The state's doctor shortage could get worse if the Legislature makes further cuts to a program that helps physicians train at Arizona hospitals, members of the medical community told lawmakers Wednesday.
"Residency programs are the single best way to grow your physician population," said David Landrith, vice president of policy and political affairs with the Arizona Medical Association. "Nothing else works as well."
Landrith and others addressed the Senate Healthcare and Medical Liability Reform Committee about graduate medical education programs, which take doctors fresh from medical schools and give them on-the-job training with internships and residencies around the state.
The programs get money from the state's general fund, which is then matched 2-to-1 by federal funds. Closing a deficit in the budget for the fiscal year ending in June, lawmakers cut $7 million allocated for the programs, meaning a $21 million loss overall.
With further cuts a possibility as lawmakers address an even larger deficit for fiscal 2010, health care experts and physicians reminded committee members of the programs' importance in attracting physicians to the state.
Dr. Javier Cardenas, a neurologist with Barrow Neurological Institute in Phoenix, said he chose to practice at Barrow because he completed his residency there.
"If I didn't have this opportunity, the likelihood of me practicing in the state of Arizona is very low," Cardenas said.
He said many physicians end up practicing where they train because they often get married or start families during their three to eight years in the programs, and they become a part of the community.
Dr. Michael Grossman, associate dean of graduate medical education at the University of Arizona, said investing in doctors makes sense financially.
"It is an economic driver for the state," Grossman said. "The hospitals are major employers. It's a big economic machine that medicine brings."
Ultimately, Grossman said, Arizonans will take the hit when it comes to their health if lawmakers make further cuts to graduate medical education programs.
"The bottom line is: If we don't train our physicians well, we're not going to have any good physicians to take care of us," he said.
Pro-life Republicans on a House panel unanimously approved legislation that would restrict abortions, while Democrats walked out of the hearing in protest.
When the Democrats on the Health and Human Services committee left the room, the five Republicans remaining all voted in favor of the bill, H2564. It mandates women be given certain information, in person, about their unborn child and their legal rights if they keep the child.
It also allows a wide range of medical professionals to refuse to provide abortions, allows doctors and nurses to refuse to provide the "morning-after" pill, and changes the regulations for minors getting an abortion without parental consent.
The Democrats said they left the committee hearing to protest the committee's makeup; with six Republicans – all pro-life – the Democrats said they are essentially shut out from affecting policy.
But House Speaker Kirk Adams said almost every Republican in the House is against abortion and was critical of the protest.
"It sounds like a temper tantrum. The responsible thing is to stay and state your case and vote against the bill," he said. "That's the kind of gamesmanship that doesn't play well with the public or down here."
Republican lawmakers have pushed for each of those restrictions in recent years, only to have them vetoed by former Gov. Janet Napolitano, a Democrat. But with Republican Jan Brewer taking over as governor after Napolitano joined the Obama administration, abortion opponents are hopeful the restrictions will become law.
Brewer has not said whether she supports the legislation, but in a 2006 survey by the anti-abortion Center for Arizona Policy, she said she opposed abortion except to save the life of the mother.
Attorney General Terry Goddard warned lawmakers that the defense of state law, public safety and consumer interests would be severely impacted if planned budget reductions for the 2010 fiscal year are enacted.
The message was delivered by Goddard to members of the Senate and House Appropriations committees, whose chairmen Sen. Russell Pearce and Rep. John Kavanagh have outlined $3 million in cuts and fund sweeps for the agency.
The majority of the cuts – about $2.5 million – would come in the form of lump sum and salary reductions from the state's general fund. The department saw its budget cut by $1 million in fiscal 2009.
Appearing before House Appropriations Committee members, Goddard laid out the vast duties of his office, from handling all criminal appeals in the state, to protecting abused children and launching grand jury criminal trials targeting complex financial fraud and crimes related to human smuggling.
His presentation noted the office defended the state from liability cases totaling approximately $3.5 billion in damages last year, and has fought a multitude of lawsuits targeting state laws regarding school choice, employer sanctions and school vouchers.
Republican members of the committee were noticeably silent during Goddard's presentation, but fellow Democrats probed to find out what further cuts would do to the agency and also praised his office's accomplishments.
Rep. Olivia Cajero Bedford, a Democrat from Tucson, commended him for breaking up several immigrant-smuggling syndicates and for the indictment of a Phoenix gun dealer accused of selling assault rifles to "straw purchasers" who send them on to Mexican drug gangs.
"It's scary what is out there that you have found and what you could find if you had more money," she said.
Also, Goddard told Rep. David Schapira, a Democrat from Tempe, that further reductions in staff due to funding losses would add to state expenses by requiring the contracting of private attorneys to defend against civil lawsuits on issues well-known by his attorneys.
"They don't have the learning curve, and we won't have to pay for a lot of hours for someone to learn what the case is about," Goddard said.
He also said cuts would reduce his office's capability to fight organized crime and to contest criminal appeals, which are filed in unpredictable numbers.
The Joint Legislative Budget Committee estimates the Attorney General's Office total funding for the 2010 fiscal year will be $89.6 million, with $21.5 million from the state's general fund making up the largest share.
Other significant contributions come from agencies using the office's legal services and an anti-racketeering fund that receives seized RICO assets from criminal cases. Each contributes approximately $13.5 million, and smaller funding levels to the office come from the federal government and the successful prosecution of consumer fraud cases.
After the meeting, Goddard said he did not think additional cuts and resulting layoffs would be "palatable."
"I don't think we could accommodate any additional losses in prosecutors and attorneys defending the state," he said. "Everyone bears a significant burden right now, whether it's for abused children or for representing the state in serious litigation."
Kavanagh, the committee chairman, told the ~Arizona Capitol Times~ he believes that actual cuts for the Attorney General's Office would not be as high as listed in the chairmen's option plan. The totals in the plan produce a higher figure than what legislators will have to cut to present a balanced 2010 fiscal year budget.
"I don't imagine the cuts being everything we could take," he said. "I imagine them being less."
The 2010 chairmen's budget plan also calls for a $500,000 sweep of the collection enforcement revolving fund, an account established to assist the Attorney General's Office recover money owed to the state through bankruptcies, fraudulent activities and other matters.
In 2009, lawmakers swept funds operated by the agency totaling approximately $750,000.
Earlier this month, Goddard announced employees in his office making more than $50,000 a year would be required to take eight days off without pay before the end of the fiscal year.
The announcement came after the Attorney General's Office laid off 20 employees in order to handle 2009 budget cuts.
U.S. Reps. Gabrielle Giffords and Harry Mitchell are among 40 Democrat junior members of the House the Democratic Congressional Campaign Committee has decided, as a precaution, are vulnerable in 2010.
The DCCC has developed a program called "Frontline" that is designed to protect the most at-risk incumbents. Frontline pushes members to focus on fundraising and outreach, and freshmen, such as U.S. Rep. Ann Kirkpatrick, are put in an early position to avoid Republican attacks.
Vulnerability is somewhat decided by the margin of wins in the 2008 election.
More senior members who still represent districts President Bush or U.S. Sen. John McCain won find themselves on the list as a precaution, despite winning by comfortable margins.
The DCCC said the Frontline program likely will "graduate" the members to "good bets for re-election."
Jeff Stapleton at state Democratic headquarters dismissed the DCCC account and went after the GOP. "Instead of working together to get our economy back on track, national Republicans are out to get the most effective and hard-working members of Congress that Arizona has in Washington: Harry Mitchell and Gabrielle Giffords," he said.
Also, David Schweikert has announced he will make another run in Arizona's 5th Congressional District.
In one of her first moves as Homeland Security secretary, Janet Napolitano has ordered a fresh review of hurricane recovery efforts in the gulf coast 31/2 years after two killer hurricanes swept ashore. In testimony prepared for a congressional hearing Wednesday, Napolitano said the Federal Emergency Management Agency will assign a new team of senior staff members to look at ways to improve hurricane recovery operations that have been under way since hurricanes Katrina and Rita in 2005. The Associated Press obtained an advance copy of her testimony.
Napolitano's announcement comes on the heels of her boss' decision to extend the Office of the Federal Coordinator for Gulf Coast Rebuilding, a position created by former President George W. Bush in 2005 that was set to expire at the end of this month.
President Barack Obama extended it through September, the end of the government budget year. Acting coordinator Paul Conway, a holdover from the Bush administration, will remain in the position until Obama chooses a replacement to head the office.
The Homeland Security Department would not give more details about the new FEMA team.
In the prepared testimony, Napolitano said this team would help clarify the federal government's role in long-term recovery and work to resolve disputes.
Paul Rainwater, the executive director of the Louisiana Recovery Authority, said he did not know about this new senior FEMA team, but if it will help resolve the $1.4 billion for recovery that the state feels the federal government underestimated, it's a welcome addition. Gulf coast officials and contractors have ongoing disagreements with FEMA officials over the cost of damages and rebuilding.
”And that has gotten extremely frustrating,'' Rainwater said Monday. ”If (Napolitano) can send down a team of senior folks to work through our issues, we welcome that.''
Katrina was blamed for more than 1,600 deaths and $41 billion in property damage.
The federal government has devoted more than $175 billion to the region since Katrina. It's unclear how much more money will be needed to fix the leftover damage. But nearly everyone agrees the federal government should continue investing heavily to strengthen the region's levees and make other flood control improvements to prevent a repeat of Katrina's devastation.
Bush contended that additional reconstruction money wasn't necessary, because billions of those federal dollars remain unspent – bogged down in bureaucracy or tied up in long-range planning.
The same reasons were given for not including Katrina money in the recent economic stimulus package.
Despite slashing state spending by $1.2 billion last month to cope with flagging tax collections, lawmakers are mulling a proposal to give massive tax cuts to Arizona businesses.
Rep. Rick Murphy, the chairman of the House Ways and Means Committee, said his intention was to foster a discussion on the issue of comprehensive tax reform and not focus on the individual components in his legislation.
"The point was to be able to have the wide-ranging discussion of fundamentally reforming our entire tax structure," he said.
Essentially, the measure would exempt small business owners from paying taxes on their commercial property. Any business with total property worth less than $10 million would be exempted from the tax. Right now, the threshold to qualify for the exemption is $65,000.
The measure, H2368, was introduced as a strike-everything amendment in the House Ways and Means Committee. The omnibus tax reform amendment also sets the stage for a series of annual reductions to the corporate income tax rate through 2011, though the specific reductions were not provided.
Legislative staff told lawmakers that a one-percentage-point cut would amount to about $80 million.
The amendment also would allow all Arizona taxpayers to deduct 57 percent of any capital-gains earnings from their taxable income when filing their state taxes.
The committee did not vote on the proposal.
Steve Voeller, president of the Arizona Free Enterprise Club, said the silver lining of the struggling economy is the opportunity it gives policy makers to examine the state's tax code to promote long-term economic growth.
"I think now is the time to really assess Arizona's tax system," he said.
Murphy said Arizona is poorly positioned to compete with other states in the region because of a heavy corporate tax burden.
"Right now, we are in a very non-competitive position," he said.
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