The 20th century brought the advent of publicly available vaccines for a variety of deadly diseases, improving the quality of life and the life expectancy of most Americans. Polio is no longer the dreaded scourge that parents feared and something once as common as chicken pox has become a story grandparents tell about why they have a scar here or there. But the other major advancement in vaccines is that they are not just for children anymore. That’s why, in the 21st century, it’s important for Congress to evaluate adding additional vaccine coverage to Medicare Part B in this session.  

Adults, specifically those over 65, are at a higher risk for increased complications from vaccine preventable diseases. Take Shingles for example, about half of all the cases reported are in adults over the age of 65. In seniors this likely means a risk of hospitalization due to the greatly increased possibility of blindness, loss of hearing, or stroke. There’s a vaccine to prevent Shingles but it isn’t covered in Medicare Part B. For those unfamiliar with Medicare, Part B is Medicare to cover just medically necessary services, but not all medically indicated services such as many of the recommended vaccines for adults. If you want better coverage – it will cost you more for Part D but even then, vaccines have a hefty co-pay, up to $225 per dose! That’s sticker shock to many on limited incomes and prevents them from being covered against known, serious health risks.  

As an independent pharmacist part of my healthcare practice is providing vaccines, I administer approximately 200 doses a week covering six different diseases. These patients know me, I know them. I know what medications they take and their risk factors for complications from vaccine preventable diseases. They know they can come into my pharmacy when it’s convenient for them, without an appointment or doctor visit co-pay, and get the vaccine they want, when they want it. This two-way relationship works to provide affordable, easy access that removes obstacles to getting vaccines and threats to their health while meeting the broader needs of the patient.  

Visiting assisted living centers to administer vaccines is also a part of my practice. For these folks it is highly convenient and cost-effective, as it eliminates both the doctor’s office co-pay and the need to arrange transportation to receive the vaccine, since I come to them. The problem is, if a patient has purchased Medicare Part D – and not all do – there are many different Medicare Part D providers with different levels of coverage and co-pays. This system creates a maze of confusion with no way of knowing what is covered or how much it will cost the patient, causing many folks to go without vaccines that could prevent serious, even life-threatening, illnesses that are prevalent in their age group.  

It’s easy to see how Medicare presents serious obstacles to better, and less costly, health care for seniors when discussing vaccines. The heavy price tag due to the lack of vaccine coverage in Medicare Part B adds to high costs, confusion and hesitancy. That’s where Medicare is short-sighted and needs revisions. 

Like no other time in recent history has the impact of vaccines played a fundamental role in protecting the health and wellness of so many. Americans are very familiar with “baby shots” and the boosters children receive to stave off deadly diseases that were once common causes of childhood deaths. But, until the appearance of COVID many adults in America didn’t give much thought to vaccines, other than maybe the flu shot. With over 60% of the adult population of Arizona vaccinated against COVID, that dynamic has completely changed. Now, Congress has a chance to make much-need revisions to Medicare Part B by adding coverage for all recommended vaccines and should act immediately to bring VACCINE coverage under Medicare into the 21st century.

Ken Patel, RPh, is the owner of Rightway Pharmacy located in Sun City, Arizona and is also an Adjunct Assistant Professor of Pharmacy Practice at Midwestern College of Pharmacy. Mr. Patel opened his pharmacy in 2014 and takes a very active role in improving the health of his community.

Gov. Doug Ducey wants to create a new state agency that can invest in water projects; dole out grants; build or purchase water-related infrastructure; and even buy and sell water.  

The proposed Arizona Water Authority is the governor’s vehicle for delivering on his promise made in January’s State of the State, and repeated on Friday, to address Arizona’s water needs for the next 100 years.

RELATED STORY: Bowers says water prices will rise highest for new residents

A document outlining the Ducey’s vision, provided to reporters on Friday afternoon, states that “the Authority would help secure Arizona’s water future by creating a means to take advantage of water supply opportunities as they arise.” It would have a wide-ranging remit, with the goal of securing water for agriculture, municipal growth, industrial use and underground storage. 

Ducey spokesman CJ Karamargin said the governor has been “working closely” with lawmakers on the project, including Senate President Karen Fann, R-Prescott, and House Speaker Rusty Bowers, R-Mesa. 

“There’s going to be a billion dollars put into an Arizona Water Authority that is moving through the legislature right now,” Ducey said on Friday morning, before the document was released. 

The document goes into significant detail about the structure, authority and limitations of the proposed AWA. But it doesn’t provide more details about what those “water supply opportunities” might be or make a commitment to the governor’s most concrete idea in the water realm – a desalination plant. 

Ducey’s proposal calls for the AWA to control two funds: a smaller fund to make loans up to $2 million and grants up to $250,000 for water supply development projects outside of Maricopa, Pima and Pinal counties; and a larger fund that could buy water or water rights as well as buy or build water-related facilities and infrastructure. That larger fund would be used for “water augmentation, innovation and conservation projects.” 

A budget proposal presented by Ducey’s team in January calls for splitting up the billion dollars into three $333 million chunks over each of the next three years. Doug MacEachern, a spokesman for the Department of Water Resources, added that the two funds would initially be capitalized by rolling in $200 million the legislature already appropriated for water projects last year. 

The AWA would be controlled by a nine-member board, made up of six members appointed by the governor along with the directors of the Department of Environmental Quality, Director of Administration and Director of Water Resources. (Those three positions are all appointed by the governor, too.) 

The proposal also calls for a new joint legislative committee on water, made up of seven members including two from the minority party. That committee would “review” expenditures over $100 million by the AWA, but it’s not clear if the governor’s plan is to give the committee veto power over spending projects. 

And the document included some details that seemed aimed at assuaging potential concerns. The proposed AWA won’t enact regulation; won’t take away any existing water rights or facilities; won’t impose taxes; and won’t overlap with the authority of existing agencies like the Department of Water Resources and the Water Infrastructure Finance Authority. 

A major question hanging over the state’s water dilemma is whether increased supply can solve Arizona’s water woes without further reductions in water use. The AWA would be allowed to fund conservation projects, according to the document.  

On Friday morning, Ducey was noncommittal about whether conservation was a necessary part of the solution. “I think it should always be all the above. I think conservation should always be talked about along with augmentation and innovation,” he said. 

The proposal was also noncommittal about prospect of a desalination plant in Mexico – an idea the governor clearly mentioned at the State of the State. “Instead of just talking about desalination… how about we pave the way to make it actually happen?” he said, also noting that Mexico would be a good place for further investment. 

The idea got a mixed reception, with some praising the suggestion, but others saying it was unrealistic or wasn’t enough to address the scale of the state’s water needs. Former Governor Bruce Babbitt said in a press conference earlier this week that desalination is too costly to make sense as a solution to the state’s water needs. 

On Friday, Ducey said that “there’s a number of potential solutions around water – desalination is one of them.” 

And the document sounded a circumspect tone about the possibility: “It is anticipated that this authority will be sufficiently funded to properly invest in large augmentation projects, including desalination plants. The Authority would not own a desalination plant located out of the state; however, owning a desalination plant is not the only way to take advantage of desalination technology.” 

It’s not clear how fully-developed the proposed legislation already is. Ducey’s comments indicated that he’s already made some headway in the legislature and the document emailed to reporters on Friday afternoon referenced “the bill” and “this legislation,” and said at one point: “Strong conflicts of interest protections were written into the bill.” But Karamargin said there wasn’t a bill ready-to-go yet. “It will be it will be fleshed out using that as a basis,” he said, referring to the document.[/vc_column_text][/vc_column][/vc_row]

The state is moving to create a new agency to search for and finance the water Arizona will need if it hopes to support the current population and grow into the future. 

But Arizonans, particularly those who plan to move here in the future, should be prepared to pay more — possibly a lot more — to get it.

RELATED STORY: Ducey Reveals His Vision For Future Water: A New State Agency

The new Arizona Water Authority announced Friday by Gov. Doug Ducey would have the unique right to obtain and even own water, much of it presumably coming from everything from piping excess from the Midwest to desalination of water from the Gulf of California. And it would start with that $1 billion the governor hopes to set aside over the next three years. 

That, however, would not go far, especially with expensive new technology required to make water from elsewhere suitable for household use. So what the plan envisions is having the state partner with private investors who would be willing to finance these projects — investors who would want a rate of return on their cash. 

House Speaker Rusty Bowers, R-Mesa, who is instrumental in crafting the plan that does require legislative approval, said that is likely to mean that the rates Arizonans pay for water, which often cover only the cost of treating and delivering it, will have to go up. 

“We’re going to have to get over the idea that water is cheap,” he said. 

The key, Bowers told Capitol Media Services, may be finding ways to protect those who already are here and charging higher rates or connection fees to those who come to the state in the future — and want that water. 

“My mother-in-law, 100 years old, down on her little lot in Mesa, shouldn’t have to pay the cost of a desalination plant in Mexico,” he said. 

But the bottom line, Bowers said, is that without that new water, expensive that it may be, there just won’t be enough to go around. 

“If we don’t do it quick, then people actually will be leaving this Valley,” he said. 

“They’ll be packing it up and leaving,” Bowers continued. “What do you do when you run out of that ditch?” 

The authority is the next step to the Drought Contingency Plan adopted in 2019 in the wake of a decline in water in the Colorado River. 

Even at the time it was recognized to be only a stop-gap measure, patching together things like obtaining water rights from tribes and some cutbacks in agricultural use. But now the region is facing its driest conditions in 1,200 years. 

“If that continues for another 10 years, Lake Mead will be empty,” Bowers said. In fact, he said that at the current rate of use versus replenishment, it will be a “dead pool” in four or five years. 

All that is leading to some more radical proposals. 

“Desalination is one of them,” Ducey said. 

How far the state’s money would go — even if it used the entire $1 billion for construction — is unclear. And even then, current estimates are that treated water would cost $2,500 an acre foot. That’s the amount of water that, depending on usage, is needed to serve from two to four single-family homes each year.

“I turn off the water when I brush my teeth,’‘

Gov. Doug Ducey

So, think possible $1,200 annual water bills. 

Bruce Babbitt, the former Arizona governor and U.S. interior secretary, told reporters this past week that the state should not look to desalination to answer the state’s water woes, at least not in the next generation. 

“We need people to understand, it isn’t going to help us out of our present crisis,” he said. 

Ducey, however, said Friday he considers it to be one of the options. 

Bowers, for his part, acknowledged that the state, in considering desalination, may be looking for a “magic bullet” to solve its water woes. But that, he said, does not make this a bad idea. 

“I would proffer that there aren’t any other bullets,” Bowers said. 

But, technology aside, Bowers said there’s something else that makes this a practical solution, even if it is expensive. 

In Arizona, a host of laws govern the ownership of ground water and surface water, meaning much of it already belongs to someone. Even treated effluent, Bowers said, is subject to certain regulations. 

And the water authority will not have the right to use “eminent domain” to seize water that belongs to someone else.

But new water from somewhere else? That’s not covered by state law. And that means it actually could be owned outright by the new water authority which then would have the power to sell it where needed without having to worry that someone else’s legal rights were being trampled. 

The high-dollar solutions like desalination and treated effluent — more colorfully referred to a “toilet-to-tap” won’t be the only ways the authority could spend its money. 

There are other options, Bowers said, like paying farmers to convert to new crops or use different irrigation techniques. Even incentives to urban landowners to cut back on their lush lawns — some of them in the Phoenix area actually watered through flood irrigation — might result in water credits that developers could buy up for new subdivisions. 

But Ducey is balking at any talk of forcing the issue, at least when it comes to farms, even though agriculture uses about 70% of the state’s water. 

“Farming and agriculture is a huge part of our economy,” the governor said. I think we’ve been able to do it successfully.” 

Any change, Ducey said, will have to come from within. 

“I think we’ve also had and seen the farmers and the companies that are involved in agriculture diversify their crops depending on what the needs and the costs are,” he said. “So I don’t know that it’s for the governor to decide who grows what.”

Nor does he particularly believe that the state needs to curtail farming, even with the amount of water used on agriculture. 

“And we’re the leafy green capital of the country,” Ducey said. “I think we’ve been pretty good at it.” 

The flip side of agriculture using 70% is that urban use is a minority. And while the governor said he thinks encouraging conservation should be part of the discussion and a “responsible practice,” he isn’t sure that it would make much of a difference. 

“It doesn’t do much to affect the water supply statewide,” he said. Still, Ducey said he does his part. 

“I turn off the water when I brush my teeth,” the governor said. 

The new authority will have a nine-member board, with six appointed by the governor and three state officials, including the head of the Department of Water Resources. 

Of those the governor would name, no more than three could be from the same political party. No more than one appointed member can be from the same county, with a limit of just two of the six coming from Maricopa, Pinal or Pima counties. 

@AzCapMedia | Twitter

Republican lawmakers are moving to let voters throughout the state override the decision of voters in some cities to set their own minimum wage. 

Legislation awaiting House action this week asks voters in November to declare that the regulation of employee benefits, including wages “is of statewide concern.” HCR 2031 also would say that not just wages but also other compensation, paid leaves, meal breaks and even rest periods, “is not subject to further regulation by a city, town or other political subdivision of this state.” 

More to the point, that language, if approved by voters, would be put into the Arizona Constitution. 

That’s needed because the proposal would override a 2016 law, approved by a 58% to 42% margin, that not only creates a state minimum wage higher than the federal figure but specifically gives cities and towns the right to do even more. 

A constitutional amendment trumps statutory changes. And the Arizona Constitution can be amended only by voters. 

The measure, if approved, would most immediately supersede what already has been enacted by voters in Tucson and Flagstaff who have set their own minimum wages higher than the current $12.80 in state law. And it would preclude voters in other communities from following suit and making their own decisions. 

This isn’t the only effort to restrict what cities, towns and counties can mandate of local employers. 

On Monday the House Appropriations Committee approved HB 2001. It would bar local governments from requiring companies to “alter, adjust or in any way regulate an employee’s labor productivity during working hours.” 

Nicole LaSlavic, lobbyist for the Arizona Lodging and Tourism Association, said this is in reaction to a 2020 bid by Phoenix officials, never enacted, to put into ordinance any limits on what private employers can demand of their workers. 

Both measures need full House approval. 

What’s behind both are efforts by Republican lawmakers to restrain the activities of local governments — and, most immediately, communities where Democrats outnumber Republicans. And they are drawing predictable reactions. 

Tucson mayor Regina Romero pointed out that Proposition 206, the 2016 law setting a state minimum wage, specifically permits higher local options. Based on that, voters in her community approved going to $13 this April and, in steps, up to $15 in 2025.  

“The state legislature should focus on overriding the aggregate expenditure limit in our public schools and stop wasting their time trying to override the will of Tucson voters,” said Romero. 

Flagstaff Mayor Paul Deasy accused lawmakers of “disrespect” for the voters of his community. 

He pointed out that residents there approved their own minimum wage the same year voters enacted proposition 206. It is now $15.50, with future increases tied to inflation. 

“This was not decided by the Flagstaff city council but by the people of Flagstaff,” Deasy told Capitol Media Services, saying that the action by state lawmakers “shows a complete slap in the face to the people.” 

And Jeanine L’Ecuyer, aide to Phoenix Mayor Kate Gallego, called Arizona “one of the worst states for infringing on local control.” 

But Rep. Jeff Weninger, R-Chandler, said that he sees nothing wrong in allowing voters from other communities that don’t have their own local local ordinances on wages and other labor issues to override what voters have done elsewhere. 

Weninger, who is part-owner of sandwich shops, said Arizona cannot attract businesses if it does not have uniform laws statewide. And for him the issues go beyond simply what employers have to pay their workers. 

Consider, he said, the idea of “predictive scheduling” that requires some employers who have a worker’s schedule out sometimes two or three weeks ahead of time. While not enacted by any Arizona community, has taken hold in places like California. 

Tucson actually has a variant of that. The ordinance requires large employers — those with an average of 26 workers — to pay a minimum of three hours’ worth of wages when a shift is cut short or canceled with fewer than 24 hours notice to the employee. 

Rep. Regina Cobb, R-Kingman, the sponsor of the constitutional amendment, said statewide intervention — and override — is necessary. 

“The ability of the cities and counties to adopt geographical specific labor regulations has created an administrative nightmare for small business owners,” she said. “Businesses are put at a competitive disadvantage based entirely on what side of the street they are working on.” 

And Cobb said she fears it won’t stop with just what voters have enacted in Tucson and Flagstaff. 

“It’ll end up in dozens of separate labor standards,” she said. And Cobb, who operates a dental practice in Kingman, said she would not want to have separate rules for her workers if she were to open an office in Flagstaff. 

Rep. Sarah Liguori, D-Phoenix, said she’s not sure a single statewide standard is a good idea. 

“I’m not sure if this is going to help or hurt wages,” she said.  

“Each city and town does business differently,” Liguori said. “So the state coming in and overseeing how everyone needs to do business is my concern.” 

Cobb also is the author behind HB 2001. 

While it cannot affect local minimum wages — that requires the constitutional amendment she is pushing — it would override local control on other labor issues, all without having to seek statewide voter approval. And it could be enacted solely by the Republican-controlled legislature without having to ask voters what they think. 

Nicole LaSlavic, lobbyist for the Arizona Lodging and Tourism Association, said members of her organization were alarmed by that unsuccessful 2020 bid by Phoenix to impose new rules on private employers. 

One, for example, would have given furloughed employees a first “right of recall” for any position for which they are qualified. There also were issues of sick leave for workers not covered by federal laws enacted during the COVID pandemic. 

And it as so specific, she said, that it would bar companies from disciplining workers who failed to clean at least 4,000 square feet of space in any eight-hour shift. 

@AzCapMedia | Twitter 

It is imperative that the Arizona Legislature pass the Override K-12 Spending Cap before March 1^st or Arizona District Schools will immediately face over a BILLION DOLLARS in cuts for the remainder of the school year. Understand, this is not a request for money!

Voters need to take notice that the majority in the Arizona Legislature are holding public school children hostage while deciding to advance a clean bill to waive the school spending cap.  A good education is the most important tool to succeed in life, and children should never be the victims of a political agenda.

Tomorrow’s future depends on the opportunities afforded to students today. Why would anyone want to deny children the best possible education? For decades Arizona’s Republican legislators have continue to reject bills that would enhance and improve public school education. Many fine educators and administrators are ready to leave the profession. Don’t those in office realize the consequences of their harmful actions? Why isn’t public education a number one priority in Arizona?

Joanie Rose

Scottsdale, AZ

As legislators, we work hard every day to best represent our communities. We represent different parts of the state and come from different parties. While we may disagree on some issues, what we all agree on is the value of our public schools. This is why we need to work together in a bipartisan way to ensure that Arizona’s public schools do not lose over $1 billion of state funding by the end of this month. This is avoidable and the fix is simple. We are calling on all our colleagues, regardless of party, to join us in supporting a clean vote on raising the Aggregate Expenditure limit before March 1.

Arizona voters approved the creation of the Aggregate Expenditure Limit back in 1980 that limits how much K-12 schools can spend in a school year. It included a provision that allows the Legislature to override the cap with a simple two-thirds vote. This cap has been lifted several times in recent years with little to no controversy.

Enrollment declines in the previous school year mean that the expenditure limit is lower this year, and easier to hit. However, we have seen signs of enrollment rebounding this school year, and schools must be able to serve students who have returned to their classrooms. The extension of Proposition 301 by the Legislature in 2018 now means that the hundreds of millions of dollars of sales tax revenue generated by it must now be counted toward the limit for the first time. Both factors help explain why we are hitting the cap this year and must act.

If the Legislature does not vote to raise the cap by March 1, our local public schools will not be able to use more than $1.1 billion of state funding that the Legislature has already allocated to them. Simply, our local public schools already have these dollars, but will not be allowed to use them without a vote of the Legislature authorizing them to do so.

The impact on our local public schools, and our communities, will be calamitous. Larger school districts like Chandler Unified and Mesa Public Schools will see their budgets reduced by tens of millions of dollars. Rural school districts, already hard hit by the pandemic, will face cuts of millions of dollars each. Schools will be forced to close, teachers, bus drivers, counselors and other staff will be let go, and our students will be sent home just when they need in-person learning the most. Removing over $1 billion from our state economy overnight will also have a devastating impact on local businesses, creating more uncertainty for Arizona families.

All of this is avoidable if the Legislature decides to act. There will be plenty of time for Democrats and Republicans to debate larger policy issues and the state budget itself. 

As legislators, we regularly visit the public schools in our districts and have seen the impact the pandemic has had on students, teachers, and staff. The last thing we should be doing right now is telling Arizona families that students will be sent home again, all over a problem that is easily avoidable and only requires a simple vote of the Legislature to fix.

The Legislature has restored hundreds of millions of dollars of support for our K-12 schools over the last several years and passed budgets that many of us supported. After all the progress we have made over the years, not acting before March 1 would set us backward at a time when our children need us the most.

All of this is avoidable if the Legislature decides to act. There will be plenty of time for Democrats and Republicans to debate larger policy issues and the state budget itself. What we should not be doing is tying this vote to other policy issues that can be debated and voted on separately. We call on all legislators, regardless of party, to put our children first and join us in supporting a clean vote to raise the Aggregate Expenditure limit by March 1.  Our schools, parents, teachers, and our economy are counting on us.

Sen. Sean Bowie, D-Phoenix, Rep. Joel John, R-Buckeye, Sen. Christine Marsh, D-Phoenix, Sen. Tyler Pace, R-Mesa, Rep. Jennifer Pawlik, D-Chandler. 

The Senate government committee on party-line vote Monday moved forward a bill to create state holidays on primary and general election day and would also repeal Arizona counties’ authority to establish early voting operations. 

According to SB1474, sponsored by Sen. Kelly Townsend, R-Mesa, state residents would be allowed to be absent from their jobs on the day of elections. Current statutes allow absence only if there are less than three consecutive hours between the opening of the polls and the closing of the polls and the person’s regular work shift. The bill also removes the ability of an employer to specify the hours during which the employee can be absent for the purpose of voting. 

Regarding early voting, the bill repeals a host of powers the state had bestowed upon Arizona counties in past sessions, including establishing voting locations and voting centers – including in the county recorder’s office — for in-person early voting. In its place, the bill would require voting locations and voting centers to be used on election day only. The bill also repeals the authorization for a county board-of-supervisors to use emergency voting centers and for counties to provide emergency balloting.   

Sen Martin Quezada, D-Glendale, attempted to add an amendment to remove the stripping of authority to counties on early voting while keeping state holidays, but it did not garner Republican support. He said he hopes the “horrendous bill” will not pass the Senate or the House. 

“I’ve heard Sen. Boyer say he’s against the idea of eliminating early voting, but I don’t know how solid he is on that,” he said. 

Sen. Paul Boyer, R-Glendale, opposed the 2020 election audit and after voting against his caucus in the past, has voiced reservations this session on current election integrity bills. 

The committee heard and passed 11 Republican sponsored bills Monday, seven of which centered on election integrity. 

More than 60 people came to speak or to simply observe the committee. In public comment, almost every speaker was in favor of the Republican sponsored bills and several claimed that the 2020 election was stolen. After rowdy crowds in previous committee meetings this session, committee chair Sen. Kelly Townsend, R-Mesa, introduced a list of ten Senate government committee rules which were unanimously adopted at the beginning of the meeting. The tenth rule states that the chair has the right to stop someone from addressing the committee and have them removed. This was already the policy, Townsend confirmed, but it is now memorialized in writing. The list of rules was adopted unanimously by the committee.  

Not every vote was on party lines, some of the non-election integrity bills passed unanimously, and Quezada twice voted with Republicans to pass bills 5-2, including Sen. J.D. Mesnard, R-Chandler’s, election integrity bill SB1411 (early ballots; tracking system). Sen. Wendy Rogers, R-Flagstaff, sat in for Mesnard whose wife had a new baby last week. This bill would require an early ballot tracking system that indicates whether an early ballot has been verified and tabulated. 

Quezada said that if the tracking system had been available in the 2020 election, fewer people might have been at the committee meeting this afternoon with concerns about election fraud. “Why not give people the opportunity to track?” 

Arizona Association of Counties Executive Director Jen Marson spoke on several of the election bills and voiced her concern several times about the “logistics” of the bills such as Sen. David Gowan, R-Sierra Vista’s bill SB1404 (eligibility; early voting; list) which would limit early voting statewide. Marson said the early voting system works well and is used by many Arizonans, an argument also made by Democrats on the committee. Rogers, Townsend and committee member Sen. Sonny Borrelli, R-Lake Havasu City, have all said repeatedly that they do not believe Arizona elections are secure.  

Quezada believes that statements about corrupt or stolen elections from legislators are a tactic to gain the support of constituents like the ones in Senate government committee today. “It’s a very strategic move on their part. They are trying to create distrust in our election system. They know this is a lie,” Quezada said. 

Other bills that passed the committee today include legislation to nullify votes counted by machines that are not certified by accredited workers, increasing voting machine hardware and software requirements and a bill to separate all ballots by precinct. 

Americans have their hands full right now. The COVID pandemic has made a major resurgence. And at the same time, inflation just hit 7 percent—the highest rate in 40 years. 

Some of the toughest increases are happening in energy costs. In December, gasoline prices were up roughly 50 percent from a year ago. And the price of natural gas nearly doubled in 2021, driving up heating costs and power bills. 

As bad as things are, they could be worse. Energy prices in Europe have exploded, and European households are now paying 54 percent more for their electricity than two years ago—even with aggressive government assistance to reduce costs. Essentially, the pain felt across the Atlantic might be a preview for what’s coming in the U.S., if we don’t make an energy policy course correction. 

Europe’s energy crisis can largely be attributed to a bungled approach to the renewable energy transition—with “decarbonization” goals overwhelming considerations for energy security and affordability. Well-operating coal and nuclear power plants have been closed across the continent, and at the same time investment in new natural gas production hasn’t kept pace with demand. Europe’s all-in pivot to renewable power—and away from a balanced, on-demand energy mix—has left it painfully vulnerable to spiking natural gas prices and Vladimir Putin’s willingness to sell Russian gas. 

Without the dispatchable fuel diversity it once had, Europe has no safety valve when natural gas prices soar and renewable power won’t cooperate. There’s simply no alternative available when the wind won’t blow or cloudy skies curtail solar power. In those instances of a winter freeze, limited natural gas supplies, and exorbitant prices, the optionality and fuel security provided by a now-dismantled coal fleet is deeply missed.  

In comparison, the United States still has a significant coal fleet to take pressure off consumers. And in markets where coal still remains an option, coal plants have picked up market share and helped to keep power prices in check by reducing dependence on higher-priced natural gas.  

However, in states that have followed Europe’s lead—and rushed to close coal plants—consumers are paying the price. New England, for example, is facing a 30 percent hike in electricity costs due to the jump in natural gas prices. And consumers are now on alert to conserve power since the region’s grid operator is warning of potential outages during a prolonged cold spell. 

The return of energy-driven inflation and the European energy crisis are stark reminders that the global energy transition could take a very perilous road if we don’t recognize the value of a balanced energy mix. Americans need fuel diversity to ensure that consumers will be shielded from price spikes, fuel shortages, and underperforming renewable power generation. Maintaining fuel diversity means recognizing the coal fleet while there’s still time—as an invaluable and affordable insurance policy that must be retained for American consumers and our economic recovery. 

Matthew Kandrach 

President of Consumer Action for a Strong Economy 

Money is tight for my family of six. Between paychecks, I have to choose between paying for groceries and filling my insulin prescription. Most weeks, there is nothing left in our monthly budget for my medication, and I have to go without my life saving medication.

Eventually, the prolonged high-blood-sugar levels will take a toll on my kidneys and I’ll need dialysis. It’s a path I watched my father go down, and I realize that it’s one I’m starting down as well.

My father was 40 when he developed Type 2 diabetes, and I was just 33. We live on the Navajo Nation Arizona reservation, where diabetes is far too common, because healthy food choices are few and far between. The closest town to our house has one grocery store, one gas station, and a dollar store. The next town over isn’t much better, with the only restaurants being fast food chains. And, like many rural areas, we lack adequate health services, so we have a heightened risk of dying from preventable diabetic complications.

I watched my dad struggle to afford insulin for years. When the price was too high at the pharmacy, he wouldn’t fill his prescription. His only other option for affordable insulin was a two hour drive away. And during winters with heavy snow, he struggled to make the four hour round trip. So, he rationed or missed doses altogether. After more than a decade of this, he developed kidney failure in 2019. At just 63, he will need to undergo kidney dialysis three times a week for the rest of his life.

Now, I find myself in his shoes. Last year, I developed gestational diabetes when I was pregnant with my youngest child. When the doctor first diagnosed me, I was terrified for the health of my baby. Concern for my own health didn’t quite hit me until I went to fill my first insulin prescription.

I don’t recall how much I paid for my first prescription, but I remember being shocked that the price was so high. I didn’t realize that the health insurance we pay so much for, would cover so little. At present, I pay $70 a month out-of-pocket for my insulin. That, along with the additional $100 I spend each month on diabetic supplies, stretches our budget almost to the breaking point.

I’ve gone as long as a week without insulin waiting for the next paycheck to arrive. When I don’t have insulin, I try not to eat, since food makes my blood sugar spike. But the hunger makes it challenging to find the energy to keep up with four kids. I try my best to push through the headaches, fatigue, and increased thirst and hunger, so I can be the perfect mom and stay positive even when my body is attacking itself.

Living paycheck to paycheck means I won’t know if we’ll have enough for my insulin from one week to the next. I hope that I won’t have to ration my insulin in the future, but there’s a good possibility I will. 

Fortunately, there’s a small glimmer of hope on the horizon for diabetics struggling to pay for their medication — but only if Congress prioritizes President Biden’s Build Back Better plan. It would cap insulin costs at $35 a month, saving diabetics like me hundreds of dollars each year. In a country where 1 in 4 diabetics report rationing their insulin due to the high price, this policy is long overdue. Cutting my insulin costs in half could save my kidneys and maybe even save my life.  

For the 34.7 million Americans living with diabetes, insulin affordability is a vitally important issue, especially in indigenous communities. I’m not surprised when I hear that Americans pay 2-3x more than citizens of other wealthy countries for the same medication. Because in America, pharmaceutical companies hold the cards and for diabetics like me, it’s either pay up or suffer.  

Every year there is talk about reducing insulin prices, but meaningful change rarely follows. My father and I are left to live with the very real consequences of Congress’ inaction on insulin prices. With Biden’s plan, Congress can fulfill its decades-long promise to reduce insulin prices and save lives in the process. I urge Arizona’s senators to stand up for diabetics like me and pass the Build Back Better plan. 

Leanna Tsinajinnie lives in Houck, Ariz., on the Navajo Reservation with her husband and four children.

Imagine you must take a trip, there is no option – you must go. You know exactly where you need to go, the route to take and what you will do when you arrive. What you can’t decide is how to get there − will you fly, take a train, drive yourself, ride a bike or even walk?  Your mode of transportation will be decided for you.

That is the scenario health care providers are faced with every day when determining the best course of action in treating patients. After all the lab work, x-rays and assessments are completed and a diagnosis made, the real work begins. It seems the logical next step would be to prescribe the appropriate medication, therapy or treatment, but due to a cost saving protocol called “step therapy”, the first thing a provider must do after determining the diagnosis is to ask, “Who is the insurance carrier?” Because, this is where the mode of transportation from a state of disease to one of health is determined.

Under step therapy protocol, even when the provider has research and practice protocols to support the need for specific treatment, the patient may be denied coverage for that treatment until they have extinguished all the “steps”, or other treatments, by trying them, and failing, to have results. It can take months to go through all the “steps”, which can lead to disease progression and onset of other diseases.

During this phase, attempting to treat our patients turns into something akin to a scene out of the 1987 film, “Planes, Trains, and Automobiles.”  It comes with complete with a detour at every turn, frustrating setbacks, irreversible damage and painful delays in recovery – leaving patients unsure if they will reach their destination of health, ever again. These experiences, however, are never a comedy for the patients, who are desperate to be healthy and functioning, yet required to wait while attempting multiple other treatments, only to fail, in order to attain the relief they so desperately need. During this process, time is not on their side.

For example, “Patient A” is a 54-year-old male, who when first diagnosed with Rheumatoid Arthritis did well on his initial medication but developed liver function problems, which are a known adverse effect of that drug. With this development came the need to discontinue the initial drug but because his disease was progressing, the next option in treatment was a biologic medication considered the standard of care to get Patient A functioning. As they say, this is when you should buckle up because it’s going to be a bumpy ride.  His health care provider requested approval for the new drug, but it was denied by his insurance carrier. The denial was appealed to the insurance carrier but was met with a second denial that also included the requirement that he to stay on the medication that had caused his liver function problems. Another appeal was made and again, a third denial was received by his insurance carrier. With further debilitation, Patient A was placed on short-term disability and began to have secondary side effects from the steroids he had been using to alleviate the pain. A third appeal was made on his behalf and this time the medication was granted. He was then placed on the biologic drug originally prescribed and began functioning within three weeks. Unfortunately, because of his long-term steroid use while going through the step therapy protocol, he remains further challenged with insulin dependent diabetes.

Did you keep up with the long winding road that is “step therapy?” Treatment that allowed Patient A to be functioning was possible in only three weeks but due to the months of delays while following “step therapy” and “try and fail” protocols, he endured suffering and disease progression, remains on disability and now also battles insulin dependent diabetes. How is this a cost saving process to him, to the public or even to his insurer?

His body took a beating, his quality of life diminished and independence gone as he remains on disability and must look forward to life of not just one debilitating disease, but a secondary disease brought on by medications. All while waiting for what is widely known as the standard of care in treatment for his disease. And at what cost to this man did the insurance company save their money? At what cost to our society, when human capital is lost and lives are left in shambles?

We all agree, health care costs must be managed.  But to overlook the word “health” in providing health care removes all purpose. Rep. Nancy Barto is sponsoring HB2420, which will establish transparency, efficiency and fairness in patient health care through necessary reforms to step therapy protocols.  I encourage anyone who has ever been denied a medication that their physician or health care provider, in their medical expertise prescribed, to please follow this bill and thank Barto for her work.

Theresa Frimel is a nurse practitioner and a member of the Arizona United Rheumatology Alliance and Scope of Practice Committee at the State Board of Nursing. She is also with the American Association of Nurse Practitioners and the American College of Rheumatology.