Category: Health

A step in the right direction

Last week, the Invest in Arizona coalition submitted more than 215,000 signatures to block the $1.5 billion in tax cuts that were passed during the last legislative session and which overwhelmingly benefit the richest Arizonans. The coalition, which is comprised of Children’s Action Alliance, the Arizona Center for Economic Progress, Arizona Education Association, Stand for Children, Save our Schools Arizona, Arizona Interfaith Network, and the Friends of the Arizona School Boards Association, submitted almost 100,000 more signatures than necessary, which makes it more likely that the effort will survive any expected legal challenges. Once it is verified that a sufficient number of valid signatures were submitted, the measure will be placed on the November 2022 general election ballot for Arizona voters to decide whether they want the tax breaks for the rich to go into effect.

The tax cuts, after being fully phased-in, would eliminate Arizona’s marginal tax brackets in favor of a 2.5 percent flat tax in which approximately 70 percent of the tax cuts would benefit the top 5 percent of income earners— households earning $224,000 or more in annual taxable income. The tax cuts will reduce the contributions from households with high incomes to the General Fund and continue Arizona’s increasing dependency on regressive sales taxes to fund state needs. Reducing revenues by an estimated $1.5 billion a year will make it virtually impossible to adequately fund public schools, universities, infrastructure, and other important needs in the future. While it only takes a simple majority of legislators to pass a tax cut, it takes a supermajority to reverse tax cuts or raise revenue.

We are grateful to the thousands of volunteers across Arizona who worked so hard over the past 90 days in this monumental effort to gather the necessary signatures. Once again, Arizonans are making a powerful statement that they want to see the wealthy pay their fair share in order to make the investments that will strengthen our public schools, communities, and economy.

We’re suing to keep kids healthy at school

If state budgets are an indication of our government’s values, this year’s state budget is a terrifying reflection. In the midst of a pandemic that has ravaged communities and left more than 113,000 American children without a parent or custodial grandparent, the legislature did not make any significant investments in health care.

Instead, lawmakers tried to strip away the ability of schools and local governments to mitigate the spread of COVID-19. Through an unprecedented - and unconstitutional - budget process, lawmakers prohibited public schools from requiring masks or COVID-19 vaccines. This provision does not apply to private schools. This will inevitably exacerbate the disproportionate impact of the pandemic on Arizonans who have low incomes and are Black, Indigenous, and people of color.

Moreover, the legislature used the budget to prevent cities and towns from creating COVID-19 vaccine “passports,” from requiring businesses to secure proof of vaccination, or issuing mask mandates. It also prohibits other mitigation measures, like lockdowns or curfews.

We’ve lost too many Arizonans to this horrific pandemic, and too many kids have lost families. Our state budget disregards both science and the sanctity of human life. That is why last Thursday Children’s Action Alliance joined education advocates, parents, and physicians in taking the state of Arizona to court.

We’ve got a lot of work to do and we need your help. Please donate to support this legal challenge.

THE BACKGROUND:

Arizona’s budgeting process has never been fully transparent. The package of bills that comprise the budget is assembled behind closed doors and voted on, often in the middle of the night, with limited public input.

This year’s process was even murkier than usual. In a 171-day marathon session, the state legislature passed its budget at around 5 pm on June 30th - narrowly evading the government shutdown that would have occurred at midnight on July 1. The budget passed on party lines, with Republicans holding a single vote majority in both the State House and State Senate.

The state budget consists of several bills that outline how the state will spend money in the coming fiscal year. The “feed” bill establishes the spending, while issue-specific budget reconciliation bills (“BRBs”) provide context and statutory changes needed to expend the funds as directed.

Under the Arizona State Constitution, bills passed by the state legislature must pass the “single subject” test, meaning the bill must pertain to a defined topic. The content of the bill must also be reflected in its title.

But this year’s budget bills do not meet these requirements. Instead of simply outlining the budget processes, the legislature slipped in significant policy changes unrelated to the BRBs in which they are located. Many of these changes had been separate bills that did not have support on their own.

This doesn’t just defy the state constitution’s single-subject rule – it sets a terrible precedent for future state budgets, and it strips the public from participating in our democratic process.

Pandemic’s impact on routine child vaccination puts Arizonans of all ages at risk

Arizona has long had some of the most linient childhood vaccination policies in the nation. Parents of children enrolled in school or child care can refuse to immunize their children by submitting a medical, religious, or personal belief exemption. The use of these exemptions has skyrocketed over the past few years. Unsurprisingly, our schools are rapidly losing herd immunity to diseases that pose a serious risk to children, older adults, immune-compromised individuals, and pregnant people and their newborns.

In the 2020-2021 school year, kindergarteners in Arizona fell far short of recommended benchmarks for protecting the community from measles, mumps, and rubella. Only Yuma and Santa Cruz counties exceeded the 95% threshold needed to achieve community immunity from these diseases.

The newly approved budget passed by Governor Ducey and the Legislature further compromises our ability to protect those with vulnerable immune systems. Tucked in the budget is a blanket prohibition on “COVID-19 vaccine passports.” It also prohibits schools from requiring the COVID-19 or HPV vaccines, and adds layers of red tape that must be completed by the Arizona Department of Health Services before any new vaccine can be required for school attendance.

A new report by researchers at Georgetown’s Center for Children and Families sheds light on a growing crisis, one fueled by inequity in our health care systems.

During 2020, visits to pediatric offices declined by a cumulative 27%, meaning fewer children were receiving timely developmental screenings, scheduled vaccines, and other routine and preventive care. The impact of this decline in pediatric visits is starkly apparent in data from the Centers for Disease Control and Prevention (CDC) and Vaccines for Children (VFC) programs: in 2020, the number of childhood vaccine doses ordered by physicians decreased by 11.7 million.

This fact is compounded by the disproportionate impact of the COVID-19 pandemic on certain populations, including Black and Latinx communities* and low-income households, who are more likely to have missed a routine pediatric visit during the pandemic and who were less likely to be on track with recommended vaccination schedule prior to the health crisis.

The state’s approach to public health policy leaves us all exceptionally vulnerable – not just to COVID-19, but to future pandemics that will be attributable to this reduction in childhood vaccination rates. We hope common sense leadership and evidence-driven policy will be willing to speak up for science and dismantle the harm caused by anti-vaccine sentiment in coming years.

*Data was suppressed for American Indian / Alaska Native children. CAA acknowledges this omission and respects Tribal data sovereignty.

SCOTUS UPHOLDS THE AFFORDABLE CARE ACT!!!

Have you heard the news? This morning the Supreme Court of the United States determined that the Affordable Care Act (ACA) is here to stay. The 7-2 ruling by the court is a huge victory for all Americans, including the 31 million people who currently have health insurance through either the ACA Marketplace or Medicaid Expansion. If the Court ruled the other way, these individuals would have been in immediate danger of losing their health care during a deadly pandemic.

Legal challengers to the landmark health care law – including Arizona’s Attorney General Mark Brnovich – argued that because the Tax Cuts and Jobs Act of 2017 set the tax penalty for not having health insurance at $0, the entirety of the ACA was unconstitutional. The Supreme Court largely saw through this argument, with only Justices Alito and Gorsuch dissenting.

It’s unfortunate that this meritless case made it to the highest court in the U.S., and we hope that this ruling will be enough to end the frivolous attacks on this pivotal law.

In Arizona, nearly 74,000 kids currently have access to high quality health insurance thanks to the ACA’s Medicaid Expansion provision. Another 54,000 Arizona children are currently insured by KidsCare – restoration of which was made possible by the ACA. An additional 177,228 Arizona adults and children have thus far found low- or no-cost coverage through the ACA Marketplace during the 2021 Open and Special enrollment periods.

The ACA Marketplace Special Enrollment Period will last until August 15th. If you or someone you know need help finding your best health care option, make an appointment with a health care enrollment specialist by visiting coveraz.org/connector, calling 1-800-377-3536, or 2-1-1.

Buying Health Insurance on Healthcare.gov Just Got Way More Affordable

The American Rescue Plan Act (ARPA) was signed into law by President Biden on March 11th, 2021. The Act provided immediate economic relief to individuals, families, localities, states, and Tribal nations. It made significant investments in communities by providing funding for broadband infrastructure, rental and mortgage assistance, and relief for small businesses. And, importantly, it took steps to make health insurance coverage more affordable for more American families. Now we need Congress to make these changes permanent.

The Act makes more people eligible for premium tax credits, which help cover some or all of the cost of health insurance on the Affordable Care Act Marketplace (Healthcare.gov). These credits are capped at the percent of modified adjusted gross income. Under the ARPA, individuals and families earning less than 150% of the Federal Poverty Level (just under $40,000 per year for a family of four) will pay $0 for health insurance purchased through healthcare.gov. In Arizona, 302,000 people are expected to qualify for health care at no monthly cost, including 207,000 uninsured adults. Another 253,000 uninsured adults are likely to qualify for low-cost health coverage under these guidelines.

Arizona Senators Kelly and Sinema have signed on to a letter urging President Biden to prioritize health care affordability. Please take a moment to thank them for their advocacy.

Send a thank you to our Senators

Enhanced premium subsidies aren’t the only important health provision of the ARPA:

  • The Act provides financial incentives to expand Medicaid in states that have not yet done so.
  • It makes it easier for states to expand Medicaid coverage to birthing people for up to 12 months after delivery. Arizona’s program provides coverage for just six weeks postpartum, a fact that is readily apparent in our state’s high maternal mortality and morbidity rates, especially among American Indian persons.
  • It clarifies that the federal government will pay for 100% of Medicaid costs for COVID-19 testing, vaccination, and treatment-related expenses.
  • It guarantees that the federal government will pay for 100% of the cost of care delivered to Medicaid participants at Urban Indian Health Centers for two years.

Unfortunately, many of these provisions – including the healthcare.gov premium tax credits – have only been temporarily authorized, and other barriers to coverage persist. Take, for example, the “family glitch” - a faulty definition that determines eligibility for Marketplace subsidies on the cost of employer-sponsored health premiums for an individual but not their dependents. This prevents 124,000 Arizonans from accessing affordable health care. Though President Biden has requested an examination of the family glitch and ARPA expanded subsidy eligibility to higher-income earners, this issue will continue to prevent many people from accessing care until it is fully addressed.

Stay tuned for advocacy opportunities to repair the family glitch and make permanent the ARPA health insurance affordability provisions.

This is our rainy day – why isn’t Arizona investing in children’s health?

The American Rescue Plan Act, or ARPA, went into effect on March 11. The effort passed through Congress with several provisions that will make it easier for Americans to get high-quality, affordable health coverage. Notably, the plan increases and expands premium subsidies for health coverage through Healthcare.gov, the Affordable Care Act Marketplace. As a result, 207,000 uninsured adults can now enroll in Marketplace health coverage at no cost.

The premium subsidy increase is a tremendous move in the right direction. Unfortunately, at this point the increase is a temporary fix to larger problem of health care affordability in the U.S.

Arizona’s lawmakers must act to provide permanent relief to Arizona families by expanding eligibility for KidsCare, Arizona’s Children’s Health Insurance Program. The state’s rainy-day fund carries a balance of roughly a billion dollars, and tax revenues continue to outpace expectations. As we’ve noted previously, an infusion of federal relief funds saved AHCCCS (which administers KidsCare) $153 million in state fiscal year 2020 alone.

And yet, more than 161,000 uninsured Arizona children – the majority of whom are American Indian and/or Latino/a – live in households earning just slightly too much to qualify for the high-quality, low-cost health coverage provided through KidsCare.

Insuring children is an investment in Arizona’s future. When uninsured kids have access to coverage through Medicaid or CHIP, they come to school ready to learn. They’re more likely to graduate from high school and pursue secondary education. They earn more as adults, and are more likely to give birth to healthier infants than those who remained uninsured throughout childhood.

That’s why we’re urging our followers to contact lawmakers now and ask that they expand KidsCare income eligibility in the state budget. To make it easier for you, we’ve put together a click and send advocacy platform – just put in your name and address, and the system will do the rest.

Want to do more?

State lawmakers should expand KidsCare eligibility ASAP

A year into a pandemic that has claimed the lives of more than 16,000 Arizonans, the state legislature has repeatedly declined the opportunity to provide low-cost, comprehensive health coverage to tens of thousands of children. CAA’s new fact sheet explores why this measure is so important – and how many children would benefit.

In 2019, Arizona ranked 48th in the US for the rate of children’s health coverage. Latinx, American Indian, and Asian/Pacific Islander children are more likely to be uninsured than their peers of other races and ethnicities, and coverage gains for children of color facilitated by the Affordable Care Act have been eroded significantly over the past four years.

Unsurprisingly, our state also has one of the lowest income eligibility thresholds for its Children’s Health Insurance Program (CHIP; known as KidsCare in Arizona). KidsCare covers children up to age 21 whose families earn too much to qualify for Medicaid. Currently, a family of four earning up to 205% FPL ($53,004 per year) may qualify for KidsCare. For comparison, the national median upper income threshold is 255% FPL, or about $67,575 per year.

In 2019 (the last year for which we have comprehensive data), over 16,000 uninsured Arizona children currently lived in households earning slightly too much to qualify for KidsCare. The COVID-19 pandemic has inevitably increased the number of uninsured Arizona children, and may have strained the finances of families with health coverage through their employers or the Health Care Marketplace.

At the same time, the state is receiving an influx of federal relief dollars. In state fiscal year 2020 alone, the state is anticipated to have saved $153 million in state funds earmarked for AHCCCS (which administers KidsCare).

HB2273 (Children’s health insurance program; eligibility), sponsored by Representative Kelli Butler (D-LD28) would have expanded income eligibility. This bill was never heard in committee. Subsequent attempts to insert this provision have failed to gain traction.

Lawmakers will have another opportunity to provide health coverage to thousands more Arizona children by including the expanded KidsCare eligibility in the state budget. We hope they do.

Good ideas that didn't fit the bill

The Arizona legislature set a deadline that any bills that did not receive an initial committee hearing by the end of last week cannot advance this session. Committee chairs wield a lot of power in deciding which bills receive consideration or not and with 1,823 bills introduced this session, we understand there simply is not enough time to hear every bill. But there were several good ideas that would improve the lives of Arizona’s children and families introduced this year that never had the opportunity to be considered in committee. Even though time has run out this year for those bills, we want to take a moment to highlight a few of those good ideas that merit stronger consideration in the future:

  • HB 2416: Sponsored by Representative Pawlik to appropriate $13 million for child care to raise reimbursement rates. Arizona’s child care assistance program continues to reimburse providers for care at rates that are far below what it costs to actually provide that care. Parents often have to pay the difference between the reimbursement rate and the cost, making accessing child care too expensive even for many low-income families who are eligible for the program.
  • HB 2291: Sponsored by Representative Osborne to provide comprehensive dental care to eligible pregnant women. Pregnant women are especially vulnerable to developing oral health problems, which if left untreated are associated with adverse birth outcomes and increased risk of dental disease in early childhood.
  • HB 2273: Sponsored by Representative Butler to increase income eligibility for KidsCare, Arizona’s health insurance program for low-income children, from 200 percent of the federal poverty level to 300 percent of the federal poverty level. Arizona currently has one of the lowest income eligibility thresholds for its children’s health insurance program in the nation. After years of progress toward reducing the rate of uninsured children, Arizona has taken an unfortunate turn. Between 2016 and 2019, the number of uninsured children grew by roughly 22%. In 2019, 161,000 Arizona children were uninsured – the fourth highest rate of uninsured children in the United States.
  • HB 2659: Sponsored by Senator Marsh to establish an annual conference on children and youth to identify and recommend policy solutions to the legislature that will improve the lives of children in Arizona.
  • HB 2146, HB 2147, HB 2148, HB 2283, HB 2566, SB 1098, SB 1736, SB 1737: Sponsored by Representatives Friese, Lieberman, and Bolding; and Senators Alston and Bowie. Several bills were introduced this session to provide much-needed reform to the private school tuition tax credit program which diverts public tax dollars to private schools. These bills would restrict use of these tax credits to low-income families and would limit the amount which can be used for administrative costs. The expansion of private school tuition tax credits has had a significant impact on reducing state revenues growing from a cost of $14 million in 1999 to $177 million in 2019.
  • HB 2728: Sponsored by Representative Sierra to make participation in extended foster care until the age of 21 an opt-out rather than opt-in program for youth aging out of foster care when they turn 18. Extended foster care can provide a better bridge to adulthood especially during the current health and economic crisis.
  • SCR 1017: Sponsored by Senator Quezada. A legislative proclamation identifying racism as a public health crisis affecting our entire society and avowing to support policies that reduce racial and ethnic health inequities and promote social justice.

The list above is not an exhaustive list. We are glad to see so many lawmakers introducing bills this session that will benefit Arizona’s children, and we hope many of those bills become law in the future.

Image source: ABC's Schoolhouse Rock

Healthcare.gov will re-open for a special enrollment period

The Biden administration has announced that it will reopen the federal ACA Marketplace for a special enrollment period in response to the COVID-19 pandemic. From February 15 to May 15, Arizonans will be able to shop for affordable, comprehensive health insurance coverage at healthcare.gov.

The Affordable Care Act Marketplace (or “exchange”) serves as a critical source of health coverage for Arizona families. In 2020, over 153,000 Arizonans enrolled in health care through the Marketplace.

This special enrollment period marks a significant shift in ideology and a step in the right direction for child and family health. The Trump administration slashed funding for health insurance outreach, enrollment, and education, cut premium subsidies and funding for marketing, shortened the open enrollment period, and made it easier for companies to offer non-ACA compliant health plans.

In contrast, the Biden administration has announced plans to spend $50 million on marketing during the special enrollment period. The President has also instructed his agencies to revisit and work to rescind measures that inhibit enrollment in health coverage, such as Medicaid work requirements and the public charge rule. While these changes can’t happen overnight, the wheels have been set in motion.

The ACA Marketplace is always open for those who meet certain criteria (for example, people who become pregnant, move, or lose health coverage from another source). Outside of these special circumstances, people can only select or change their plan during the regular open enrollment period from November 1 to December 15. Medicaid and CHIP enrollment is open year-round for those who meet eligibility requirements.

Families and individuals who need help applying for coverage don’t have to do it alone. Health care assistors statewide can help Arizonans find the best source of health coverage for them and can help with completing applications for coverage through the Marketplace, AHCCCS, KidsCare, and more. CAA is proud to support CoverAZ, a service that helps people find an assistor near them. Interested parties can book an appointment online at coveraz.org/connector. CoverAZ also operates a phone line staffed by bilingual community health workers, who can help book a personalized appointment with an enrollment assister. Appointments are available by phone or in person.