel- along with an authorization to increase the fee up to $6/test to pay for it.  Babies born with Severe Combined Immunodeficiency look normal at birth but they can’t fight infections. They often die before 1 year of age without medical treatment, but if caught at birth,  before the onset of infection, a bone marrow transplant can successfully treat the disorder.  It’s particularly important to test for SCID in Arizona because the disorder is much more common in certain populations in Arizona: 1/2,000 among Navajo’s and Apache’s and about 1/20,000 among Latinos.

The Arizona Daily Star wrote a nice story this week about adding Severe Combined Immune Deficiency to the panel  from the perspective of a family.

Senate Bill 1368 is the bill that would authorize raising the newborn screening fee by $6/test which would allow the ADHS to add SCID testing to their panel…  and AzPHA will be at the hearing this Wednesday at 2 pm urging the Senate panel to recommend passage of the proposal.  

Our Public Health Policy Committee has been pretty busy over the last few weeks following bills making their way through the state legislature… the latest 1115 Waiver application that AHCCCS has submitted to the Centers for Medicare and Medicaid Services… and activity at the national level regarding the possible repeal of the Affordable Care Act.  Here’s a snapshot of AzPHAs activities over the last few weeks and what’s up this week.

Active Health-related Bills

Last week AzPHA signed up in support of and testified for HB 2335 which if it passes would move the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  There’s good evidence that when a person starts smoking before they’re 21 they’re far more likely to be a life-long smoker (because people that start in their teens are more highly addicted as a result of changes in the brain).   HB 2335 passed in the House Health Committee 7-2, but still needs to get through the House Commerce Committee and then of course get a full House floor vote. 

We also signed in support of House Bill 2082 sponsored by Jesus Rubalcava and, which would require all schools to have 50 minutes of recess per day from K through 5th grade… and it needs to be unstructured meaning that kids get to make their own physical activity choices.  That bill passed 11-0, but like HB 2335, there’s still a ways to go and plenty of hurdles to overcome before this would become law.

Last week we expressed support for SB1086  SB1087  SB1088… all of which address distracted driving in various ways.  None of the bills have been heard in their respective committees yet, but if and when the time comes, we’re prepared to inform the committee about the public health and safety risks posed by distracted driving.

HB 2046 went down in flames last week- it would have required motorcycle drivers and passengers operators to wear a helmet at all times unless they pay a fee to ADOT when they register their motorcycle.  That bill failed to get out of the Transportation Committee in the House and appears to be dead.

The House Health Committee will be really active this week (Thursday starting at 9 am).  There are several bills up that we’ll be supporting.  Included are: HB 2090- which would require hospitals to offer influenza vaccines to seniors during the cold and flu months; HB 2134- which would make it clear that kids can take sunscreen to school; HB 2190 – which would ask ADHS to compile stroke statistics; and HB 2208- which would authorize school staff to administer inhalers for kids having asthma symptoms (under certain circumstances). Dr. Lynn Gerald and colleagues at the UA College of Public Health have been doing active research in this area which is informing the policy development- just like things should be.

Meanwhile, over in the Senate Health & Human Services Committee (Wednesday at 2 pm), we’ll be in support of SB 1368 which will authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests.  I’ll have a blog post on that topic later this week.

We’re watching the Legislature’s hearing calendar closely and will offer our support and/or information.  If you’re interested in joining our Public Policy Committee, you can contact [email protected] and she’ll get you on our list.  We have a weekly call every Monday at 11 am and someone from the committee is always down at the Legislature for key hearings.

Budget Proposals

Our AzPHA Board met a few weeks ago and authorized AzPHA to express support for several bills that Legislators have proposed, as well as some of the elements of the Governor’s budget proposals.  We’re in firm support of proposals in the budget to: 1) add Severe Combined Immune Deficiency (SCID) to Arizona’s Newborn Screening Panel; 2) increase funding to the state’s loan repayment program by $350K (potentially allowing the state to qualify for a full $1M in matching funds from HRSA); and 3) adding up to $1,000 annually for adult emergency dental services among  all AHCCCS members.  

 

We believe that these are all important proposals that will improve public health in Arizona.  Since the budget isn’t being formally negotiated yet, we haven’t had an opportunity to sign in support of these proposals, but we’re poised to jump into the fray when the time comes.   

AHCCCS Waiver

AzPHA is also working on comments to submit to AHCCCS and the Centers for Medicare and Medicaid Services regarding Arizona’s 2017 1115 Medicaid waiver application (as required by a state laws that passed in 2015).  AzPHA will be submitting comments on the Waiver application focusing on 4 key areas: 

• The proposed requirement for all “able-bodied” adults to become employed or actively seeking employment or attend school or a job training program.
• The proposed requirement for able-bodied adults to verify on a monthly basis compliance with the work requirements and any changes in family income.
• The authority for AHCCCS to ban an eligible person from enrollment for one year if the eligible person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements.
• The authority for AHCCCS to limit lifetime coverage for all able-bodied adults to five years except for certain circumstances. 

Our comments are due February 28.  We will be done before that deadline and will share our comment letter with AZPHA members as soon as we’re finished.  If you’d like to participate in writing the letter you can always contact [email protected] and she’ll get you on our Public Health Policy Committee list.