5 Things Arizona: COVID in context, AHCCCS applications, June budget update

Yesterday, 79 people died of COVID in Arizona, the highest daily total yet. The 7-day average is trending steeply upwards. According to three studies, approximately 80% of infections appear to come from as few as 5% of carriers, meaning “super spreaders” are driving infection counts.

Projections show usage of masks reduce the daily death count in Arizona by about 90% by the fall. It appears to be the single most impactful factor to limit the spread and the impact of the disease.




With help from Michael Goldberg

1. AHCCCS applications haven’t kept pace with unemployment

Earlier this month, we hosted a virtual convening titled “5 Slides: Responding to COVID-19 in Arizona.” In one of many highlights from the event, Marcus Johnson, Director of State Health Policy and Advocacy at the Vitalyst Health Foundation, presented data which showed that while unemployment filings have skyrocketed in Arizona, new AHCCCS applications have flatlined.

Johnson said the National Association of Medicaid Directors has indicated that this is a national trend. When asked for his hypothesis on misalignment, Johnson discussed a “Maslow’s Hierarchy of Needs,” of sorts: “When people lose their jobs, they might be filling for unemployment , signing up for SNAP benefits, etc, before they begin to think about insurance. The result is a delayed onset.” Johnson underscored that even if the uptick in Medicaid applications is delayed, it is expected to happen eventually.


2. June budget update

General Fund revenues have not declined as much as anticipated since April. As a result, the Joint Legislative Budget Committee’s (JLBC) June budget update reduced their FY 2020 shortfall projection to $190 million, down from the $668 million predicted in April. However, the projected FY 2021 shortfall has increased to $518 million, up from the $462 million figure projected a few months ago. Assuming the FY ’20 shortfall gets made up via reserves, that shortfall would mean the complete hit to the FY ’21 budget is $708 million, which begins July 1.

This is significantly better than the $1.1 billion combined shortfall predicted in April. Lawmakers are divided are divided about whether Gov. Ducey should call the Legislature back for a special session. Without a session, the governor has several administrative and federal funding options to address the 2020 shortfall, namely $1.4 billion in CARES Act funding.

3.  COVID numbers in context

Arizona’s specific effective reproductive rate, or Rt, is among the highest in the country at 1.26. But even that comparatively high Rt doesn’t explain the size of the spike in daily new infections. That rate of rise suggests the community spread is far wider than current testing can grapple with. ADHS data shows 20% of PCR tests to check for active infection are positive. This would suggest that the actual number of daily infections could be 10x to 40x higher than the current 7-day average of new infections of 2,726.

A lot of folks were hoping that the summer heat would dampen the spread of COVID. In at least one study, air conditioning appears to be the catalyst for spreading the disease. And, while humidity appears to weigh down expressed droplets, bringing them to the ground more quickly, it’s possible they linger in the air longer in a drier heat. The impacts from the heat may be correlation or causation, but “weekly case counts have increased faster than testing… This differential supports the notion that community transmission is increasing.”

4. Hospital capacity stretched thin

Amid rising cases and stretched capacity, Arizona hospitals are reportedly facing a dire situation. While hospitals spent months preparing for a strain on surge capacity, that preparation has not ameliorated staffing shortages. Skilled-staffing shortages along with the potential for staff-fatigue have been exacerbated by an 85% utilization of ICU and inpatient bed capacity. 508 ICU beds are available and about 348 ICU beds are projected to be needed, according to today’s IHME data, leaving about 160 beds to spare. That gap closes by July 18th but doesn’t quite tip past the 508 count

The CEOs of Banner Health, Dignity Health, Honor Health, and Abrazo Health all denied interview requests with a local news affiliate, and according to ABC 15, no alternative spokesperson was offered. Hospital representatives said that leadership was busy addressing the crisis. Banner, the state’s largest hospital system, is bringing in support staff from other states.

5. Juneteenth virtual conversations on race

On June 19th we hosted our “Black Leadership in US Health Care and Health Policy” virtual conversation with Eric Hunter of CareOregon, Demetria Malloy, MD, of Anthem Medicaid in California, and 30-year Texas legislator Rep. Garnet Coleman. During this honest and important conversation, the panelists described their experience as Black leaders, the role the health care sector can play to address structural inequality and racism in American society, and how to lobby organizational leadership to act more boldly to stand up for racial equality.

On this same day, more than 1,000 protesters marched through downtown Phoenix in honor of the holiday and to continue organizing for police reform. A bipartisan coalition of 48 US Senators announced this morning that they are introducing legislation to make Juneteenth a federal holiday.