The AZ Corporation Commission & Public Health (Part I): Rubber Stamping Rate Increases & the Social Determinants of Health

At first glance, the Arizona Corporation Commission might seem like it has pretty much nothing to do with public health. But when you scratch the surface, you’ll discover that the Commission does in fact influence public health in important ways.

This week we’ll cover the Commission’s regulation of monopoly electricity utilities and how that impacts the social determinants of health.

Disposable income is a primary driver of the social determinants of health. The Corporation Commission can have a big impact on family budgets depending on whether they listen to the well-heeled utility executives & lobbyists or ordinary working Arizonans.

The average annual residential utility bill in Arizona is more than $2,200 per year (1,201 kWh * 15 ¢/kWh). That means between 4 and 10% of a low income’s total household budget goes toward electricity.

That’s a big chunk out of a working family’s household budget, restricting the choices families can make to keep their family members healthy.

The current Commission has developed a well-founded reputation of taking utility rate increases at face value and pretty much approving anything the utilities want – to the detriment of low-income households (well, really all ratepayers, but rate increases hit low-income folks the hardest).

For example, a couple of months ago the Corporation Commission approved APS’ proposed 8% rate increase. The four Republicans on the Commission approved the rate hike. The only Democrat on the Commission, Anna Tovar, voted no. The rate hike approved by the Commission infuses APS with a net $253 million or so in increased annual revenue.

Pinnacle West (APS’ parent company) in February reported net income of $501 million for 2023, up from $483M in 2022 (attributable, in part, to the Commission’s 2022 rubber stamping an 8% price boost to “cover the rising cost of methane” last year – that’s on top of the 2024 8% increase).

The Commission also recently rubber-stamped APS’ request to set their future ‘return on investment’ to 9.55%, up from the previous 8.9%… paving the way for even more future rate increases.

In a March 4 investor presentation APS even bragged that they enjoy a “supportive regulatory environment” (their words) that envisions ‘more constructive and consistent outcomes’.

In other words, “we’re not getting any pushback from the Commission“.

After you scratch the surface, it’s easy to see that who you vote for in the upcoming Corporation Commission race can have a big impact on the social determinants of health for working families.

Note: Three of the five Arizona Corporation Commission seats are up for election in November — those of Republicans Jim O’Connor and Lea Marquez Peterson and Democrat Tovar, who has announced she will not run again.

Next week we’ll cover how the Corporation Commissioners can have a good or bad impact on Arizona meeting goals to limit carbon emissions.

USDA Updates Foods Provided Via WIC

USDA updated the list and amounts of foods eligible for purchase by WIC this week and outlined how the additional $1B that was added to the WIC program in the last national budget bill will be used.

WIC is very different from SNAP (aka food stamps). SNAP is a nutrition assistance program that allows folks to buy virtually any food. By contrast, WIC provides prescribed foods specifically designed to supplement the foods and beverages participants already consume and fill in key nutritional gaps to support healthy growth and development.

The big change USDA made this week is to increase the amount and variety of healthy foods available for purchase, providing participants with up to four times the amount they would otherwise receive for some kinds of healthy foods.

Other enhancements include:

  • Expanding whole grain options to include foods like quinoa, blue cornmeal;
  • Providing more convenience and options within the dairy category, including flexibility on package sizes and non-dairy substitution options;
  • Including canned fish in more food packages; and
  • Adding more flexibility for infant formula provided to partially breastfed infants to support moms’ individual breastfeeding goals.

The changes will provide participants with a wider variety of foods to support healthy dietary patterns and allow WIC state agencies more flexibility to tailor the food packages to accommodate personal and cultural food preferences and special dietary needs – making the program more appealing for current and potential participants.

WIC is a federally funded program that supplies important nutritional services and support for eligible pregnant and postpartum individuals and their children until age 5. WIC uses nutritional education, breastfeeding support, nutrition help, and referrals to more services as mechanisms to improve the health of the low-income individuals it serves.

Family income needs to be below 185% of the federal poverty limit in order to qualify (slightly more generous than AZ’s Medicaid participation standard). WIC money goes to states who further manage the overall program. ADHS mostly distributes the money to the county health departments and federally qualified health centers to implement WIC programming.

ADHS will have two years to implement these changes, allowing time to engage with key partners on how best to tailor the new food packages to meet the needs of participants.

WIC – Building Healthy Foundations Infographic

Studies suggest that every $1 spent on WIC results in up to a $3.13 reduction in spending for Medicaid programs. This is particularly pertinent given the large overlap between WIC and Medicaid recipients. Reductions in poor health outcomes because of nutrition aid programs such as WIC are also expected to save significant amounts in private healthcare as well.

WIC at a Glance

ATF Closes ‘Gun Show Loophole’

The U.S. Bureau of Alcohol, Tobacco and Firearms filed a final administrative rule last week eliminating the ‘gun show loophole’ – which up until now has allowed sales of guns without background checks of guns at ‘gun shows’ (sales that occur outside of regular retail stores).

The rule was issued under the new authority given to ATF as part of the ‘2022 Bipartisan Safer Communities Act’. It requires that anyone who sells guns for profit to have a license and that buyers be subject to a background check, including at firearms shows and flea markets. 

The gun show loophole has allowed unlicensed gun dealers to sell firearms without background checks at gun shows, on the internet and out of their homes.

ATF expects the new rule will affect “tens and tens of thousands of gun sales” each year.

In an assessment of its gun trafficking investigations (2017 to 2021) ATF identified sales by unlicensed dealers as the most frequently used gun trafficking channel. 

The final rule:

  • Eliminates the ‘gun show’ loophole;
  • Lists the types of commercial activity requiring a person to be a licensed dealer and run background checks;
  • Prevents people from evading the licensing and background check requirements by claiming that they are just selling a few guns; 
  • Prevents people from falsely claiming that guns are part of a personal collection in an attempt to evade the law; and
  • Closes the ‘fire sale loophole’ – business inventory can no longer be transferred to a person’s personal collection after a license is revoked.

Enforcement of the law will be by the US Justice Department and ATF.  States won’t be formally involved in enforcement of the provisions.

See AZPHA’s Landmark Report on Gun Violence in Arizona: Firearm Violence in Arizona: Data to Support Prevention Policies

Maricopa County Public Health Accepting 2-Year Paid Fellowship Applications

Maricopa County Department of Public Health is now accepting applications for their paid Fellowship Program! This two-year program provides recent graduates with advanced degrees an opportunity for a hands-on learning experience in a diverse and thriving public health environment.

Public Health Fellows will work with MCDPH teams to address the emerging needs of Maricopa County residents. Throughout this program, Fellows can expect to gain exposure to county operations, actively contribute to impactful and evidence-based initiatives, receive personalized mentorship, and participate in ongoing professional development.

Applications can be found at Public Health Internships and Fellowship | Maricopa County, AZ.

This two-year program connects recent graduates of advanced degrees with practical, hands-on learning experience. Fellows will:

  • Receive full pay & benefits;
  • Work with internal projects to execute initiatives aimed at current public health issues in our communities;
  • Receive continuous support and mentorship from Fellowship Coordinator and Project Point of Contact;
  • Be a part of a fellowship cohort; and
  • Transition to Senior status in year two when new Junior Fellows join the program.

Candidates are encouraged to apply soon as this application will be open for a limited time. You can contact MCDPH Fellowship Coordinator Lisa Polovin at  [email protected]  with questions.

Apply Here

ADHS Announces Positive Changes to their Vaccines for Children Program!

ADHS is making several encouraging changes to their management & policies in Arizona’s Vaccines for Children program!

Leadership of the Immunizations Bureau will be changing (although that job announcement isn’t posted yet) and they’re actively recruiting a new Assistant Director that oversees the VFC program.  See: Assistant Director of Public  Health  Preparedness

Why doctors are leaving Arizona’s Vaccines for Children Program making it harder for parents to get their kids vaccinated | KJZZ

They’re also making substantial changes to their policies that partially resulted in more than half of VFC providers quitting the program after the last few years.

New CDC Report: Arizona Has Among the Lowest Childhood Immunization Rates in the U.S.

The Department ran a webinar last week entitled… “Making Improvements to the Vaccines for Children Program”. The webinar capped out at 100 participants – highlighting the interest among providers who were looking for more info about the planned changes to VFC.

You can see the recording on “Making Improvements to the Vaccines for Children Program” or use this URL.

Among the important promises made on the webinar was the removal of the Department’s former punitive restitution policy which threatened and sometimes fined practices for discrepancies in their inventory – sometimes because of issues with the immunizations database run by the agency called ASIIS.

Are We Finally Turning the Corner on Arizona’s Decaying Childhood Vaccination Network?

The question-and-answer segment is currently being compiled and will soon be shared on their VFC webpage, along with the slides and the link to the webinar. You can submit additional ideas or queries to the VFC team by clicking on the link provided here.

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Important Background

The Vaccines for Children Program makes sure kids whose parents can’t afford vaccines can still get their kids vaccinated. Funding for VFC comes via the CDC, who buys vaccines at a discount and distributes them to states. States distribute them to physicians’ offices & clinics that take part in the VFC program. ADHS manages the VFC program in our state.

Arizona lost 50% of its VFC providers during the Ducey administration – going from 1,200 to 600… reducing access to vaccine, lowering childhood vaccination rates and harming overall AHCCCS network capacity. 

Maricopa County Department of Public Health contracted with The Arizona Partnership for Immunizations to study this issue and prepare a report describing the facilitators and challenges to participating in the VFC program from healthcare providers’ perspectives, as well as recommendations for reversing this course. TAPI hired OMNI Institute, a social sciences non-profit consultancy to conduct this assessment.

That report, entitled An Assessment of the Facilitators & Challenges Providing-Vaccine in Arizona was released in December 2023. The 96-page report has many findings. A common theme as presented in the Executive Summary:

“Respondents expressed frustration with the complexity surrounding ordering and returning vaccines, the challenges integrating practice electronic medical record systems with the Arizona State Immunization Information System and the administrative burdens regarding compliance and reconciliation.”

“When asked about the significant challenges/barriers to their continued participation in the VFC program, a common theme respondents raised was an adversarial tone in the enforcement of VFC policies and communications, with administrative errors (some of which stemmed from ASIIS) often being met with accusations of fraud and/or wastage. Many non-VFC providers pointed to administrative burdens, expensive charges to rectify incorrect dose counts, and a generally punitive tone from the VFC program as rationales for their non-participation.”

Read the Report

See also:

AZ Vaccine Congress Meets RE Plummeting Provider Participation in the Vaccines for Children Program

Free Webinar: Public Health Workforce & Substance Abuse in Rural Arizona

Friday, April 26, 2024

9-10am

Agenda

  • Public health relevance of substance use prevention, harm reduction and treatment focusing on opioids and stimulants.
  • Effective prevention, harm reduction, treatment and recovery services that are being deployed across rural Arizona.
  • Importance of addressing both the social and environmental determinants of health in Rural Arizona.
  • Data collection, analysis, and synthesis to inform public health and health care stakeholders as they make policy and program decisions related to the public health and healthcare workforce in Arizona.

Our Speakers:

Dr. Bridget S. Murphy, DBH, M.Ed., has more than three decades of education and experience in public and behavioral health. She has had positions in academic institutions, community-based, and private sector organizations. Dr. Murphy has a doctorate in behavioral health and a master’s in education.

Her principal expertise is in substance use, mental health, and related infectious diseases for culturally diverse populations in various settings. As a teen, Dr. Murphy struggled with substance use and mental health issues and participated in treatment. This experience provided the foundation for her academic and professional direction.

Bryna Koch, DrPH has over 17 years of experience in public health policy analysis, research, and evaluation at the local, state, and national level.

In her current position as an assistant research professor at the University of Arizona, her work focuses on data collection, analysis, and synthesis to inform public health and health care stakeholders as they make policy and program decisions related to the public health and healthcare workforce in Arizona.

Dr. Mona Arora is an Assistant Research Professor at the College of Public Health. Dr. Arora has over fifteen years of experience in disaster preparedness and response, community resilience, and climate change. Dr. Arora currently leads the CDC-ADHS COVID-19 Health Disparities Initiative at the Arizona Center for Rural Health and is Co-Pi on the NIH funded Southwest Center for Resilience on Climate and Health.

Her research focuses on building the public health capacity to address “wicked’ public health challenges through the development of decision-support tools; enhancing science communication and translation; and integrating a health and equity lens to adaptation planning.

Register Here

EPA Issues Contaminant Limit for ‘Forever Chemicals’ (PFAS): Finally Clearing the Way for their Regulation in Drinking Water

EPA just established a maximum limit (Maximum Contaminant Level) for PFAS (aka perfluoroalkyl and polyfluoroalkyl substances) often referred to as “forever chemicals” because they the chemicals don’t degrade over time in the environment as many other chemicals do, like gasoline.

The main sources of PFAS’ in the environment are:

  • Military bases and airports, mostly from training and testing exercises using firefighting foam;
  • Petroleum stations and terminals, chemical manufacturers, commercial printers, plastics and resin manufacturing sites; and
  • Paint and coating manufacturers, semiconductor manufacturers, makers of metal products and electrical components, and electroplating and polishing.

The new MCL for the chemicals is 4 parts per trillion, which is the lowest level that can be detected using current laboratory technology. EPA set the limit using the usual process for setting MCLs which considers a chemical’s ability to cause adverse health effects and an extrapolated assessment of a chemical’s ability to cause cancer.

PFAS will now be regulated under the Safe Drinking Water Act – which in Arizona is overseen by ADEQ (although some counties act under an agreement with ADEQ). Water systems with more than 15 service connections will now have to test for the chemical – and if present either treat to remove it, dilute it, or not use the water (private wells with 14 or fewer connections are off the regulatory grid).

See: EPA sets official limit for six ‘forever chemicals’ in drinking water

Pima County Health Department Internships

Pima County Health Department has 10 paid summer internship positions open!  These internships are located within various divisions throughout the department including Epidemiology, Consumer Health Vector, Clinical Services, Community Mental Health, Addiction, and Injury, Policy, Equity and Resilience, Cross Functional Operations and the Director’s Office. If you are interested in applying, please use the link below.  These internships require a commitment of 400 hours minimum from May 28, 2024 – August 2, 2024.

Pima County Job Opportunities | Departments: Health | Sorted by Posting Date descending | Current Job Opportunities

Arizona Supreme Court Upholds 1864/1901 Law Banning Nearly All Abortion Care: Training this Friday to Circulate Petitions to Legalize Abortion

This Friday: Training to Circulate Petitions for an Arizona Constitutional Amendment that Would Legalize Abortion Care in Arizona

The Arizona Supreme Court today upheld a territorial-era law that will shortly end nearly all abortion care in Arizona. Today’s ruling held that Arizona’s pre-statehood law mandating 2 to 5 years in prison for anyone aiding an abortion “… unless it is necessary to save her (the pregnant person’s) life” is the law of the land. The court believes the territorial-era law banning nearly all abortion care supersedes the more recent law from 2022 that allowed most abortions up to 15 weeks’ gestation.

The court indicated that their ruling can’t be applied retroactively – suggesting that providers who have assisted with abortion care prior to today’s landmark ruling can’t be prosecuted and imprisoned.

Governor Hobbs issued an executive order last year giving all power to enforce abortion laws to the state attorney general as opposed to county attorneys as is normally the case. Attorney General Mayes has suggested she won’t prosecute providers providing abortion care. However, Hobbs’ executive order could easily be challenged by various county attorneys who intend to enforce the territorial era law.

Reproductive-Rights-in-Arizona-1864-2022

Criminal enforcement of the new law will depend on whether county attorneys challenge Hobbs’ executive order. The Arizona Department of Health Services, which regulates clinics and hospitals that provide abortion care, has largely administrative authority (e.g. ensuring licensed facilities comply with the ruling). It’s unclear whether or when ADHS will provide guidance to the clinics they regulate that provide abortion care. See: Abortion Care in Arizona – 2023

In any event, it’s likely that all clinics that provide abortion care will suspend that care within the next couple of weeks. Hospitals, which also provide some abortion care, will likely suspend most care. They’ll also need to develop criteria for determining what “… unless it is necessary to save her life” means.

Arizona Supreme Court Ruling: Planned Parenthood v. Mayes No. CV-23-0005-PR

Held:  Simultaneous enforcement of the overlapping criminal and regulatory provisions of A.R.S. § 13-3603 and Title 36, including A.R.S. § 36-2322, does not facially violate physicians’ constitutional due process right to notice of their criminal and regulatory liability because the statutes clearly define the conduct prohibited and the punishment authorized.

Translation: Arizona Supreme Court holds that Arizona’s 1864 law prohibiting the provision of all abortion care unless the mother’s life is in danger is the law of the land. They believe the newer (2022) law limiting abortion care to 15 weeks does not apply and is superseded by the territorial era law.

Arizona for Abortion Access:  Petition Circulator Training for AZPHA Members

Friday, April 12, 2024: 10:00 AM 

Healthcare Rising Arizona is helping a coalition of organizations to collect signatures for a voter initiative to protect access to abortion care in Arizona. Healthcare Rising Arizona is offering a 1-hour online training event for AZPHA members who would like to become authorized to collect signatures for an amendment to the Arizona constitution the Initiative at 10am on Friday, April 12. After participating in the training, you’ll be authorized to circulate petitions.

During the one-hour webinar you’ll learn:

  • Background and context for the Initiative and get messaging frames for the Arizona for Abortion Access Act;
  • Procedures to properly collect petition signatures to ensure that the signatures are valid; and 
  • Learn strategies to avoid engaging with those who oppose the Initiative.

By the end of the training, you should feel comfortable collecting signatures (and know how to do so properly) and will learn how you can pick up petitions.

Register for the Training

View the Constitutional Amendment Language that Would Ensure Abortion Care in Arizona