Wednesday July 11 is the Deadline to Turn In Your Arguments for the Upcoming Ballot Measures

Do you feel strongly about any of the upcoming voter initiatives or referendums that will be on the November ballot?  Do you have some solid arguments that could persuade fellow Arizonans to see things your way? 

If so, you’re in luck.  The AZ Secretary of State’s Office has made it easier than ever for you to post an argument for or against any of the measures- but you’ll need to act before Wednesday at midnight. 

Arguments for or against proposed ballot measures for the 2018 General Election can now be submitted electronically through the new Ballot Measure Argument Submission Portal available at

The fee is just $75 per argument and can be paid online.  They also dropped the notarization argument that had previously existed.  Your ballot measure argument will be printed in the publicity pamphlet that is mailed out to registered voters. I submitted comments in favor of the Clean Energy Amendment and the Campaign Disclosure Initiative- (on behalf of myself) and the process was simple and straightforward.

Here’s the listing of the 2018 Initiatives, Referenda & Recall Applications

The Stop Political Dirty Money Constitutional Amendment PDF establishes voters’ right to know the identity of all major contributors who are trying to influence the outcome of Arizona elections. Contributors will no longer be able to hide by transferring their money through intermediaries. Anyone spending more than $10,000 to oppose or support candidates or ballot measures must disclose everyone who contributed $2,500 or more promptly, publicly and under penalty of perjury.

The Clean Energy for a Healthy Arizona Amendment PDF requires affected electric utilities to provide at least 50% of their annual retail sales of electricity from renewable energy sources by 2030. The Amendment defines renewable energy sources to include solar, wind, small-scale hydropower, and other sources that are replaced rapidly by a natural, ongoing process (excluding nuclear or fossil fuel). Distributed renewable energy sources, like rooftop solar, must comprise at least 10% of utilities' annual retail sales of electricity by 2030. The Amendment allows electric utilities to earn and trade credits to meet these requirements.

The Invest in Education Act PDF increases the classroom site fund by raising the income tax rate by 3.46% on individual incomes over a quarter million dollars (or household incomes over half a million dollars), and by 4.46% on individual incomes over half a million dollars (or household incomes over a million dollars); designates 60% of new funds for teacher salaries and 40% for operations; and adds full day kindergarten and pay raises for student support services personnel as permitted fund uses. 

Save Our Schools PDF asks voters whether to validate a 2017 Bill passed by the Legislature (Chapter 139 SB 1431) that greatly expanded Empowerment Scholarship Accounts (commonly referred to as private school vouchers) and removed the existing ESA enrollment cap, increasing it annually by 0.5% of total public school enrollment through 2022 and capping ESA enrollment in 2023.

The Protect AZ Taxpayers Act PDF would amend the Arizona Constitution to prohibit state government, as well as county, municipal and other political subdivision governments and taxing districts, from imposing or increasing any transaction-based taxes, fees, stamp requirements, or assessments on any service performed in Arizona, or on the gross receipts of sales or gross income derived from any service performed in Arizona.


Medicaid Program Scorecard Released by Feds

The Centers for Medicare & Medicaid Services released a new Medicaid program scorecard last month. It includes some quality metrics along with federally reported measures in a Scorecard format.

The data that’s built into the state by state scorecard only uses information that states voluntarily submit.  There are 3 main categories (state health system performance; state administrative accountability; and federal administrative accountability) and lots of subcategories.

The Scorecard includes a State Health System Performance Measures portion.  Some of the subcategories that are reported in that category on a state by state basis are things like include hospitalization for mental illness, opioid use in high dosage, alcohol and other drug dependence treatment, and other chronic health conditions.


Opioid Public Health Emergency Executive Order Ends

In May, the Governor of Arizona officially ended the emergency public health declaration that was signed via an Executive Order about a year ago.  Much has been accomplished over the last year including implementing legislation that improves prescribing practices and enhances emergency responses and increases access to treatment.  Of course- the work will go on.  The epidemic didn’t start overnight, and it surely won’t end overnight.  You can read the official end of the emergency declaration here.

Rep. McSally (R) hosted a House of Representatives Border and Maritime Subcommittee hearing on May 30 at 9:30 am at the UA College of Medicine Phoenix (Building 2) entitled: “An Unsecure Border and the Opioid Crisis: The Urgent Need for Action to Save Lives” featuring the Governor, various federal officials from the DEA, CBP, and DHS as well as Dr. Christ, Debbie Moak, and some people from faith-based organizations. You can see the panel line up here.


Aligning Health and Early Childhood Learning

Evidence shows how important early childhood education is in protecting people from disease and disability as an adult-  and that a child’s health impacts his or her ability to learn and succeed in school and later in life. Even with these known positive connections between early learning and wellness- health and education systems sometimes fail to align and provide opportunities to maximize health and early learning outcomes for children.

To address the disconnect between health and education, the HHS & US Department of Education outlined a set of recommendations for states and communities to align health and early learning systems. The recommendations emphasize the need for a comprehensive, seamless, and coordinated set of systems to support children, parents, and families.


Legislative Session Webinar Posted

The UA has posted AZPHA's webinar from May that summarizes the legislative session from a public health perspective.  The whole thing is about an hour long.  You can check out the webinar on the UA Telemedicine Website.  Here’s the PowerPoint.


Sonoran Prevention Works Scores Syringe Access Grant

Sonoran Prevention Works received a $125,000 grant in May from the Vitalyst Health Foundation  to support advocacy and education for syringe access programs – a proven harm reduction strategy in response to the opioid crisis and rising hepatitis-C and HIV infection rates. They’ll be partnering with the University of Arizona College of Medicine Tucson and Creosote Partners to destigmatize syringe access programs and understand the comprehensive needs of people who inject drugs.

The Maricopa County Sheriff's Office will also work with Sonoran Prevention Works to implement a needle stick prevention program and to educate law enforcement on injection drug use. These partnerships will work to support policy change that treats substance use as a public health issue.


Federal Government Won’t Defend the Affordable Care Act in Court

So far, the Affordable Care Act has survived the 2 court challenges that made it to the US Supreme Court.  Back in 2012 the ACA was upheld by the Supreme Court for the first time (by a 5-4 margin) in the National Federation of Independent Business v. Sebelius case.   It was upheld again in 2015 when (in a 6-3 decision) the Supreme Court upheld ACA’s federal tax credits for eligible Americans living in all 50 states (not just the 34 states with federal marketplaces).

But, there are additional challenges out there that haven’t made it to the Supreme Court yet. One that’s progressing through the courts is a challenge filed by 20 states (including Arizona) arguing that the ACA’s individual mandate is unconstitutional and key parts of the act — including the provisions protecting those with pre-existing conditions — are invalid.


Kaiser Family Foundation Issue Brief on Work Medicaid Requirements

Last month the Kaiser Family Foundation published an Issue Brief regarding CMS’ recent decisions to grant states the ability to experiment with their Medicaid programs that condition Medicaid eligibility on work or community engagement. The Issue Brief examines evidence of the effects of the Medicaid expansion and some changes being implemented through waivers.

Many of the findings on the effects of expansion are drawn from the 202 studies included in our comprehensive literature review that includes additional citations on coverage, access, and economic effects of the Medicaid expansion.

Regarding work requirements, the Brief concludes that “state-specific studies in Colorado, Kentucky, Michigan, Pennsylvania and most recently Montana and Louisiana have documented or predicted significant job growth resulting from expansion. No studies have found negative effects of expansion on employment or employee behavior. In an analysis of Medicaid expansion in Ohio, most expansion enrollees who were unemployed but looking for work reported that Medicaid enrollment made it easier to seek employment, and over half of expansion enrollees who were employed reported that Medicaid enrollment made it easier to continue working.  Another study found an association between Medicaid expansion and increased volunteer work in expansion states.

Furthermore, “work requirements have implications for all populations covered under these demonstrations. Those who are already working will need to successfully document and verify their compliance and those who qualify for an exemption also must successfully document and verify their exempt status, as often as monthly. States would incur costs to pay for the staff and systems to track work verification and exemptions.”

If you’re interested in the public health policy implications of our upcoming work/community engagement and reporting requirements, the KFF Issue Brief is a must-read.


Snapshot of Public Health-related Bills in 2018

HB 2324 Voluntary Certification for Community Health Workers

HB 2088 Public Health Guidelines in Schools

HB 2235 Dental Therapy Licensure

SB 1245 SNAP- Fruits and Vegetables

HB2371 Statewide Food Truck Licensing

Public Health-related Bills Signed Into Law (2017)

HB 2038 Drug overdose review teams; records was passed and signed.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2228 Annual waiver, applicability was signed by the Governor.  It’s good. It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor.  This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years.

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1389  HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program. 

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

HB 2038 Drug overdose review teams; records

HB 2228 Annual waiver, applicability

HB 2484 local food tax; equality

SB 1022 ADHS; homemade food products

SB 1083 Schools; recess periods

SB 1389  HIV; needs assessment; prevention

SB 1394 Abortion reporting