Will Humble Firearm Safety, Injury Prevention, Prevention, Wills Blog

Today’s National Public Health Week Topic: Violence Prevention

Gun violence is an epidemic in America. On this second day of National Public Health Week — which has a daily theme of “Violence Prevention” — about 100 Americans will be killed with guns, and hundreds more will be injured.  That’s just today.

Beyond gun violence, 1 in 4 U.S. women experience intimate partner violence, 1 in 6 has been the victim of rape or attempted rape, and hundreds of thousands of children experience abuse and neglect. Yet violence is preventable with the right research, resources and policies.

In support of today’s NPHW theme, urge policymakers to pass commonsense measures to reduce gun violence and provide research funding on par with the nation’s gun violence epidemic. Learn about ways to help make your community safer for all, such as using trauma-informed services to identify victims of violence and calling on law enforcement officials to treat all people with dignity, respect and fairness.

Also remember (see below) that we have some free upcoming free Mental Health First Aid Certification Opportunites for AzPHA Members.

For more on Tuesday’s NPHW theme and ways to take action, read our Violence Prevention fact sheet and help spread the word on social media. And join APHA and the Coalition to Stop Gun Violence for a gun violence prevention Twitter chat at 4 p.m. ET today. Use the hashtag #PublicHealth4GVP to join in.

Also today, as part of APHA’s NPHW celebrations, the Association will host a webinar at 3 p.m. ET with the Aetna Foundation and U.S. News & World Report on the recently released Healthiest Communities ranking. RSVP for the event now.

Join APHS tomorrow for the 9th annual #NPHWchat hosted by @NPHW (RSVP here), and on Thursday for NPHW Student Day activities. Don’t forget to check our calendar of local NPHW events to see what’s happening in your community.

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Free Mental Health First Aid Certification Opportunities for AzPHA Members

AzPHA is delighted to announce that we’re partnering with Crisis Response Network to provide our members a free opportunity to become certified in Mental Health First Aid.  We’ll have 3 separate opportunities in the next few months to take the 8-hour (one day) Mental Health First Aid course in which you’ll learn risk factors and warning signs for mental health and addiction concerns, strategies for how to help someone in both crisis and non-crisis situations, and where to turn for help.

When you take a course, you’ll learn how to apply the Mental Health First Aid action plan in a variety of situations, including when someone is experiencing:

  • Panic attacks

  • Suicidal thoughts or behaviors

  • Nonsuicidal self-injury

  • Acute psychosis (e.g., hallucinations or delusions)

  • Overdose or withdrawal from alcohol or drug use

  • Reaction to a traumatic event

Upon completion of the one-day course you’ll receive a three-year certification.  It’s a terrific opportunity to build your public health skill set while enhancing your professional credentials.

We’re offering the free Mental Health First Aid course on:

If you have any questions or concerns please reach out to Shelby Graves at Shelby.Graves@CrisisNetwork.org.

Will Humble Family Planning, Maternal Health, Wills Blog

Arizona Family Health Partnership Snags Title X Family Planning Grant

The Arizona Family Health Partnership is once again the sole Title X Family Planning grantee for Arizona. They received their Notice of Award last week for up to 3 years. The grant is for the $5.2M per year.

Title X is a super important public health program that provides folks with comprehensive family planning and related preventive health services. It’s designed to prioritize the needs of low-income families or uninsured people. Its overall purpose is to promote positive birth outcomes and healthy families by allowing individuals to decide the number and spacing of children.

The services provided by Title X grantees include family planning and contraception, education and counseling, breast and pelvic exams, breast and cervical cancer screening, screenings and treatment for sexually transmitted infections and HIV.  It also focuses on counseling, referrals to other health care resources, pregnancy diagnosis, and pregnancy counseling. Title X funding does not pay for abortions.

The AFHP has been the awardee for these services in AZ for many years. When I was at the ADHS, we didn’t apply for the Title X grant because our team believed that the AFHP did a really good job providing these services.  A couple of years ago one of the state budget bills required the ADHS to apply for the Title X grant.

Many people believe the line item was included in the budget in hopes that ADHS rather than AFHP would get the grant.  The motivation for that is that the ADHS is prohibited from contracting with Planned Parenthood for Title X services (which do not include abortion services), while AFHP (as an independent nonprofit) could continue to contract with Planned Parenthood.

Will Humble State Legislature, Wills Blog

Legislative Update

This week will be a tricky one – especially in the House.  That’s because Representative Stringer (R-Prescott) resigned last week (I’m sure you’ve heard about the details regarding why- so I’ll spare you that).  His replacement hasn’t been named yet by the Yavapai County Board of Supervisors. Until someone is named it’ll probably slow things down in the house- because the party margin is now 30-29… meaning that for partisan votes there aren’t 31 Republicans anymore (temporarily).

There’s not much new since last week’s legislative update except a new strike all bill (SB 1147) which makes changes to how cigarettes and e-cigarettes are regulated.  Here’s the House’s summary of the Bill.  It received a pass recommendation from the House Health and Human Services Committee (5-4).

If you read the summary you’ll see that the bill is pretty complicated and involves a number of different laws- plus- there were a number of confusing amendments that were discussed in committee.

We’ll pay a lot of attention to this bill in the coming week and make sure that our position is consistent with our previous resolutions on this important public health subject.

Lots of bills still need to go to the Rules Committee before being released to a floor vote.  Here’s our weekly spreadsheet with the bill updates. 

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Remember- there’s only a month to go until our Spring Summit:  From Ideas to Action: Addressing Arizona Children’s Oral Health Disparities 

Thanks to a generous grant from the Arizona Oral Health Coalition & the Denta Quest Foundation, we are able to offer a special registration discount for AzPHA members of only $65! 

Register as a Member of AzPHA  ……………………………………….…….     $65

Non-Member Registration w/Free AzPHA Membership ………..  $140

View Our Agenda &

Register!

Will Humble Medicaid, Wills Blog

Judge Strikes Medicaid Work Requirement Waivers

A federal judge on Wednesday struck down Medicaid work requirements for “able-bodied” adults in Arkansas and Kentucky. The requirements are somewhat similar to community engagement requirements that CMS has approved in Arizona (and scheduled for implementation on January 1, 2020).

The rulings found that the KY and AR waivers pose numerous obstacles to getting health care that haven’t been adequately addressed by CMS and the state officials in those states.

The ruling doesn’t apply to the AZ community engagement/work requirement waiver (which has already been approved) and probably won’t impact AHCCCS’ pending community engagement/work requirements scheduled for a 1/1/20 start date.

Will Humble Affordable Care Act, Health Insurance, Medicaid, Wills Blog

US Justice Department Won’t Defend the ACA

A couple of months ago a federal judge in Texas (Judge Reed O’Connor) dealt a blow to the ACA when he ruled in Texas v. Azar that it’s unconstitutional in its entirety- including the implementation of market reforms (e.g. protections for folks with pre-existing conditions), the health insurance marketplaces, and the expansion of Medicaid. He didn’t issue an injunction ordering the suspension of the law – so the ACA will remain the law of the land for now.

Last week the DOJ made it crystal clear that they have no intention of defending any of the provisions of the ACA (including covering pre-existing conditions) because they agree with the plaintiff States. That clear message came in a short statement by the Attorney General when he notified the court that they fully side with Judge O’Connor’s decision in Texas v. Azar & won’t defend the ACA.

The December 2018 ruling isn’t the last word. The case has been appealed to the federal appellate court system.  It will probably end up with the US Supreme Court…  which has a different cast of characters than it did when the ACA was originally upheld back in 2012 by a 5-4 vote.

Since then, Gorsuch replaced Scalia and Kavanaugh replaced Kennedy.  Both Scalia and Kennedy voted against the ACA- so not much on that score has changed.

Chief Justice Roberts voted with the majority that upheld the law.  His argument rested on the ACA’s link to the financial penalties for not having health insurance. But remember, the financial penalties for not having health insurance were removed from the IRS tax codes in last year’s federal tax overhaul, pulling out the structure that Roberts used in his argument.

In the 2012 Ruling, Justice Roberts wrote that: “… the Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax… because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” 

Roberts rejected the Administration’s argument that the federal government’s authority to regulate interstate commerce provides the authority needed for the ACA to be constitutional (the Court struck down that argument 5-4).

The bottom line is that the ACA, including its protections for folks with pre-existing conditions, may very well be in jeopardy if Roberts views the ACA as fundamentally different now that the financial penalties are gone.

Will Humble Affordable Care Act, Health Insurance, Medicaid, Wills Blog

How Can AZ Prepare for a Post ACA America?

It’s easy to see how the ACA could end up being struck down in a couple of years once this case gets to the highest court. Gone would be the health insurance market reforms like protection for folks with pre-existing conditions, community rating pricing and guarantee issue as well as Medicaid expansion and the health insurance marketplaces.

Prior to the ACA, the standards to protect people with pre-existing conditions were determined at the state level.  Most states including AZ had very limited protections. Many insurers maintained lists of up to 400 different conditions that disqualified applicants from insurance or resulted in higher premiums.  35% of people who tried to buy insurance on their own were either turned down by an insurer, charged a higher premium, or had a benefit excluded from coverage because of their preexisting health problem.

Fortunately, Arizona is partially in control of our own destiny if the ACA is struck down. We couldn’t do much about Medicaid rolling back to pre-ACA levels or the loss of subsidies on the Marketplace, but we could have some control over the market reforms like pre-existing condition exclusions, community pricing, and guarantee issue.

Several states have enacted their own laws to be consistent with the ACA market reforms. Several states already have their own laws that incorporate some or all the ACA insurance market protections. Arizona could do the same. 

The good news is that we have time before the Texas v. Azar case makes it to the Supreme Court. A good 1st step would be for the Governor to ask our state agencies to generate (or commission) a report outlining the real-life impact in Arizona in the event that the Texas v. Azar suit is successful. The report would put forward options for state-based health insurance market reform laws to require things like prohibiting pre-existing condition exclusions.

Such a report would give the Arizona State Legislature an analysis to evaluate public policy options for state-based market reforms.

I know what you’re thinking, it’s impossible to pass these kind of market reforms in Arizona.  Maybe, but many thought that Arizona’s expansion of our Medicaid system back in 2013 was impossible.  That case study shows that with the right kind of leadership on the 9th floor, anything is possible.

Will Humble Public Health Law, State Legislature, Wills Blog

Legislative Update

Legislative Update

It was a busy week especially in the House with the various bills that were advocating for and against (mostly for).  Here’s a run down on this week’s action and a forecast for next week.  Lots of bills still need to go to the Rules Committee before being released to a floor vote.  Here’s our weekly spreadsheet with all the bill updates.

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Bills that have passed one chamber and received a do pass committee recommendation in the sister chamber:

SB 1040 Maternal Mortality Report (Brophy-McGee) – AzPHA Position: YES

Passed the Senate 30-0. Bill Passed the House Health Committee 9-0. 

SB 1085 Association Health Plans- AzPHA Position- Opposed

Passed the Senate 24-6.  Passed the House Health and Human Services Committee 6-2-1. Rules Committee Next.

SB 1088 Dental Care During Pregnancy (Carter) – AzPHA Position: YES

Passed the Senate 27-3.  Passed the House Health & Human Services Committee 8-1.  Passed House Appropriations 7-4. Rules Committee Next. Will still need to get into the final budget.

SB 1089 Telemedicine Insurance Coverage (Carter) – AzPHA Position: Yes

Passed Senate 30-0. Passed the House Health & Human Services Committee 9-0.

SB 1109 Short Term Limited Health Plans- extension – AzPHA Position: Opposed

This bill has passed both chambers and has been signed by the Governor.  It authorizes the sale of short- term limited health plans in Arizona for terms up to 3 years.  The previous limit was 1 year.  These plans don’t cover pre-existing conditions and have limited consumer protection because they aren’t required to cover the essential health services under the ACA and can drop enrollees.  We urged a not vote because of the poor consumer protections.

SB 1165 Texting and Driving Prohibition (Brophy McGee) – AzPHA Position: YES

Passed Senate 20-10. Passed the House Transportation Committee 5-1-1.  Rules Committee Next.

SB 1174 Tribal Area Health Education Center – AzPHA Position: Yes

Passed Senate 30-0. Passed the Senate Education Committee 13-0. Rules Committee Next.

SB 1211 Intermediate Care Facilities (Carter) AzPHA Position: Yes

Passed the Senate 30-0. Passed the House Health & Human Services Committee 9-0.

SB 1247 Residential Care Institutions (Brophy McGee) AzPHA Position: Yes

Passed the Senate 30-0.  Bill passed the House Health Committee 9-0.

SB 1245 Vital Records- Death Certificates (Brophy McGee) AzPHA Position: Yes

Passed the Senate 30-0.  Passed through all House Committees- ready for a Floor Vote.

SB 1354 Graduate Medical Information & Student Loan Repayment (Carter) AzPHA Position: Yes

Passed Senate 28-2.  Passed Hiouse Appropriations Committee 10-1, HHS Committee Next.

HB 2125 Child Care Subsidies (Udall) – AzPHA Position: YES

Passed House 46-13.  Passed the Senate Health and Human Services Committee 7-0-1. Rules Committee Next.

HB 2488 Veteran Suicide Annual Report (Lawrence) AzPHA Position: Yes

Passed House 60-0. Passed the Senate Health and Human Services Committee 7-0-1. Rules Committee Next.

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On this Week’s Agenda:

House Health & Human Services: Thursday 03/28/19 at 8:30 AM, House Rm. 4  

SB 1009 Electronic Cigarettes, Tobacco Sales (Carter) – AzPHA Position: YES

Passed the Senate 30-0. Assigned to the House Health and Human Services Committee.

SB 1355 Native American Dental Care – AzPHA Position: Yes

Passed Senate 25-5.  Assigned to House Health & Human Services Committee.

SB 1456 Vision Screening- AzPHA Position: Yes

Passed Senate 29-0. Assigned to Senate Education Committee.

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Bills that passed one chamber and have been assigned to a committee but have not yet been put on an agenda yet include:

SB 1060 (Strike-all Amendment) Electronic Cigarettes. Smoke Free Arizona Act (Carter) – AzPHA Position: YES

Passed the Senate 28-0. Assigned to the House Health and Human Services Committee. 

Will Humble Oral Health, Prevention, Wills Blog

Arizona’s New Oral Health Plan Published

The Arizona State Oral Health Action Plan 2019-2020 Workgroup released the Arizona 2019-2022 Oral Health Action Plan this week.  The report articulates goals, delivers recommendations, and identifies strategies to improve the oral health of all Arizonans. It incorporates strategies gathered over three years of collaboration with health care stakeholders, state and regional oral health coalitions, educational institutions, professional associations, and grassroots organizations. This plan offers solutions to address the tremendous burden of preventable oral diseases that affect individuals across the lifespan by collaboratively creating a new blueprint to improve oral health and overall health.

The goals and objectives address four cross-cutting systems of care: Policy, Care, Community, and Financing.  The goal and objectives for each category begin on page 18 of the Report.  Recommendations include:

Policy—using data and stories to educate, advocating for Medicaid dental coverage for pregnant women, increasing the number of Arizonans with optimally fluoridated water, and establishing a state oral health surveillance plan;

Care —ensuring an adequate, diverse, and culturally competent workforce, incorporating oral health as an essential component of overall health and well-being through integrated inter-professional systems, and encouraging, supporting, and tracking inter-professional educational models of care;

Community—maintaining a statewide network of champions and leaders for oral health advocacy and planning, supporting evidence-based prevention and early detection programs, and implementing and disseminating consistent and uniform messaging; and  

Financing—financing oral health as an important component of overall health, funding and expanding oral health prevention, and sustaining financial support to improve health outcomes.

As is the case with any plan- the real key is translating the plan goals and objectives into public policy via administrative advocacy (policy interventions by state agencies), legislative advocacy (policy interventions like SB 1088 which would provide preventative oral health care for pregnant Medicaid members), by working with systems of care to improve inter-professional collaboration and by influencing policies by payors to drive better outcomes (e.g. teledentistry).

Will Humble Maternal Health, Oral Health, Wills Blog

Extending Preventative Oral Health Coverage to Pregnant Medicaid Members will Save Money & Improve Birth Outcomes

Good oral health is more than just a nice smile. Having good oral health improves a person’s ability to speak, smile, smell, taste, touch, chew and eat. Untreated tooth decay leads to needless pain and suffering; difficulty in speaking, chewing, and swallowing; and missed school days. Evidence also suggests that poor oral hygiene and health increases the risk of other health problems like diabetes, stroke, heart disease and bad pregnancy outcomes. 

Physical and nutritional changes that occur during pregnancy often lead to an increased risk of dental and gum problems from increased inflammatory response, loosened ligaments and increased acidity in the mouth. In addition, several studies have found a link between gum infection and poor birth outcomes, such as pre-term deliveries, lower birth weight and high blood pressure, which can lead to serious complications for both mom and the baby.

Many studies have found a relationship between periodontal disease and worse birth outcomes- but until now there hasn’t been a systematic overview of systematic reviews.  Now there is.  This new systematic overview found a clear relationship between periodontal disease and pre-term birth, low birth weight and preeclampsia (potentially dangerous high blood pressure during delivery).  The researchers reviewed 23 systematic reviews (including between 3 and 45 studies) and found an association between periodontal disease and preterm birth (relative risk, 1.6), low birth weight (LBW; relative risk, 1.7), preeclampsia (odds ratio, 2.2), and preterm low birth weight (relative risk 3.4).

The implications of the study are profound.  The estimated population-attributable fractions for periodontal disease has a mid-point of 16%, 18% for low birth weight, and 22% for preeclampsia.  Let’s look at what that means here in AZ.

In 2015, 7.2% of AZ live births were low birthweight (less than 2.5 kg).  With about 80,000 births (5,760 low birthweight births a year), that means periodontal disease is potentially contributing to 1,036 low birthweight weight babies each year in AZ. 

About half of AZ births are paid for by our Medicaid program- meaning periodontal disease may be contributing to 520 low birth weight babies among Medicaid members every year.  Let’s look at what that might be costing.

An analysis by Truven Health Analytics a few years ago found that the average health care cost for a low birth weight baby during the first year of life is $55,393 compared with $5,085 for a non-low birth weight baby. 

Putting the two estimates together suggests that the 520 pre-term babies potentially attributable to periodontal disease (and paid for by Medicaid) would cost about $29M for the first year of life compared with only $2.6M for a similar number of non pre-term births, a savings to the state that is much greater than the estimated cost of the benefit (less than $200K in the first year).

Let’s do whatever we can to get comprehensive oral health coverage for pregnant Medicaid members   SB 1088 over the line this year and improve birth outcomes while reducing health care costs!  It’s being heard in the House Appropriations Committee Wednesday, March 20 starting at 2 pm.  We’re signed up in support of the initiative and I’ll be speaking briefly at the hearing.

You can help by contact the House Appropriations Committee members with the contact info at the end of this email and letting them know that investing in better oral health for pregnant Medicaid members will improve birth outcomes and reduce healthcare costs. The piece below is also posted on our website at: https://azpha.org/wills-blog

Member & email address

Regina E. Cobb rcobb@azleg.gov  

Diego Espinoza despinoza@azleg.gov

Charlene R. Fernandez cfernandez@azleg.gov

John Fillmore jfillmore@azleg.gov

Randall Friese rfriese@azleg.gov

John Kavanagh jkavanaugh@azleg.gov

Anthony T. Kern akern@azleg.gov

Aaron Lieberman alieberman@azleg.gov

Bret Roberts broberts@azleg.gov

Ben Toma btoma@azleg.gov

Michelle Udall mudall@azleg.gov

 

 

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