5 Things Arizona: Agency budget asks, AHCCCS leadership, ACA timeline

This is our inaugural newsletter of 5 Things We’re Watching in Arizona health care and health policy. This market and policy intelligence newsletter provides five things that we think are worth keeping an eye on in Arizona health care. They may not always be the most important five things on your radar screen, but hopefully you’ll find them worth tracking.

And, if we’re off, I’d love to hear what you think we should be watching. You can always reply to this email, which I’ll see in my inbox.


DJ 5 Things Signature


With help from Emily Boerger and
Sara Gentzler

1. Department requests teed up for gov’s budget

Governor Ducey’s budget proposal isn’t expected until January, but the priorities and funding issues included in state agency budget requests offer a glimpse into what we might see when his executive budget is released. In this piece, Senior Reporter Emily Boerger breaks down the budget request packages for the Arizona Department of Health Services (ADHS) and the Arizona Health Care Cost Containment System (AHCCCS).

Both agencies are asking for funding increases compared to FY 2019. For ADHS, a top funding issue is securing additional money to support the department’s Licensing Division. AHCCCS has 19 decision packages for consideration, covering a broad range of issues, and both budget requests stress the need for compensation raises for key department positions to retain qualified staff.

2. Leadership turnover at AHCCCS

Tom Betlach’s last day at AHCCCS will be next Friday, January 4th, marking a significant leadership shift at the agency. Betlach says he’ll take a few months off and then do some consulting work, likely in states outside of Arizona rather than in-state.

Gov. Ducey has not made a public statement about his timeline for making an appointment to fill Betlach’s shoes. However, MCO and Medicaid stakeholders we talk with have a high degree of confidence in the leadership of Deputy Director Jami Snyder. Whether she is promoted to lead the agency or remains in support of a new director, I’m told to expect Snyder will provide a steady, informed hand to guiding AHCCCS during this transition.

3. Arizona’s two new U.S. senators

Now that Governor Ducey announced his appointment of Rep. Martha McSally to the vacant seat left by the late Sen. John McCain (and which appointed Sen. Jon Kyl will leave on December 31), Arizona’s sending a unique pair to the Senate come January. Arizona will be one of six states sending two women to the Senate, and one of 10 states sending senators from different parties. This is one of only a few times in US history that a state will be sending two new members to the US Senate in the same month (the last time being 1995 in Tennessee).

The intense campaign between the soon-to-be-Senators often focused on health care. Both McSally and Sinema have positioned themselves as “bipartisan” in the past. We’ll see how well they work together on health policy for Arizona in the new Congress. In a gridlocked institution, riven with partisanship, any level of bi-partisanship from the new pair would stand out among their peers.

4.  Health policy in the 2019 legislative session

recent legislative report from the Arizona Health Care Cost Containment System (AHCCCS) ahead of session shows that the number of Medicaid members in Arizona who utilized emergency departments for non-emergencies decreased by 8.6 percent between 2012 and 2017. The report credits, in part, efforts AHCCCS launched in recent years that discourage the overutilization of EDs — like incentive payments, integration, and value based purchasing.

Perhaps it’s because of AHCCCS’s success in recent years that health care won’t be a priority in the upcoming session. None of the prefiled bills currently online point to major action. Recent interviews with GOP leaders made no mention of health policy as a priority.  Though, notably, none of the members of 2019’s Senate Health and Human Services Committee or House Health Committee were featured in the article.

5. The timeline for deciding the ACA ruling

The decision earlier this month invalidating the ACA drew two responses: one that claimed victory, and one that said nothing has changed as this ruling will get overturned. Here’s what I think we know about this process based on the 2012 NFIB v. Sebelius case, which was the landmark ruling on the ACA.

First, the timeline for a decision will be some time, but not that long. Marjie High and Sara Gentzler on our team researched this question and estimate a decision possibly as soon as June 2020. Like 2012, that would be like setting off an earthquake in the middle of the presidential election. It’s also a fool’s errand to suggest anyone knows how the Supreme Court will ultimately decide this. No one foresaw the nuance and complexity of the Roberts decision in NFIB in 2012 – I was wildly off the mark – and few will probably predict (correctly) how this court will react in 2020.