Q&A: Rep. Kelli Butler discusses women and children’s health care, social determinants of health

Representative Kelli Butler has served Arizona’s 28th Legislative District — encompassing Paradise Valley and much of North Central Phoenix — since 2016. Butler serves on the House Health and Human Services Committee.

In this Q&A, Butler discusses the health care conversations she looks forward to having in the upcoming legislative session, as well as various women and children’s health care issues for which she will continue to fight.

 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

 

Soraya Marashi: What have you been up to during the interim pertaining to health policy?

Rep. Kelli Butler: “I think the first thing that we’re talking about and focusing on is COVID, of course, and how we can really positively use the resources that we’ve been getting from the federal government, and how we can invest those dollars to best mitigate COVID. Unfortunately, our process with the governor’s office has not been very transparent in terms of deciding where those dollars should go … it’s obviously a huge focus of … how we need to really respond and how our public health system needs to be …

… One thing that has really become obvious is that we have a real workforce problem in our health care system. We’re seeing shortages and so we’re looking at ways to improve our nursing workforce by improving training, improving all kinds of incentives to stay in the job, and obviously we know that those investments have such a return because we won’t have to pay traveling nurses and we won’t have to have overtime and overworked people that are doing those jobs.

I feel like there hasn’t been enough conversation in Arizona particularly about how we can better utilize our public health experts in crafting mitigation strategies. We’re one of those states who have kind of pushed back against what are obvious mitigation and public health strategies. We’ve had lawsuits, we had bills that prevent schools from even implementing mask mandates. Those things are moving in the courts right now, so it’s been disappointing to see that we haven’t really had the focus on public health and science that we should have had all along.”

SM: What are your health care-related priorities for the upcoming legislative session? What conversations are you looking forward to having?

Rep. Butler: “I have been really excited to have … opportunities to really leverage Medicaid to especially improve health for women and children. I’m working on bills to, and I did last year as well … expand eligibility for our CHIP Children’s Health Insurance Program. We’re currently one of the lowest and the stingiest in the nation in terms of our eligibility criteria. I’d like to raise that to the U.S. median so that we could potentially have about 20,000 more children enrolled in our CHIP program and get that really good, comprehensive, quality care. So that was one thing we’re looking at.

I understand that the Biden administration has sort of incentivized states to expand postpartum coverage beyond what is really minimal coverage in Arizona right now, and expanded to a year for coverage through Medicaid for postpartum care, [which is] super important in Arizona. We have made some progress in the area of maternal care and at least a couple of sessions ago we passed a bill to at least start really studying the data around maternal mortality and morbidity. So now we have some good data. Now we need to act on that data and use it, and I think an obvious way [to do that] is to expand the coverage so those women can get in and have the care they need and see doctors. A very troubling fact that we’ve discovered is 80% of pregnancy-related deaths in Arizona were determined to be preventable. And … then that more than a third of those pregnancy-related complications occurred between 42 days and one year postpartum. So really in that timeframe is where we need to make sure that women have access to care. Expanding postpartum coverage is a huge opportunity and I think the data, obviously, shows that we need to do that. 

And then third … we have been working for years on adding a dental benefit for pregnant women who are on Medicaid … not only do we know that there’s a correlation between oral health, preterm birth and poor birth outcomes, but … obviously using it as a touch point in a woman’s life to really improve her health. So, I will continue to work on that dental benefit for pregnant women. We’re also looking at expanding other dental benefits through our Medicaid programs so that other adults on Medicaid could get access to care too.”

SM: You have been a strong advocate for women’s health care and sexual/reproductive health in general. How will you continue this fight in the upcoming session?

Rep. Butler: “Obviously, there’s been some real attacks on reproductive health that we’ve seen from Texas. We have heard that we may be seeing bills like that introduced in Arizona this session … There are so many positive steps we could be making to make pregnancy more safe in Arizona … to support people who are having children, and to take a step like that, take a real step backwards into really restricting access would just be really tragic. When we have opportunities to improve health, to instead focus on restricting health options, would be just a tragedy.”

SM: What is it like to be in the minority party when you’re having conversations about health care? How do you plan to make sure your health care priorities are heard even though you’re in the minority?

Rep. Butler: “You know, it is really frustrating to try to resolve these issues when they seem to me to be so common sense. It is so obvious to me that investing in health for people in Arizona would pay so many dividends, and so many benefits, and so much return on that investment, and to not be having these really good conversations has been extremely frustrating.

I will say, I’m really encouraged in this interim. We have the chair of the House Health Committee, Representative Joanne Osborne, convening stakeholder meetings. And last week we heard and met with our director of our AHCCCS program, and we heard their solid estimates of what my initiatives related to children’s and women’s health would be from an economic standpoint. 

So, I’m really encouraged that we’ve finally had a really good conversation with people on both sides of the aisle about those measures in particular that I talked about. And that’s much more conversation that has happened, than it has happened in the past. So we’ll see if any of that bipartisan study of those issues can turn into bipartisan legislation. Not only would it benefit Arizona, but it would just be such a dream come true.”

SM: You’ve also been a strong advocate for various social services in Arizona. I’m thinking about Senate Bill 1514 in particular, which would provide emergency shelter bedding for homeless senior citizens. Why do you feel that this bill is important, and how will you continue to advocate for the social determinants of health for Arizonans in the future?

Rep. Butler: “We often try to say housing is health care. You cannot be healthy if you are without a home. If you can’t create meals for yourself, if you can’t sleep well, you cannot be healthy unless you have a place to go that’s safe. So I think that bill is extremely important, and we’re seeing especially, really sadly, older senior women in particular who are experiencing homelessness because they are often in those caregiving roles that pay less … So we’re seeing increasing numbers of women, of older women in particular, and then they’re so vulnerable if they are to become homeless. So shelter beds, especially, are so critical, but especially for that really vulnerable population, it’s just incredibly important. 

The conversation around health care needs to be broader to talk about the social determinants of health and how if we really want to have healthy people who are functioning in the workplace [and[ children who are functioning in school and succeeding, you have to have all of these broad needs addressed. 

And so we’ll just continue to try to find ways .. and most often a lot of those resources are reliant upon funding. A lot of times it’s really hard to address those needs without providing enough funds to do what is necessary. It costs money to open a shelter, it costs money to make sure that people have food and housing and access to physicians. It’s been tough because there is such a focus by the majority on just cutting our budget, cutting taxes, cutting our revenue, instead of thinking about that revenue and how we should be investing in people, and investing it in health, and how those investments will pay off.”

This interview was edited for clarity and length.