My Day at the Arizona Legislature

I am looking forward to writing on and sharing developments in emergency medicine legislation for the 2019 Regular Session! Before getting into the weeds on specific bills, I wanted to share the amazing opportunity to participate in the ArMA Doctor of the Day program, thanks to Dr. Jennifer Hartmark-Hill and Stephanie Butler. This was an experience that I would recommend to any of my fellow policy-minded medical students. Here’s just a few snapshots of that day.

Walking into the Arizona Senate building, you would never guess that it was a Monday morning. The lobbies and hallways swelled with people in a hurry to get somewhere, and the energy was tangible. Our brief tour took us to the elegant House and the Senate floors, which were eerily empty at 10 AM. Even without the lawmakers present, the power of each room was clear and served as a good reminder of where change in Arizona occurs.

Next, we met with Rep. Michelle Udall (one of Dr. Hartmark-Hill’s representatives!), who is the chair of the House Education Committee. We discussed graduate medical education and community health outreach in a relatively informal way. Dr. Hartmark-Hill shared thoughts and opportunities for health improvement that she is working on, which was a great demonstration for how democracy should work.

After a tour of the Arizona Capitol Museum, we met with Rep. Tony Rivero to discuss the latest developments in the ongoing fight against the opioid epidemic. Significant progress was made in the previous year’s special session, but preventing opioid overdoses and morbidities will take continued efforts. Constituents of Rep. Rivero brought to his attention that it is difficult or impossible for minors to receive inpatient medication-assisted treatment (MAT) in Arizona. Given that MAT has the best evidence for helping individuals quit opioids, he pointed out that Arizona’s minors should not have to leave the state to receive this therapy. Some of ArMA’s policy buffs were present in the meeting as well, along with several people working in addiction rehabilitation. They provided valuable insight into why providing inpatient MAT to minors will be challenging and reminded me that progress is often piece-wise and slower than we wish it could be.

As interesting as discussing rehabilitation with Rep. Rivero was, we were plucked from his meeting for a scheduled visit with House Speaker Rusty Bowers. He greeted us warmly and expressed appreciation for participating in the Doctor of the Day program. Afterwards we caught some fresh air on the lawn and had the fortune of running into Rep. Amish Shah, an emergency medicine physician! It was a pleasure to meet him and see an impressive example of how physicians can truly get involved in policy development.

This legislative session has already begun in full force, with hundreds of bills pertaining to the delivery of healthcare have the potential to become law over the next four months. I thoroughly enjoyed seeing some of the moving pieces within the Arizona Legislature, and I look forward to returning for the AZCEP ED Doc Day @ the Capitol on March 13th. Check back here for updates on bills especially important to emergency medicine and healthcare.

Fellow classmate Joe Neely (left) and I joined Dr. Hartmark-Hill on the Senate floor for a photo op

Arizona State Government in 2018

This year was tumultuous and stressful, as any visit to a news website can attest to. Much like the federal government, the Arizona state government had an eventful year. These happenings may not have much to do with emergency medicine, but it is important to reflect on the past year as the new Arizona Legislature begins its session in January.

#RedForEd

Garnering national attention in the spring, K-12 teachers across the state participated in a strike

that affected nearly a million students. Arizona has ranked last or close to last in several metrics

of public education for years compared to the rest of the states. Funding was the focus of the

RedForEd movement, which ended in May after Gov. Doug Ducey signed HB 2663 into law.

The deal provides a 20% raise to schoolteachers over the next two years, along with hundreds of millions in funding for school districts, totaling over a billion dollars. The powerful movement

continued into November when it helped squelch Proposition 305. The ballot measure rejected

SB 1423, which would have given funding for students wishing to use non-public education

resources. The proposition was framed as diverting state money to private schools. However,

proponents claimed that passing proposition 305 would reduce the resources available for

students with special needs.

Abortion

The AZ Senate passed SB 1394, requiring healthcare providers to ask women why they are

seeking an abortion during initial consults. After a round of amendments, the law specified

available responses to include whether an abortion would be elective, for health reasons, because of domestic violence, or for other reasons. Supporters of the law claimed that it would allow the government to be better informed on issues of abortion in the state, while others argued that it creates a barrier to abortion access and intrudes on the personal lives of women. The bill was signed into law after two months of contentious debate.

November Election

Democrats flipped 40 seats in the federal House of Representatives that were previously held by Republicans, sealing a new Democratic majority. In the AZ House, Democrats made

proportional gains by flipping 4 of the 60 seats, but remain in the minority with 29 seats. The AZ

Senate remained unchanged, with Republicans holding a 17 of the 30 seats. Gov. Doug Ducey

won reelection for governor, completing the Republican control of the state government. Arizona is split up into 30 legislative districts, each sending a senator and two representatives. Split-ticket voting is uncommon in the state. District 17 was the only one to send representatives from different parties, and only District 28 sent a senator from a party different from their representatives.

Emergency Medicine Legislation Introduction and Mission

Hello! My name is Luke Wohlford, and I’m a 1st year medical student at the University of Arizona College of Medicine - Phoenix. My goal for this column is to provide useful and informative content on current topics in health policy to my peers. The topics I plan to post on may range from analyzing specific legislation on the docket in Arizona to national trends in emergency medicine. 

To start off, I watched an interesting recording of a Google Hangout discussing health policy in emergency medicine with Drs. Cedric Dark and Alison Haddock. If you have the time and are interested in policy, I highly recommend watching it in full below. However, if you prefer a synopsis, I have provided one below!

- AMA is a great way to get involved in health policy, it brings multiple voting groups together in conferences that are open to students. Health policy writing can begin in those meetings. 

- ACEP holds a Leadership and Advocacy Conference in DC every year, which can be a great experience to observe health policy discussion and creation. 

- Getting a Master of Public Health can be a tool to pursue specific goals in research and health delivery, but not having one will not necessarily close doors. 

- EMRA has a Health Policy Committee, which has a newsletter and a forum to discuss current topics.

- When asked what the most important issues in health policy now are, Medicaid expansion, psychiatric boarding, gun control, insurance reimbursement were listed.

- Medicaid is a complicated issue for states that have not expanded it through the ACA. 

Dr. Dark mentioned that states that did not expand Medicaid essentially pay for it in states that have adopted it through taxes and lost revenue.

- With the 2018 election resulting in the Democratic Party taking charge of the House of Representatives, the Republican attempts to repeal the ACA repeal is unlikely to continue.