COVID19 Revealed the Dismal State of Arizona’s Healthcare System
The post-COVID19 world will be different from “the before times” and hopefully better. In my opinion, the past will never return exactly as it was, and we have to plan for that. Travel, tourism, consumerism, healthcare, entertainment, K-12 schools, higher education, work life, prisons … many changes will come in these areas and others, whether we want substantive change or not.
Our job is to create the world we want. Here are some of my priorities for 2021 and beyond.
Arizona had one of the worst pandemic outbreaks in the country, thanks to random executive orders; states rights; for-profit medicine; chronic doctor and nurse shortages; widespread healthcare deserts; and no comprehensive federal or state disaster plans or leadership.
It doesn’t do our community, our state, or our country any good to force people to live in poverty and sickness — just to save a buck. Arizona’s healthcare system was an inadequate, broken patchwork before COVID19; it won’t improve without investment and serious reform.
Maternal & Child Health
Arizona is not only shortchanging its school children. Our stingy policies are shortchanging some children before they are even born. In 2020, I proposed major legislation to improve and expand maternal and child health, improve birth outcomes, and save money while doing it. Premature birth alone is costing Arizona billions of dollars a year because the state’s Medicaid system (AHCCCS) pays for 52 percent of the live births. The cost of premature birth doesn’t end when the baby leaves the nursery intensive care unit. Premature babies often have chronic health issues, along with long-term intellectual and developmental disabilities. We should be investing in healthy babies by expanding pre- and post-natal care, not forcing Moms and their children to struggle.
On top of this, Arizona has the worst record in the US for Adverse Childhood Experiences (ie, food insecurity, housing insecurity, death or loss of a parent, domestic violence, drug addiction). What if the Legislature’s goal was to ensure that all of Arizona’s children have food on the table and a roof over their heads? This could be accomplished with better-paying, fulltime jobs, or when times are tough and jobs are scarce, an adequate social safety net to prevent homelessness, hunger, family separations, and childhood trauma.
Far too many single Moms and their children are forced to live in poverty with food and housing insecurity, and the Republican-controlled Legislature has done nothing about this.
In 2021, to tackle poverty and food insecurity, I will again propose expanding Temporary Assistance to Needy Families (TANF) to the full five years and raising the amount, which is currently set at 36% of the 1992 poverty level. To tackle housing insecurity, I will again propose full restoration of the Housing Trust fund and implementation of fair tenant/landlord laws and property tax assistance for the elderly.
In October 2017, I organized the 200 Stories: Tucson Healthcare Forum. More than 75 people participated in the forum, and most of them shared their stories about health insurance, medical care, drugs, and cost in writing, on video or through the forum survey.
The message was clear. People are not ready to give up on the Affordable Care Act. The vast majority (91%) said they are against repeal of the ACA. Two-thirds of the attendees wanted ACA to be fixed (primarily due to cost), and 70% said health insurance should be government-based (Medicare for All). Too many people are still going bankrupt from medical bills because they buy the insurance they can afford–not the insurance they need. The ACA was a good attempt as balanced public policy. It should be amended. One change I would make is negotiation of drug prices. That would save us millions.
When asked what adjectives they would use to describe the health insurance system they want, they said they want a system that is universal (91%) and fair/equitable (76%). Any plan that leaves millions of American adults and children without healthcare insurance is not universal, fair or equitable. I agree with them, and that is why I co-sponsored Rep. Kelli Butler’s bill to allow Arizonans to buy into the Arizona Health Care Cost Containment System (AHCCCS or Medicaid). Buying into Medicaid would give people a state-wide public option that is cheaper than what they can buy on the ACA exchange. I think it is a great idea. It’s too bad that party gridlock stopped this great bill from being heard in 2018.
I believe that eventually the US will have Medicare for all because the current hodgepodge is not working, after repeated attacks from the Republican Party and President Trump. In the meantime, I plan to do what I can to improve cost and access to care. (For more information and results from the Healthcare Forum, go here.)
Arizona’s Comprehensive Opioid Bill
In my first term in the Arizona Legislature, I was the ranking Democrat on the House Health Committee and a member of the Banking and Insurance Committee.
As a result, I have spent many hours reading, debating on and voting on bills that are related to public health, healthcare delivery, behavioral health, child safety and welfare, drugs, drug addiction, health insurance, insurance contracts, workers’ compensation, defined benefits, presumptive work-related medical conditions, changes in nursing, pharmacy and dental practice and much, more. The Arizona House Health Committee is pictured above, after we passed the opioid bill.
Serving on the Health Committee and in the Arizona Legislature has been an interesting journey and one for which I am well qualified. I have a Masters in Public Health from the University of Arizona and decades of work experience in healthcare, public health, medical communications, and research. Most recently, I was the managing editor of the American Journal of Medicine.
There were two big wins for public health in 2018– the passage of the comprehensive opioid bill and the passage of dental therapy. My seatmate, Dr. Randall Friese, and I are the only two medical people in the Arizona Legislature. We both played an integral role in the negotiation and passage of the Arizona Opioid Epidemic Act (SB1001/HB2001) in 2018.
Unlike much of what we do in the Arizona Legislature, the opioid bill was a truly bipartisan effort. The governor even gave the Democrats the bill language in advance and asked for our input. The Republicans included us in the bill development process because they needed our votes and because didn’t want us to blow it up on the floor with our debate skills.
As someone who worked in public health and nicotine addiction treatment for years, I was proud to serve on the Democratic Caucus team that reviewed the bill and offered suggestions for revision. It was very heartening that they included several Democratic ideas in this bill. Four of my suggestions were included: offering treatment instead of jail during an overdose situation, AKA the 911 Good Samaritan bill (HB2101), which has been proposed by Democrats for four years in a row; providing funds to counties for life-saving NARCAN kits (HB2201); providing a non-commercial treatment referral service; and offering treatment in a brief intervention after an overdose scare (when your doctor says, “You didn’t die this time. Maybe you should quit!”). The Democrats also suggested including the Angel Initiative (where addicts can drop off their drugs and ask for treatment, without fear of arrest) and $10 million for drug addiction treatment services for people not on AHCCCS (Medicaid) or private insurance.
The passage of the dental therapy scope of practice in Arizona was win for access to care and workforce development. A dental therapist is a mid-level dental professional who is in between a dentist and a dental hygienist in their training and scope of practice. (A dentist can perform 400 procedures; a dental therapist can perform 80 of the simpler dental procedures.)
The passage of dental therapy was a hard fought battle. Going into the Sunrise Hearing in November 2017 (pictured here), only Republican Senator Nancy Barto and myself being solidly in favor of dental therapy, and Navarrete was leaning support.
I fought hard for the passage of dental therapy because it expands access to affordable dental care and screening and helps prevent tooth loss. Senator Barto likes dental therapy’s potential cost savings to the state’s Medicaid program. After five solid hours of testimony in the Sunrise Committee, dental therapy passed on a 5-4-1 vote with three Democrats (Bradley, Navarrete and Powers Hannley) and two Republicans (Barto and Montenegro) voting yes. (It is not often that four powerful Republicans are on the losing side of anything in the Arizona Legislature.) Dental therapy was killed in the House Health Committee but– after further negotiations and modifications– rose from the dead as a striker on the last day of the 53rd Legislative Session. Dental therapy will improve access to affordable dentistry for people living in urban and rural areas and on tribal lands.
I am proud to have played an integral role in the passage of both of these landmark bipartisan health efforts. I hope we can work together to pass future legislation that can help a broad range of people.
‘View from the Left Side’ Blog & YouTube Videos
Since 2018, I have been making daily video updates from my office at the Capital and regular videos during the interim, when I am in Tucson. As a result, I have an extensive collection of videos on Facebook and YouTube. Both collections are organized into playlists to facilitate learning more about specific topics like education, taxes, or public health.
For more information, here are more blog posts and YouTube links on healthcare, medicine, and public health.
Here are some of health-related one-minute updates from my office at the Capitol.