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 SB1107, healthcare moves into the gig economy. SB1107 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.]

Are Unregulated Health Insurance Plans Good for #AZ Consumers?

Healthcare forum

In the Health and Human Services Committee on Thursday, Feb 14, we are hearing a long list of bills including two about health insurance.

HB2375 would extend short-duration insurance to three years. This insurance is currently capped at one year because it is seen as a stop-gap measure for people who are between jobs or disconnected from insurance for some reason.

HB2376 relates to association health care plans for small businesses and sole proprietors. This bill allows them to band together and buy insurance as a group. A concern with this idea is regarding the quality of insurance that will be purchased and how that will impact workers who will be included under these plan.

Will association health plans cover essential health benefits, like the Affordable Care Act does? Will they cover people with pre-existing conditions? Will they have lifetime insurance caps? Will coverage be determined by the employer’s “deeply held religious beliefs”?

These association health insurance plans will NOT be regulated by the Arizona Department of Insurance. I fear that this will be Wild West Health Insurance, which will be cheap but not comprehensive.

We still have a problem in this country with medical bankruptcy. People buy the insurance they can afford, rather than the insurance they need. Cheap plans don’t offer full coverage and can leave patients in dire financial straits.

On the macro-economic level, these plans could lure people out of the Healthcare Marketplace and weaken the system.

If you are on Request to Speak at the AZLeg website, please offer an opinion on 2375 and 2376.

Balanced Public Health Policy Should Be Legislature’s Goal (video)

Arizona Opioid Epidemic Act

This is the transcript of my opening remarks at the Arizona Public Health Association Conference on Oct. 3, 2018. A video of the speech is below.

It is an honor for me to address the Arizona Public Health Association, since I have a Masters in Public Health from the University of Arizona. I worked in health communication, medicine, public health and behavioral research for many years before deciding to run for the Arizona House in 2015.

In fact, it was my background in public health that prompted me to run for office. Many times since I moved to Arizona in 1981, I have found myself shouting at the radio or the TV or the newspaper or a social post about bad policy decisions made by the Arizona Legislature. Anybody else have that experience?

In the public health arena, the Legislature far too often makes short-term decisions to save a buck or make an ideological point, but in the long-term, these decisions cost money and lives. Do you remember Governor Jan Brewer’s Death Panels? Brewer knocked more than 250,000 adults off of Medicaid—including people on transplant waiting lists. That decision made national news as transplant patients began dying.

Another example of a short-term savings that caused long-term problems is the $80 million cut in childcare subsidies and preventive services for families in need. That recession-era funding sweep played a major role in Arizona’s foster care crisis. At its peak, nearly 19,000 Arizona children were in foster care. Most of those children were removed from their homes for “neglect”. Unfortunately, in Arizona, neglect is a catch-all term which could encompass anything from lack of reliable child care to drug abuse to domestic violence.

None of that $80 million in state funding for childcare has been restored. Why not? Because, of course, we have to cut taxes every year—regardless of the needs of the people.

Continue reading Balanced Public Health Policy Should Be Legislature’s Goal (video)

Pam Powers Hannley: Your Voice in the Arizona House

Rep. Pamela Powers Hannley

When I ran for office in 2016, I said I wanted be your voice—the voice of the people—in the Arizona Legislature. And that is exactly what I did.

I used my voice, my votes, my amendments, and my bills to fight for the rights and wellbeing of workers, patients, teachers, students, women and the underserved.

Protecting your family…

I was a strong voice for public health and affordable access to care during the negotiations and eventual passage of both the Arizona Opioid Epidemic Act and dental therapy. I also co-sponsored a bill to allow Arizonans to buy-in to Medicaid (AHCCCS). This is a potentially cheaper option for folks who are struggling with the cost of health insurance. House Democrats will be proposing it again in 2019.

On budget night 2018, I proposed an amendment to appropriate $56 million in federal child care subsidies to fill the $80 million gap left after Republicans swept the funds during the Great Recession. Arizona House Republicans voted to leave those funds unspent; Arizona is the only state in the country that didn’t use those earmarked childcare funds. (I’ll try again in 2019.) I also backed a bill for tiered reimbursement for childcare subsidies. This bill, which was signed into law, and the $56 million in subsidies would go a long way to help Arizona families and children.

Protecting your rights…

Also on budget night, at around 4 a.m., I defended the rights of pregnant homeless women to have access to abortion and abortion referrals. I have seen young homeless women with infants on the streets of Tucson. The streets are no place for adults– let alone children and babies. Because we are a state that does very little to help women once their babies have been born, I believe we should expand access to contraception and all legal medical procedures and teach medically accurate sex education in the schools.

ERA
ERA advocates participated in the Together We Rise rally on opening day at the Arizona Legislature in 2018. Besides me on the far left, legislative candidates Victoria Steele (third from left) and Sharon Girard (far right) are also pictured above.

Two years in a row, I proposed ratification of the Equal Rights Amendment (ERA) in Arizona. Arizona women won’t have equal pay for equal work without passage of the ERA.  Overall, women are paid roughly 78 cents on the dollar compared to men. Due to the intersectionality of race, class, ethnicity and gender,  African-American women, Native American women and Latinas are paid far less than white men. Latinas make roughly 55 cents per hour for every $1 earned by a white man. Tucson’s population is 41% Latino. Just think of the economic impact to our city and our region if Latinas were paid fairly and if they were offered quality education for themselves and their children. It doesn’t do our community, our state or our country to force people to live in poverty and sickness.

Continue reading Pam Powers Hannley: Your Voice in the Arizona House

Passage of Dental Therapy Expands Access to Affordable Care (video)

Rep. Pamela Powers Hannley

For several weeks during the 53rd Legislative Session, I posted (almost) daily one-minute video updates from my office at the Capitol and posted them on Facebook and YouTube.

I never imagined how wildly popular these videos would be. At the Capitol, #RedForEd advocates would randomly come up to me and say, “I love your videos!” Now that I am back in Tucson, people come up to me at events, at church and in stores, and say, “I love your videos!”

So… I will be keeping them up during the interim.

My first interim video is on the passage of dental therapy. To catch up, I am doing a few videos on some of the bills we passed in a flurry at the end of the 53rd Session last week.

On the very last day, we passed dental therapy as a striker on another bill. I played an integral role in getting dental therapy out of the sunrise committee hearing last fall. I believe it is good public health policy because it will offer affordable dental care in rural and urban areas. This will expand access to care, prevent tooth loss and offer a new career to residents of Arizona.

To Learn more about why dental therapy is important, you can read:

Economic Inequality, Access to Care & Workforce Development: A Progressive Roadmap.

Here is some of the media coverage on the passage of dental therapy:

Arizona law creates dental therapists to handle fillings, extractions and crowns 

Arizona is about to get a new type of dental professional

Chester Antone: Dental therapists good for tribes, good for Arizona

#AZ Leg Passes Landmark, Bipartisan Opioid Bill (video)

Arizona Legislature

January 25, 2018 was one of the most dramatic days at the Arizona Legislature, since I was elected.

Not only did we have ~75 Luchadores visiting their Legislators and five extremely aggressive anti-immigrant, pro-Trump protesters heckling them, we also had the big vote on the Arizona Opioid Epidemic Act (SB1001).

We have been working on SB1001/HB2001 for weeks. Unlike much of what we do in the Arizona Legislature, the Arizona Opioid Epidemic Act 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 speechifying, as we did with the stingy TANF and teacher raises in 2017.

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.

Continue reading #AZ Leg Passes Landmark, Bipartisan Opioid Bill (video)

Economic Inequality, Access to Care & Workforce Development: A Progressive Roadmap (video)

On December 4, 2017, I gave a talk on economic inequality at the Democrats of Greater Tucson Luncheon. This is the text of that speech.

Economist Dean Baker, of the Center for Economic and Policy Research, recently gave a talk which focused on solving economic inequality. He pointed to five key areas of the economy that keep the rich rich and keep the rest of us in our places:

  • Macroeconomics;
  • Intellectual property rights;
  • Practice protection by highly paid professionals;
  • Financial regulation; and
  • Cooperate governance.

Given this list, can a state legislator like me make a dent in economic inequality? I think so.

I ran on a platform that focused on economic reform and public banking; equality and paycheck fairness; and attacking the opioid crisis.

How does my platform dovetail with Dean Baker’s list? There is quite a bit of overlap—particularly in macroeconomics, intellectual property rights, and practice protection.

Continue reading Economic Inequality, Access to Care & Workforce Development: A Progressive Roadmap (video)