#AZ Republican Budget Cuts Taxes by $386 Mil & Shortchanges K-12 (video)

One of the prevailing messages from the grassroots in 2018 was: no more tax giveaways until the schools are fully funded. Republicans didn’t get that message. They also didn’t get the Invest In Ed message that we — the people– think the rich could pay more in taxes to help fund education.

The Republican budget cuts income taxes, TPT and fees by $386 million and leaves education and other needs underfunded (or unfunded).

We started the year with a $1 billion surplus to invest in the People’s To-Do List: education, infrastructure, healthcare and safety and security. The Republicans have added bits of money to these areas — just enough to make it look like they’re doing something— but the need is much greater.

Republicans are ignoring multiple crises that are brewing in our state including unnecessary maternal and child death; rock bottom education funding; crumbling roads, bridges and school buildings; lack affordable and low-income housing; the shortage of teachers, doctors and nurses; too many people living in poverty; lack of access to affordable healthcare… need I go on?

Continue reading #AZ Republican Budget Cuts Taxes by $386 Mil & Shortchanges K-12 (video)

#AZLeg Hears Competing Bills on Vaping (video)

Vaping is a hot topic in the Arizona Legislature this session. E-cigarettes (also known as nicotine vape pens) are unregulated in Arizona. Nicotine vaping is widespread, and usage is increasing, particularly among youth.

Many adults use nicotine vape pens as a way to stop smoking real cigarettes. E-cigarettes don’t have the particulates that tobacco cigarettes do, but that doesn’t mean they are safe.

We have had two competing vaping bills in the Legislature. SB1147 is a tobacco industry bill that carves out vaping and regulates it separately in the Arizona statutes; it also preempts local laws. HB2357 regulates “any product derived from tobacco or containing nicotine” the same.

Back in the 1990s, when e-cigarettes first came to the US, tobacco control researchers at the UA and elsewhere said that e-cigarettes were “drug delivery devices” that should be regulated by the Food and Drug Administration (FDA). The tobacco industry fought this and said e-cigarettes were tobacco and should be regulated like tobacco. They won their court case at the national level, and e-cigarettes have been regulated like tobacco since then.

HB2357 is aligned with the federal law. SB1147 puts vaping into its own category— not a tobacco product or a nicotine delivery device.

Public health advocates are backing HB2357, and so am I.

For more background about these two bills, check out this story in the Capitol Times.

What’s the News on the #AZ Budget? Check Out Video & Town Hall

Many constituents have asked me where the budget is and what’s going on– after all, it is May. On the budget, the status quo of the past month still exists. All of the budget action continues to be behind closed doors, among a closed group of Republicans.

In addition to the Democrats, there are a significant number of House Republicans who are not part of the budget process, and they’re grumbling about it. This is a state budget– not the budget for a small town church. The deacons and the pastor don’t get to decide the budget on their own in the back room. The budget should be negotiated with all parties at the table– not just a handful of those close to power. Democrats make up 48 percent of the Arizona House. When more than 50 percent of the Legislature is kept in the dark and has to rely on rumors, that is not a fair process, and it ultimately hurts the people of Arizona.

Except for the Governor’s budget, which has been public for months, and some leaked details about the Senate Republican budget, little is known about the budget, beyond a few trial balloons. What we do know is that the Senate Republican budget is far more conservative and not even close to Governor Doug Ducey’s budget.

This chasm in the GOP has left an opening for Democrats. The House Democrats will unveil our balanced budget ideas on Wednesday morning at 9:30 a.m.  We have been saying since January that we agreed with parts of the governor’s budget– like full tax conformity and more money for P-20 education. [Stay tuned for details.]

On the right, Senator J.D. Mesnard and other tax cut fans still want to zero-out the money the state could bring in from tax conformity (~$150 million) and Wayfair (~$85 million). There are multiple trial balloons about making the income tax rates flatter. One proposal is to have only two personal income tax brackets. This is a horrible idea– unless, of course, your goal is to return to austerity and Draconian budget cuts, while making your rich donors happy. Under the Republican proposals to eliminate or lower tax brackets, rich people would pay less, and the rest of us could pay more. (Think of the Republican tax bracket plan as Arizona’s mini-Me to the Trump Tax Cut and Jobs Act. Both significantly lower taxes for the wealthy by reducing the top tax rate.)

Continue reading What’s the News on the #AZ Budget? Check Out Video & Town Hall

#AZ House Debates, Passes Association Health Plans SB1085 (video)

Although we had a short floor calendar on May 1, we had some rousing debates. The highlight was a two-hour debate on SB1085, association health plans. (Watch the action here, beginning at 19:32 min.)

The Republicans have had three bills this year to lower healthcare insurance costs by encouraging people to leave the healthcare marketplace. I agree that the Affordable Care Act is too expensive, particularly for sole proprietors (like my husband who was offered a silver ACA plan for more than $1000 per month just for him.) This is why I voted for direct care contracts. I believe those are a better deal for sole proprietors than association health plans.)

Democrats debated valiantly, led by Health and Human Services Ranking Member Rep. Kelli Butler (right). Here, she does Q&A with Rep. Isela Blanc.

I get that costs are too high, but the association health plans are not the way to go. They could, indeed, lower costs for business owners, but they could be risky due to limited coverage. There are reasons why these plans will likely be cheaper. Remember the old adage “you get what you pay for”. If sole proprietor business owners want to take a risk with their own insurance and their own health, I have a mind to let them take their own risk. (Just don’t ask me to help you later with a Go Fund Me Request if it turns out I was right on limited coverage under cheap junk insurance plans.)

Where I object is when businesses are making these risky insurance decisions for their employees— just to save money.

Continue reading #AZ House Debates, Passes Association Health Plans SB1085 (video)

‘Democracy in Chains’ Connects Dots on Libertarian & Republican Strategies (video)

Affordable Care Act

If you often scratch your head at the bad bills that the Republicans pass in Congress and in the state legislatures and wonder what their end game is, you should read Democracy in Chains by Nancy McClean.

What you may think are random bad ideas that have somehow gotten into law are actually part of a grand scheme that has been playing out since Brown versus the Board of Education attempted to desegregate public schools in the United States.

An academic, McClean has studied the articles, books and letters of James Buchanan, the economist not the former president. Buchanan was the primary theorist of public choice theory. In the 1950s, public choice theory was used as a rationale to close all of the public schools in the state of Virginia (rather than comply with desegregation) and is being used today to support state-funded vouchers for private and religious schools. In Virginia in the 1950s, the state gave money to white parents for private school vouchers and allowed hundreds of black children to go uneducated for years. Needless to say, this was a travesty of justice.

Continue reading ‘Democracy in Chains’ Connects Dots on Libertarian & Republican Strategies (video)

In #AZ, Maternal & Child Health Is in Crisis (video)

Maternal and child health is in crisis in the state of Arizona. Too many infants die. Too many new

Maternal and child health is in crisis in the state of Arizona. Too many babies die. Too many new Moms die. Too many babies are born prematurely. Too many babies are born with birth defects. Too many pregnant women don’t get adequate prenatal care.

Some Arizona counties have been labeled maternal health deserts because of lack of medical care. Cochise, Graham, Gila, La Paz, Santa Cruz and Yuma are the worst off. Around 50% of the babies born in Arizona are born to unwed mothers (which makes them more likely to live in poverty with their Moms.) And around 50% of the live births are funded by AHCCCS (Arizona’s Medicaid program).

Arizona’s lack of attention to maternal and child health and our stingy social safety net policies have exacerbated the situation and cost the state lives and money. Each premature baby born under AHCCCS costs the state around $1 million. How many of these one-million-dollar babies are accidents due to lack of access to affordable birth control and the scarcity of women’s health clinics, particularly in rural Arizona? We should be funding women’s health and well baby clinics in rural Arizona and should be hiring community health workers to do outreach with pregnant women and new Moms. You can hire an army of community health workers for the cost of one or two premature babies.

Continue reading In #AZ, Maternal & Child Health Is in Crisis (video)

Direct Care Contracts: Cheap Non-Insurance Plans Could Put Patients at Risk (video)

Banner University Medical Center

In the Health and Human Services Committee, we have heard a few different insurance plans that would be cheaper and less comprehensive alternatives to the Affordable Care Act (ACA).

With SB1105, healthcare moves into the gig economy. SB1105 covers direct primary care agreements, a non-insurance alternative to the ACA.  In Arizona, people are already allowed to make one-on-one contracts with a healthcare provider for certain services for a designated mount of money per month.

This bill clarifies existing law and says that these contracts are not insurance and, therefore, not regulated by the Arizona Department of insurance. It also says that you can have contracts with doctors, physicians assistants, nurse practitioners, nurses, dentists, and physical therapists.

If you take this to it’s illogical extreme, you could have multiple contracts with different providers for different menus of services. Unless you are really good at contract law, you could end up having several contracts, paying monthly bills to each of these providers and still not getting the care that you need. Since these plans are not insurance, you would not be able to take your complaints to a bureaucrat at an insurance company or at the Department of Insurance.

Direct current primary care agreements are supposed to fill a niche in the healthcare market. The ACA is too expensive, particularly for sole proprietors. These are business people who are their business. Professional people, consultants, artists and musicians could all be sole proprietors.

Continue reading Direct Care Contracts: Cheap Non-Insurance Plans Could Put Patients at Risk (video)

Protect Patients: It’s time for Cannabis Testing in AZ (video)

marijuana

Thirty-four states have some form of legal marijuana. Arizona is the only state that has no quality control testing for contaminants (like pesticides) or for make-up (how much THC, CBDs, etc.)

Cannabis testing died at the end of the session in 2018 during a flurry of negotiations regarding several marijuana reform bills. It is back in 2019 as SB1494, which passed the House Health and Human Services Committee last week. This is a clean cannabis testing bill with no other issues attached.

Arizona has 200,000 medical marijuana patients who purchased 61 tons of marijuana and related marijuana products, like edibles and concentrates, in 2018. Ours is the third largest program in the country… and the only one with no quality control testing.

In committee, the governmental liaison for the Arizona Department of Health Services (ADHS) Shannon Whitaker said that they don’t know how to do quality control testing for marijuana and want more specifics on what to do. I asked if anyone at ADHS had looked at the testing standards and programs from the other 33 states, and she said, “No”. Looking at how other health departments are testing samples of marijuana could be very helpful in setting up the Arizona program. Just sayin’.

Before I voted “yes” on SB 1494, I talked with the lobbyists on both sides of the issue, medical marijuana patient and NORML representative Mikel Weisser, and former ADHS Director and current Executive Director of the Arizona Public Health Association Will Humble.  Humble, who wrote the current medical marijuana rules, said that testing is in the Arizona Medical Marijuana Act (AMMA). He had planned to write testing rules back in 2011, but he was pressed for time with a 120 day window to write all of the rules. He added that he “was getting beat up from all sides” during the process. (I confessed that I was blogging about the card costs, which are the highest in the country.) Humble supports SB1494 but adds that ADHS has the authority to write rules on testing, even without SB1494.

ADHS is sitting on $60 million in card fees that can be spent only on the medical marijuana program. It’s time to protect patients. It’s time for Arizona to spend some of those AMMA funds to write the rules and set up testing.

SB1494 was debated at length in the House Health and Human Services Committee last Friday and passed unanimously. Since almost everything we do is on video, you can watch the debate on the AZLeg website. Click on Archived Meetings and scroll down to House Health and Human Services on March 29, 2018. You have time to voice your opinion on Request to Speak.

Look for amendments and a rousing debate on this in the coming weeks.

Legislators Should Stand with #RedForEd: No New Tax Giveaways (video)

The Arizona House Ways and Means Committee is like an extended game of tax giveaway wack-a-mole. I have lost count how many tax giveaway bills Republicans have passed since January.

This week, we heard SB1027, which dramatically increases a tax credit that currently benefits only poor children with chronic diseases or physical disabilities.

Tax credits take money out of the general fund. SB1027 would dramatically expand this tax credit from helping poor children with certain medical conditions to helping *anyone* of any age and any income who has a chronic illness or physical disability.

This bill is overly broad, and it has an unknown cost and no sunset date. Most of the committee testimony focused on one physical therapy center and gym in Tucson that serves clients with Parkinson’s disease, but there are many chronic diseases, most notably diabetes. More than 600,000 Arizonans have diabetes, and another 1.8 million have prediabetes.

The public health problem of helping people lead healthier lives with chronic disease goes far beyond what would be fiscally responsible to fund through tax credits. Medicare, Medicaid, and commercial insurance cover some services. If more is needed, the Health and Human Services Committee should look at it– instead of going to Ways and Means for a tax credit.

Continue reading Legislators Should Stand with #RedForEd: No New Tax Giveaways (video)

#AZLeg Should Include Healthcare in Workforce Development (video)

The Arizona House has begun debating HB2657, a high-tech workforce development bill which would funnel money through the Arizona Commerce Authority to community colleges to train workers in “high-demand” fields. The CEO of the Commerce Authority would manage the fund created by this bill, and they would determine what to fund.

As it is currently written the bill would “support career and technical education programs and courses that prepare a capable workforce for manufacturing in information technology and related industries.”

Why are we focusing only on manufacturing, financial services and technology? Previously, we saw this with CTED (formerly JTED) classes. In the last session, proposed legislation would have funneled 9th grade students into select industries like machine tooling, aerospace, and automotive services, while they left healthcare, coding and other careers by the wayside.

To meet the needs of our state, workforce development could and should go beyond tech. Why is healthcare not included in HB2657? We have a need for expanded access to care particularly in rural Arizona, and we do not have enough medical and health professionals to fill the gaps. We could train rural Arizonans to be community health workers, certified nursing assistants and home health aides. When I taught health education at the University of Arizona, I had many students from rural Arizona, particularly tribal lands, who were studying in Tucson and planned to take their new skills back to rural Arizona to help their people. How can we foster this?

Arizona has five rural counties — Cochise, Gila, Graham, Santa Cruz and LaPaz– that are considered maternal and child health deserts because of lack of medical personnel and health services in those areas. The face of premature birth in Arizona is young, brown and rural. Every preemie birth that is funded by AHCCCS costs the state between $500,000 – $1 million.

We could improve access to care, foster workforce development, save money and tackle urban/rural health disparities if we put as much effort into the healthcare workforce as we do into tech.

[In the photo, I am posing with the doctor of the day from Banner Univerity Medical Center.]