5 Things Arizona: Medical Debt proposition, Pima County vax incentive work, Addressing fentanyl deaths


Eli Kirshbaum


This month’s newsletter includes a look at Arizona’s ballot initiative that aims to lower medical debt, a successful COVID vaccination incentive effort conducted by Pima County, and recommendations from AzPHA’s Will Humble about how to combat rising rates of fentanyl-related deaths in the state.

Thank you for reading!

Eli Kirshbaum
State of Reform


1. Expert says medical debt ballot initiative won’t be much help to those in deep debt

Arizonans will vote on Proposition 209 this fall, which aims to lower ever-increasing levels of medical debt by limiting interest rates on what patients owe for medical services. The proposition would limit medical debt interest rates to either the debt’s weekly average maturity yield over 1 year or 3%, whichever percentage is lower.

The proposed measure would benefit those with lower amounts of debt/higher income more than those with higher amounts of debt/lower income, according to Dr. Keith Joiner, Professor of Medicine and Public Health at U of Arizona. He says switching from Arizona’s current maximum medical debt interest rate of 10% to a 3% interest rate would lower the financial burden for someone with, say, $1,000 in debt. But for someone with $100,000 in debt, lowering the interest they pay wouldn’t put a dent in the crippling amount of debt they owe.


2. Unvaccinated Pima County employees cost the county more than vaccinated employees

A recent memorandum from Pima County Administrator Jan Lesher shows that the county’s decision to raise health insurance premiums for its employees who didn’t get vaccinated against COVID helped reduce health care costs for the county. In August of 2021, the county imposed a $45.51 surcharge on the medical premiums of unvaccinated employees to incentivize vaccination. Between October and July of 2021, the average health care cost for unvaccinated employees was $768 per employee per month, while it was only $475 for vaccinated employees.

“Even though there’s a relatively smaller number of employees in that unvaccinated category, they cause a disproportionate amount of costs because they are the people who are requiring pulmonologists and other advanced specialists in treatment,” said Francisco Garza, Pima County’s Deputy County Administrator and Chief Medical Officer. With the statewide ban on vaccination mandates for government employees having gone into effect last week—nullifying the Pima County mandate—the memorandum encourages the county to instead incentivize vaccination by offering 16 additional hours of paid leave to employees who are vaccinated.

3. What They’re Watching: Sherell McDearmon, Bristol Meyers Squibb

In this edition of our “What They’re Watching” series, Sherell McDearmon, Director of Strategic Alliances at Bristol Meyers Squibb, lauds Arizona’s passage earlier this year of House Bill 2144. The legislation requires health plans to cover biomarker testing, which McDearmon says was a key goal for her organization’s broader mission of improving accessibility and health equity.

She also discusses Bristol Meyers Squibb’s commitment of $150 million to promoting health equity over several years. “We have been actively engaged in how we are operationalizing that internally and externally. How does our organization have a health equity lens on everything we do, from sales to marketing to R&D to policy?”



4. Strategies for lowering Arizona’s fentanyl death rate

Overdose deaths due to prescribed opioids have been on the decrease in Arizona since 2018, but deaths due to fentanyl have skyrocketed in recent years. 57% of overdoses in the state are currently related to fentanyl, compared to 4% in 2017. AzPHA Executive Director Will Humble says the state needs to focus on fentanyl-specific prevention strategies like fentanyl test strips and medication-assisted treatment.

Humble says certain injectable medication-assisted treatments last for weeks, unlike other options like methadone, and that Arizona should add these to its Medicaid formulary. He says getting rid of prior authorizations for these treatments will also be key. Another part of the issue, he adds, is the lack of pain management specialists to meet the state’s need.

5. State implements updated CHW training curriculum

Arizona’s Health Start Program, which uses community health workers to provide reproductive health care services to underserved pregnant and postpartum women throughout the state, now has an updated training curriculum for these professionals. ADHS leaders say the new curriculum—which will focus on educating parents about things like child development and immunizations—will help augment the role CHWs play in providing care to new and expecting mothers.

In another recent move to more thoroughly incorporate CHWs into the health care system, the state approved new rules this month for the CHW voluntary certification mandated by 2018’s HB 2324. “I see more programs being developed that will hire voluntarily certified [CHWs] to do a lot of the work for less cost as well, because they can do the education, they can do the advocacy, they can get people and families linked to services and the health care system, and promote healthy behaviors,” said Sarah Rumann, Manager of the Health Start Program.