AzCRH Director and AzPHA member , Dan Derksen, MD, discusses the American Health Care Act and its implications for state Medicaid programs.

The American Health Care Act fundamentally changes the financing of state Medicaid programs. It repeals Title XIX of the Social Security Act’s statutory 50% minimum federal funding of state Medicaid programs. It caps Medicaid funding to states – either as a block grant, or a per person cap.

Currently there are 74 million Americans covered by Medicaid and the Children’s Health Insurance Program (CHIP).Over half of those covered are children. Sixteen million people have been added to Medicaid and CHIP since the first open enrollment period of the Affordable Care Act in October of 2013. Eleven million were added in the 31 states expanding Medicaid. 

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» Watch video at link & learn more:  https://vimeo.com/209444118

We’re at a critical point in Congress’ attempts to repeal the Affordable Care Act.  The current proposed plan (called the American Health Care Act or AHCA) would fundamentally change the Medicaid funding approach by switching it to a block grant or per capita cap. The full House will likely vote on the on the proposed law this Thursday, March 23.  AHCCCS has an easy to read 2-page summary of how AHCA would impact Medicaid in Arizona.  It’s worth a look for sure.

Right now about 1.9 million low-income Arizonans have their health insurance through AHCCCS.  About 400,000 Arizonans are included in the main eligibility groups initially affected by the changes proposed by the AHCA.  The proposed law would change the enhanced federal funding for childless adults (with incomes up to 100% FPL) and the expansion population of adults (people with incomes 100-133% FPL).  The AHCA would allow the State to continue claiming enhanced federal matching funds for members who are enrolled as of December 31, 2019 but don’t have a break in eligibility (for more than one month).  The bill would also limit federal payments to states to a fixed amount per eligible enrollee starting in FY 2020. 

The law in its current form would also eliminate the Prevention and Public Health Fund, a critical resource for protecting Arizonans from dangerous infectious diseases and other crucial public health issues like the opioid poisonings.

Passage in the House of Representatives is not a foregone conclusion, and your voice is needed now to add to the chorus of folks with concerns about the current proposal.  Please visit the American Public Health Association web tool today to urge your Congressional Representative to revise the plan to allow Arizonans to maintain their healthcare coverage and make coverage, premiums and co-pays affordable for all Arizonans and to protect the Prevention & Public Health Fund.

You can also directly contact your Representatives by calling, emailing, and tweeting them! Join the movement today! 

Representative Paul Gosar (CD4)

(928) 445-1683: Prescott | (480) 882-2697: Gold Canyon | (202) 225-2315: DC Office

http://paulgosar.house.gov/contact/ | Twitter Handle: @RepGosar

Representative Martha McSally (CD2)

(520) 881-3588: Tucson | (520) 459-3115: Sierra Vista | (202) 225-2542: DC Office 

https://mcsally.house.gov/contact | Twitter Handle: @RepMcSally

Representative Kyrsten Sinema (CD9) 

(602) 956-2285: Phoenix | (202) 225-9888: DC Office 

https://sinemaforms.house.gov/forms/writeyourrep/ | Twitter Handle: @RepSinema

Here’s this week’s summary regarding the action at the State Legislature.  

Physical Activity

HB 2082 which would enhance recess time in Arizona is looking good.  It passed its hearing in theSenate Education Committee last week (but was amended to eliminate the 50 minute per day requirement).  It’s still an improvement, and we’re pleased that the Bill appears to be headed to the Governor’s desk (although it needs to go back to the House since it was amended to get rid of the 50 minute per day requirement).

The data suggest that physical activity during the school day improves cognitive skills and attitudes, enhances concentration and attention, and improves classroom behavior: The Association Between School-based Physical Activity, Including Physical Education, and Academic Performance a few years ago has the data.  

Community Health Workers

Sadly, HB 2426, which would have set up a pathway for Community Health Workers in AZ appears to be dead for this year.  It wasn’t heard in the Commerce and Public Safety Committee this week, meaning that it’s effectively finished for this year.  But- the Arizona Community Health Workers Association did a great job of organizing and is in a solid position to keep the momentum going next legislative session.   

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 passed the full House awhile back and has now passed the required Senate committees and even both Caucuses.  All good news so far.  

Nurse Anesthetists

SB 1336 passed the Senate last week and, after a compromise amendment, passed through the House Health Committee last week.   AzPHA is still in support and also submitted information to the committee talking about how this bill would be good for access to care in rural AZ.

Newborn Screening for SCID

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 and the was unanimously approved by the House Health Committee.  This one is looking good.

Traffic Safety Cameras

HB2525 passed the House last week but was never heard in the Senate Transportation and Technology Committee, so it’s effectively dead for this year (for now).   

Teenage Texting & Driving

SB 1080 which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license (if they’re under 18) passed the Senate and passed the House Transportation and Infrastructure Committee on March 1.   Still waiting for the Rules Committee hearing.

Sunscreen & Tanning Beds

HB 2134 which would make it clear that kids can take sunscreen to school and camps… and that school and camp staff can help them put it on will be heard in the Senate Education Committee Wednesday at 9 am.  We’re of course signed up in support. 

HB 2194 which would have prohibited kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free is effectively dead for this year.  

Drug Overdose Review Team

HB 2493 which would set up a drug overdose review team at the ADHS (much like the child fatality review team) was assigned to the Senate Health & Human Services Committee.  No hearing date set yet.

If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org 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.

Here’s this week’s summary regarding the action at the State Legislature.  We’re still looking through the information from the congressional budget office regarding the American Health Care Act. 

Physical Activity

HB 2082 is a good bill that would require schools to have 50 minutes of unstructured recess per day from K through 5th grade. It passed the House awhile back and is being heard in the Senate Education Committee on Thursday, March 16 at 9 am in Senate Hearing Room 1.  AzPHA is of course supporting it.  We also sent the committee members a letter this week pointing out that the literature suggest that physical activity during the school day improves cognitive skills and attitudes, enhances concentration and attention, and improves classroom behavior.  The data were published by the CDC in a report called The Association Between School-based Physical Activity, Including Physical Education, and Academic Performancea few years ago.  

Community Health Workers

HB 2426, which would set up a pathway for Community Health Workers in AZ, passed successfully through the House but faces a tough time in the Senate.  It’s been assigned to the Commerce and Public Safety Committee where it will need to be heard in Committee by Monday, March 20 (the last scheduled Committee meeting before the deadline).  The committee is chaired by Senator Steve Smith of District 11 (Casa Grande, Maricopa, Eloy, Avra Valley).  We sent out an Action Alert this week to our members urging them (especially any that live in District 11) to reach out to Senator Smith (602) 926-5685and urge him to hear the Bill in committee next week.

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 passed the full House awhile back.  Last week it passed through the Senate Health and Human Services committee.  All good news so far.  On to the Senate floor and ultimately to the Governor for his signature.

Nurse Anesthetists

SB 1336 passed the Senate last week and was assigned to the House Health Committee where it will be heard this week (Thursday am at 9 am in HHR 4).  Interestingly, it is the only bill on the House Health Committee agenda this week.  It would basically let nurse anesthetists issue a medication order in the scope of his or her practice.   AzPHA is signed in support and also submitted information to the committee talking about how this bill would be good for access to care in rural AZ.

Newborn Screening for SCID

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 was unanimously approved by the House Health Committee last week.  This one is looking good.

Tribal Courts and Involuntary Commitment 

HB2084 which would allow a mental treatment facility to admit a patient for involuntary treatment pending the filing of a tribal courts involuntary commitment order was assigned to Senate Judiciary Committee and was quickly approved by that committee last week. Looking good.    

Traffic Safety Cameras

HB2525 passed the House last week.  It would ban traffic safety cameras in AZ.  We’re against this one. It was assigned to the Senate Transportation and Technology Committee.  No hearing set yet.  If it’s not heard in committee by next week this is probably dead (for now).

Teenage Texting & Driving

SB 1080 which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license (if they’re under 18) passed the Senate and passed the House Transportation and Infrastructure Committee on March 1.   

Sunscreen & Tanning Beds

HB 2134 which would make it clear that kids can take sunscreen to school and camps… and that school and camp staff can help them put it on was assigned to the Senate Education Committee. No committee hearing set yet in the Senate.

HB 2194 – which prohibits kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free was assigned to the Commerce and Public Safety and Health and Human Services Committees.  That’s called being “dual assigned” and it’s almost always a bad thing for a bill because it will need to pass through both committees unless we can convince the President of the Senate to withdraw it from one of the committees.

Flu Vaccines at Hospitals

HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months was assigned to Senate Health and Human Services Committee.  No hearing date is set yet.  All bills need to be heard in the second Chamber by 3/24… so this one is on a pretty short leash right now.  

Drug Overdose Review Team

HB 2493 which would set up a drug overdose review team at the ADHS (much like the child fatality review team) was assigned to the Senate Health & Human Services Committee.  No hearing date set yet.

Voter Initiative Stuff
Perhaps some of the most troubling bills and resolutions in terms of public health have to do with the voter initiative process.  Many of the real big achievements in public health have been voter initiatives (e.g. Smoke Free Arizona Act).  A couple of the bills that would change how voter initiatives work would require voter approval, but a couple could be approved by the Legislature (with the Governor’s signature).  We’re not alone in our opposition to these proposals- lots of people are concerned about them. Here’s a quick summary:

•  HCR2002 & HCR2007 (which would need to be approved by voters to become effective in the 2018 general election) passed the House has been assigned to the Senate Judiciary Committee.  These bills haven’t been scheduled yet but we expect there to be action the week of March 20.  

• HCR2029 passed the house yet but would require signature gatherers to get a certain number of signatures in each of the 30 legislative districts.  This one would ultimately need to be approved voters in the 2018 general election.  Sent to the Senate but it’s not assigned to a committee yet.
• HB 2404 passed through the House (as amended) and would prevent signature gatherers from getting paid by the signature (for voter initiatives- not for candidate signatures).  This one could become law without voter approval and was assigned to the Senate Judiciary Committee where it’ll be heard on Thursday at 9 am.

AHCCCS Waiver Comment Period Extended to March 29, 2017.

Senate Bill 1092 was passed and signed into law in 2015 requiring the AHCCCS to annually apply the CMS for an Amendment to the current AHCCCS Section 1115 Waiver that would implement the following requirements for “able-bodied adults” receiving Medicaid services:

• Limit lifetime AHCCCS coverage for all able-bodied adults to 5  years except for certain circumstances.
• Require all able-bodied adults to become employed or actively seeking employment or attend school or a job training program and require them to verify on a monthly basis compliance with the work requirements and any changes in family income.
• Ban eligible persons from enrolling in AHCCCS for 1 year if the person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements.

The initial deadline was February 28, however, AHCCCS has extended the deadline to March 29.  AzPHA submitted comments on the Waiver in February.  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 publicinput@azahcccs.gov by March 29.

If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org 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.

AZPHA has a track record which goes back to decades of advocating for the advancement of public health.  When it comes to achieving that goal, many factors come into play. At the cornerstone is the importance of preventing illnesses and injuries – think of the old saying “a stitch in time saves nine”.  

But prevention (things like vaccines, epidemiology, food safety and security, nutrition, maternal and child health, assurance and licensure, physical activity) isn’t enough to improve health outcomes.  Folks need access to healthcare too for both preventive checkups and other care that might be associated with acute or chronic medical conditions.

That’s one of the reasons that we were so pleased when the Affordable Care Act passed a few years ago.  Not only did the law make strides toward providing healthcare to people that didn’t have health insurance, but it also implemented interventions and aligned incentives to keep people healthier.  An essential core public health value. 

I’ve never been one to believe that there’s only one way to improve health outcomes and provide better access to care, but I’ve always believed that the ACA brought us down the road toward achieving those goals.  

When Americans voted in the last election, there were clear differences of opinions amongst candidates for various offices about the effectiveness of the ACA.  Now that the election is over, elected officials are in the process of implementing policy decisions related to access to care and public health that could have very real-life consequences. 

This week the US House of Representatives leadership unveiled their plan to overhaul the US healthcare system and repeal and replace the ACA.  It’s called the American Health Care Act. There would be a lot of changes to the US healthcare system if it ultimately passes as-is. It’s complicated, but I’ll try to hit the high points.  

For one thing, the bill would repeal the individual mandate that people get health insurance or face a tax penalty.  A main reason that the individual mandate was included in the ACA is to broaden the pool of people buying health insurance- a tool to lower overall costs.  It’s unclear how premiums will be kept in check without the mandate.  The proposal mentions the creation of high-risk pools, something that has been tried before but hasn’t been successful.

The bill would offer people “refundable tax credits” to help people buy health insurance rather than the current subsidy system. Current ACA subsidies to buy insurance in the state and federally facilitated ACA marketplaces would end and be replaced by lower advance-able refundable tax credits.  I can’t intuitively see how making this kind of change makes buying insurance more affordable- but maybe I’m missing something.   It would generally keep intact the ACA’s requirement that health insurance cover people with pre-existing health conditions- but it would let insurers charge higher amounts to people that let their health insurance lapse.  

Perhaps some of the biggest changes in terms of access to care would be in the Medicaid system- our health care system for low income people. Low income has long been linked to worse health outcomes for a host of reasons- so it’s no surprise that many of the health disparities in the US are among people that have their health insurance through the Medicaid system.  

The American Health Care Act would restructure the Medicaid program so that states get a set amount of money from the US every year, placing a lot more financial risk on the states basically transferring financial risk from the federal government to the states.  Down the road, this would likely result in more stringent enrollment criteria, lower payments to providers, and fewer covered services in states- limiting healthcare among those with the largest health disparities.

The plan would also repeal the federal funding that helped finance Medicaid expansion up to 138% of the federal poverty limit.  Thirty one states have expanded Medicaid as allowed by the ACA (including AZ of course).  It’s unclear what the plan would be to get this group (people between 100 – 138% of federal poverty access to healthcare).  

The proposal also freezes Medicaid funding to Planned Parenthood for a year.  Thus would limit low income women’s access to cancer screening, family planning etc. in many parts of Arizona.  

Finally, the proposed plan would eliminate the Prevention and Public Health Fund which would have a profound impact on core public health functions at the CDC and in state and county public health programs.  The plan eliminates the fund in FFY 2018, substantially reducing CDC investments in states for things like vaccines, programs to reduce chronic diseases, epidemiology and laboratory capacity.  This would result in an immediate reduction in about $9.3M/year in public health funding in Arizona.  

Perhaps the most damage would be done to the “317” vaccine program, which would be reduced by 50%. The 317 Immunization Program plays a critical role in achieving national immunization coverage targets and reductions in disease. This critical program supports vaccinations from newborns to seniors.  Hardly a smart idea, since vaccines are the number one and most cost-effective public health intervention of the last 100 years.

By eliminating these public health investments in evidence-based disease prevention programs states (including Arizona) could also lose critical programs that fight obesity, tobacco, and respond to public health threats like outbreaks of infectious diseases.  

The Prevention and Public Health Fund represents 12% of CDC funding – so that kind of loss to the agency would inevitably result in lost public health prevention capacity across the country.

Remember, the proposed American Health Care Act released this week is just that- a proposal.  In order to be implemented, it would need to be approved by our federal elected officials- people that work for us- the American people.  

To view APHA’s stance on the AHCA, please click here. 

Let’s make sure they’re acting in our best interest by asking important questions and adding our public health voice to the debate.  

Today, I thought I’d focus on the mechanics of how folks can track bills, get involved in the process, and sign in to support, oppose, or be neutral on bills. If I can do it, anybody can do it.

The main URL to bookmark in your computer is http://www.azleg.gov – which is the State Legislature’s official website.  It got a major overhaul this year and is a lot easier to work with (at least I think so, but I’ve heard some groaning from some folks).

If you have the number for a bill you’re interested in following, simply go to the upper right corner of the http://www.azleg.gov website and punch in the numbers. Up pops the bill and including it’s recent status, committee assignments and the like.

You’ll see that bills have committee assignments on the Bill Status pages. You can easily check the committee agendas each week on the website too.  Simply go to the “Committee Agenda” and pull up the agenda for the committee you”re interested in.  Most of the bills that we’ve been following and advocating for or against have been assigned to either the House Health Committee or the Senate Health and Human Services Committee.  Committee assignments for the following week are usually posted on Friday afternoon.

You can click on each bill and find out who has signed in for or against or neutral too.  Just go to the tab over each bill that says “RTS Current Bill Positions” and you can see who has signed in support or against each bill.  Sometimes you’ll see our name up there (AzPHA).  You can even do it yourself from your home or office.

All you need to do is create an account with an email address and a password and you’ll be able to sign in and support or oppose or be neutral on bills.  If you plan to actually be down there and attend the committee hearing, you can request to speak once you sign in, too.  You can create an account using the button at the top of screen where it says “Sign On”.  

It’s fun and easy.  Give it a try.  Now for the committee assignments and hearings this week for the bills we’re interested in:

Community Health Workers

HB 2426 which would set up a pathway for Community Health Workers in AZ to voluntarily become certified (a good thing) got assigned to the Commerce and Public Safety Committee (probably not a good thing). We thought it would go to Health and Human Services.  Thus assignment will cause us to figure out a new strategy.  So, committee hearing for the bill has not been scheduled yet. 

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 was assigned to Senate Health and Human Services and will be heard onWednesday, March 8 at 2 pm.

Vaccines

HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months was assigned to Senate Health and Human Services Committee.  No hearing date is set yet. 

Sunscreen & Tanning Beds

HB 2134 which would make it clear that kids can take sunscreen to school and camps… and that school and camp staff can help them put it on was assigned to the Senate Education Committee. No committee hearing set yet.

HB 2194 – which prohibits kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free was assigned to the Commerce and Public Safety and Health and Human Services Committees.  That’s called being “dual assigned” and it’s almost always a bad thing for a bill because it will need to pass through both committees unless we can convince the President of the Senate to withdraw it from one of the committees.

Physical Activity

HB 2082 which would require all schools to have 50 minutes of unstructured recess per day from K through 5th grade was assigned to the Senate Education Committee.  No hearing set for it yet.  

Tribal Courts and Involuntary Commitment 

HB2084 which would allow a mental treatment facility to admit a patient for involuntary treatment pending the filing of a tribal courts involuntary commitment order was assigned to Senate Judiciary Committee and was quickly approved by that committee last week. Looking good.

Nurse Anesthetists

SB 1336 passed the Senate last week and was assigned to the House Health Committee.  It would basically let nurse anesthetists issue a medication order in the scope of his or her practice.  No committee hearing scheduled yet.

Drug Overdose Review Team

HB 2493 which would set up a drug overdose review team at the ADHS (much like the child fatality review team) was assigned to the Senate Health & Human Services Committee.  No hearing date set yet.

Traffic Safety Cameras

HB2525 passed the House last week.  It would ban traffic safety cameras in AZ.  We’re against this one. It was assigned to the Senate Transportation and Technology Committee.  No hearing set yet. 

Teenage Texting & Driving

SB 1080 which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license if they’re under 18) passed on a Senate and was assigned to the House Transportation and Infrastructure Committee.  It was approved on Wednesday, March 1st. 

Newborn Screening

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 and has been assigned to the House Health Committee.  It’s on the House Health Committee agenda this Thursday morning.  This one is looking good.

Voter Initiative Stuff
Perhaps some of the most troubling bills and resolutions in terms of public health have to do with the voter initiative process.  Many of the real big achievements in public health have been voter initiatives (e.g. Smoke Free Arizona Act).  A couple of the bills that would change how voter initiatives work would require voter approval, but a couple could be approved by the Legislature (with the Governor’s signature).  We’re not alone in our opposition to these proposals- lots of people are concerned about them. Here’s a quick summary:

•  HCR2002 & HCR2007 (which would need to be approved by voters to become effective) passed the House have been assigned to the Senate Judiciary Committee.  No hearing dates set yet. 

• HCR2029 passed the house yet but would require signature gatherers to get a certain number of signatures in each of the 30 legislative districts.  This one would ultimately need to be approved voters.  Sent to the Senate but it’s not assigned to a committee yet.
• HB 2404 passed through the House (as amended) and would prevent signature gatherers from getting paid by the signature (for voter initiatives- not for candidate signatures).  This one could become law without voter approval nd was assigned to the Senate Judiciary Committee.

If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org 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.

Unintended pregnancies, especially teen pregnancy and its social consequences, are a significant cause of inter-generational poverty and poor health outcomes. Teen mothers are less likely to finish high school or college, meaning they’re less likely to find well-paying jobs. Unintended pregnancies  also can result in depression, diabetes and obesity in the mother and affect the physical and mental health of the child.

The bottom line is that the physical, social and economic consequences of unintended teen pregnancies can perpetuate across generations. The Arizona teen pregnancy rate is almost 50% higher than the national value and the need to lower the unintended pregnancy rate is compelling. The question is, what can we do about it?

Increasing access to Long Acting Reversible Contraceptives (LARCs) is increasingly  recognized as a key tool to reducing unintended teen pregnancies. LARC includes birth control methods like intrauterine devices and implants that last three to 10 years and don’t require user effort daily, weekly or monthly. In fact, LARC is nine times more effective at preventing unintended pregnancies compared to the pill and 18 times more effective than male condoms.

Despite the effectiveness, LARC utilization remains low in the United States (about 11%) compared with the pill (25%).   Some states, however, have made great strides toward increasing use of this more effective family planning tool.

Colorado was one of the early adopters of LARC, which were provided at no cost to the low-income population through the state’s Title X-funded family planning clinics.  The Initiative was tremendously successful, resulting in lower-than-expected fertility rates, lower abortion rates, reduced unintended teen pregnancies and decreased high-risk births. The state’s Medicaid program has avoided $79 million in birth-related costs between 2010 and 2012 due to reduced fertility rates, resulting in a return on investment of $5.85 per dollar spent.

There are other tools Arizona could use to replicate the successes seen in Colorado, including the Medicaid Family Planning Waiver and the Centers for Disease Control and Prevention’s 6|18 Initiative: Accelerating Evidence into Action. 

Real-world evidence-based stories like Colorado provide a template for strategies that could be used in Arizona. Decreasing teen pregnancy rates will have a significant impact on reducing inter-generational poverty. It’s time for us to work together to overcome the barriers to LARC usage in Arizona. Visit the Center for Population Science and Discovery’s Long Acting Reversible Contraceptives (LARCs): Efficacy & Cost Effectiveness issue brief for all the details!

Good news for the most part on the public health policy front last week.  Many of the bills that we like passed out of the House or Senate on floor votes- and will be getting committee assignments in the other house this week.  Some of the bills we like died in their committee, but you can’t win ’em all.  A couple bills that look problematic survived last week. Committee agendas will be lighter this week as bills come over from the opposite house of the legislature to be read and then assigned to committee by the President of the Senate and the Speaker of the House.    

Health-related Bills 

Good news on several bills that we supported last week, with most of them getting approved by their house of origin. A couple of bills that would be bad for public health progressed despite our efforts last week,  Here’s a quick summary:

Community Health Workers

HB 2426 made it through the full House of Representatives last week by a score of 41-17-2 and will now head to the Senate.  If it makes it all the way, it’ll set up a pathway for Community Health Workers in AZ to voluntarily become certified which would be a big step forward for this important health profession…  expanding the use of CHWs in Arizona’s healthcare system in part by making it easier to get reimbursement for their services.  We should find out its committee assignment in the Senate this week.

Oral Health

Bad news on the oral health front last week. HB 2442 which would add some dental services for pregnant women enrolled in AHCCCS never made it to the House floor for a vote, so it’s effectively dead. Gotta hand it to Rep. Kelli Butler for giving it the old college try.  

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 got through the House by a vote of 50-8-2.  On to the Senate.   

Vaccines

HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months got through the full House 58-0-2.  On to the Senate.   

Sunscreen & Tanning Beds

HB 2134 which would make it clear that kids can take sunscreen to school and camps… and that school and camp staff can help them put it on passed through the House 46-12-2.  

HB 2194 – which prohibits kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free passed through the House 39-19-2. Both will get Senate committee assignments this week. 

Physical Activity

HB 2082 which would require all schools to have 50 minutes of unstructured recess per day from K through 5th grade got through the House 39-20-1.  On to the Senate.  Good news for physical activity!  

Tribal Courts and Involuntary Commitment 

HB2084 is a new one for our list.  Basically it would allow a mental treatment facility to admit a patient for involuntary treatment pending the filing of a tribal courts involuntary commitment order.  This is good (and we support it) because it will provide better treatment logistics for patients.  It passed through the House 60-0.  

Nurse Anesthetists

SB 1336 passed the Senate last week.  It would basically let nurse anesthetists issue a medication order in the scope of his or her practice.  We’re for it because it would help improve access to care in rural areas by adjusting the prescribing authority for nurse anesthetists (helping fill a care gap).  This passed through the Senate floor 25-5-0, so it’s on to the House for this one.

Drug Overdose Review Team

HB 2493 which would set up a drug overdose review team at the ADHS (much like the child fatality review team) passed the House 52-6-2.   

Traffic Safety Cameras

Let’s face it. Getting a ticket in the mail for speeding or running a red light is no fun.  But evidence suggests that photo enforcement of red lights and speeding is an effective public health intervention, which is why we don’t like HB2525.  It would ban traffic safety cameras in AZ.  Unfortunately, this passed on a House floor vote 32-28-0.  A close call, but it did pass.  We’ll be trying to inform the debate over in the Senate regarding how traffic safety cameras prevent injuries and save lives.

Teenage Texting & Driving

SB 1080 which would ban brand-new teen drivers from using their smart phone (for the first 6 months of their license if they’re under 18) passed on a Senate floor vote 24-6-0.  Not exactly a robust prohibition on texting and driving because it only applies to new teenage drivers for 6 months, but at least it’s a start.  The only other AZ state law that prohibits texting and driving applies to school bus drivers.  AZ is behind the national curve in this area. Next stop is a Senate committee.

Newborn Screening

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 28-1-1.  

Tobacco

A couple of weeks ago we signed up in support of and testified for HB 2335 which (if it had passed) would have moved the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  It passed in th House Health Committee 7-2, but was never heard in the Commerce committee and it effectively died last week because it didn’t get a floor vote.   

Voter Initiative Stuff

Perhaps some of the most troubling bills and resolutions in terms of public health have to do with the voter initiative process.  Many of the real big achievements in public health have been voter initiatives (e.g. Smoke Free Arizona Act).  A couple of the bills that would change how voter initiatives work would require voter approval, but a couple could be approved by the Legislature (with the Governor’s signature).  We’re not alone in our opposition to these proposals- lots of people are concerned about them. Here’s a quick summary:

• HCR2002 & HCR2007 (which would need to be approved by voters to become effective) passed the House and would repeal the Voter Protection Act – which stops the Legislature from altering voter initiatives except under strict circumstances.
• HCR2029 hasn’t passed the house yet but would require signature gatherers to get a certain number of signatures in each of the 30 legislative districts.  This one would ultimately need to be approved voters.
• HB 2404 passed through the House (as amended) and would prevent signature gatherers from getting paid by the signature (for voter initiatives- not for candidate signatures).  This one could become law without voter approval.

AHCCCS Waiver

AzPHA submitted 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 topublicinput@azahcccs.gov by February 28.

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If you’re interested in joining our Public Policy Committee, you can contact tiffany@azpha.org and she’ll get you on our list.  We have a weekly call every Monday at11 am and someone from the committee is always down at the Legislature for key hearings.

Good question.  Often those of us in public health tend to focus on the importance that access to care has in public health outcomes.  But we also know that having a robust economy that provides opportunities is a key driver in the social determinants of health that dramatically impact health status of populations.

The Children’s Action Alliance commissioned the W.P. Carey School of Business at ASU to study the economic impact of removing the federal funds that are coming into Arizona as a result of the Affordable Care Act.  Among the report’s conclusions is that if all federal and state ACA-related funding including tax credits were eliminated, the Gross State Product in AZ would decline by $5 billion with a loss of $3.5 billion in personal income. Employment losses in all sectors would be about 62,000 with the health care sector losing 29,000. 

The 25-page report has a host of results that demonstrate repealing the ACA’s healthcare funding provisions would do more than just reduce access to care, it would result in impacts to Arizona’s economy that would affect those social determinants that are so important to maintaining population health.

Some members of the U.S House of Representatives and the U.S. Senate have vowed to repeal and replace the Affordable Care Act.  A key public health question is “what does replace mean and what does it look like”.  If you’d like to have your voice heard, you can take action now by using this APHA tool to send your message to Senators McCain and Flake and your Representative (based on the address you use). 

The time to voice your opinion is now!

Chances are that some of your most memorable moments of elementary school were outside. Back in the day, lunchtime lasted just as long as all the other periods and we had at least one short recess period, and maybe two.  It’s still that way in some places, but in others – lunch and recess haven’t been competing for time as successfully as other academic subjects. 

That might be about to change thanks to a bill working its way through the state legislature that 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 choices for physical activity. This week, the House Education Committee approved House Bill 2082 sponsored by Jesus Rubalcava and 14 co-sponsoors.  In the committee hearing Rep. Rubalcava explained that his experience as a teacher convinces him that kids benefit from physical activity during the school day.

Rep. Rubalcava and his co-sponsors are on to something.  There’s solid scientific evidence that they’re right.  A few years ago the CDC published a review of published studies and concluded that physical activity during the school day improves cognitive skills and attitudes, enhances concentration and attention, and improves classroom behavior.  Maybe it’s time to think about lunch and recess as a catalyst for improving overall academic achievement and classroom behavior.  Talk about the best of both worlds!

There was some debate in the Committee hearing this week from members wondering about the evidence base relating physical activity to academic achievement.  Fortunately the public health community is front and center with the data about the evidence in the CDC’s report entitled The Association Between School-based Physical Activity, Including Physical Education, and Academic Performance.  

We at AzPHA are committed to building public policy that improves health using evidence.  That’s exactly what  House Bill 2082 does- which is why it has our ringing endorsement.  

P.S. Local school districts make decisions every year about how and when to incorporate physical activity into their academic day.  Public health folks can help shape those decisions by working with schools and districts using the CDC’s School Health Index.  

 

Distracted driving kills people just like impaired (drunk) driving does. Thousands of people each year are killed by distracted drivers.   

There are a lot of ways people can be distracted while driving… it happens anytime you take your eyes off the road.   Any non-driving activity is a distraction that increases your chances of crashing and hurting or killing yourself, your passengers or other drivers.

Let’s face the facts.  Our cell phones are an increasing part of our lives whether we want to admit it or not.  It seems perfectly natural to pick up your smart phone and check email or texts or other social media, like twitter.  Sometimes we do it while driving, like at a stop light – when the main problem is not seeing that the light has turned green and the driver behind you honks at you to get going.  You make it through the light but the guy behind you doesn’t.  That’s a harmless irritation.

But sometimes people check their phones while they’re actually driving- and that’s what’s lethal.  Sending or reading a text or checking or social media takes your eyes off the road for at least 5 seconds.  At 55 mph, that’s like driving the length of an entire football field, blindfolded.  Here’s another point of view.  Texting while driving increases your risk of crashing by 23% and slows your reaction time to an equivalent of a 0.1% blood alcohol level- which is legally drunk.  Does that sound safe to you?  Probably not, but chances are you’ve done it.  It’s super dangerous, but most of us don’t recognize how dangerous it is.  

Luckily, the National Traffic and Highway Safety Administration (NTHSA) tracks data regarding distracted driving…  allowing  elected officials to have some data with which to make public policy regarding texting or social media and driving.  Here’s a quick factoid from the mounds of data they have: In 2014, there were a total of almost 30,000 fatal crashes in the U.S. and about 10% (3,000) of those fatal crashes involved distracted drivers.

So, now we know that distracted driving is a clear and present danger.  The question is what should we do about it in terms of public policy?  There are all kinds of social media and other messaging out there discouraging distracted driving.  That might work for some folks, but let’s face it, sometimes there needs to be more at risk for people to take things seriously.  That’s where distracted driving laws come in.

NTHSA also tracks what the state laws are that address distracted driving.  You can visit their State Laws page to what the laws are in the various states.  Currently, 46 states ban text messaging for all drivers.  Forty one of those even have primary enforcement, meaning that law enforcement folks can pull you over for violating thedistracted driving law.  

Of the 4 states without an all driver texting ban (Arizona is one of those 4) , 2 at least prohibit texting by novice drivers.  In Arizona, the only restriction applies to school bus drivers.  Montana doesn’t even prohibit school bus drivers from texting. 

Over the years Arizona lawmakers have introduced bills that tried to put a little muscle into distracted driving laws, to no avail.  This year there’s increasing optimism that AZ might actually be able to pass a law that deals with distracted driving  because of the makeup of the new legislature.  

Here are the bills that have been introduced:

SB1086   Sentencing; aggravating factor; texting

SB1087   Wireless communication device; driving; prohibition

SB1088   Vehicles; collisions; injury; texting; penalty

Here at AZPHA, we’ve expressed public support for SB 1086, 1087, and 1088, all of which move the ball forward.  Our state legislature actually makes it pretty easy to stay engaged and track the progress of various bills. If you’d like to see bills like these be successful, you can track their progress online.

Interested in adding your voice and learning more about how you can make a difference?  You could always join AZPHA and participate in our Public Policy Committee which continually tracks and advocates for bills like these that enhance public health in Arizona.

Interested in learning more about distracted driving generally?  Check our NTHSA’s website on distracted driving.