November’s elections ushered in sweeping changes in state government, including new state leadership at the highest levels and new state laws, some of them affecting health care and the medical community. Arizona medical propositions passed in 2014 include Propositions 303, the Right to Try Act, and Proposition 480, which provides funds to expand and modernize Maricopa County’s aging health care facilities.

Ballot propositions are measures put forward by interest groups or individuals for the voters to decide upon. A certain number of signatures must be collected for a proposition to make it on the ballot. If approved by enough voters, the propositions are coded into state law.

Proposition 303, the Right To Try Act

This act allows terminally ill patients to try experimental drugs not approved by the Food and Drug Administration (FDA). FDA approved medications require a rigorous and lengthy review period that lasts an average of ten years before receiving the official stamp of approval to be sold to the public, according to AZ Central. The entire process costs almost $1 billion for most drugs.

Because of the lengthy review period, there are many promising drugs still in the research phases that terminally ill patients may not have access to without participating in a trial.

The proposition passed by a landslide, with 78% of voters voting yes, according to Channel 3 News. Other states with Right To Try bills include Colorado, Missouri, and Louisiana, AZ Central reports.

Medications potentially impacted by the bill include experimental ones such as stem cell treatment for amyotrophic lateral sclerosis (ALS), the neurological disease that affects voluntary muscle movement.

Patients wouldn’t have access to just any drug; the medication would at least need to have passed a Phase 1 trial, which measures the drug’s safety in a healthy population, according to the FDA. Phase 1 efforts to ensure the drug isn’t toxic to humans precedes studies for efficacy, which come in Phase 2.

Other rules require patients to have a doctor’s recommendation for the drug, and the drug maker must agree to supply the medication.

Advocates for this Arizona medical proposition fought for its passage, saying that terminally ill patients should not have to wait for FDA approval in order to access potentially life-saving drugs.

Paulina Morris, the mother of a young bone cancer survivor who traveled to England for treatment because a certain drug wasn’t available domestically says:

“This is the United States. If you make an informed decision and it’s gone through a trial and you’ve jumped through all those hoops, you should have the ability, the right to try and save your life and save your family.”

Opponents, however, cautioned that unscrupulous individuals could take advantage of dying patients by selling them ineffective drugs. The FDA already has a compassionate-use program that gives patients access to experimental drugs. Because drugs haven’t been fully tested, doctors don’t know the proper dosages to give and other important considerations.

The FDA’s compassionate use program is similar to Proposition 303, but the recently passed Arizona medical proposition allows drug companies to charge for providing the medication, according to AZ Central. Patients participating in the FDA’s program usually aren’t charged.

The Pharmaceutical Research and Manufacturers of America, the industry association, did not voice its opinion over Arizona’s ballot measure, AZ Central Reports.

Proposition 480, Maricopa County Hospital Funding

Proposition 480, which affects Maricopa County only and not the entire state, was a hotly contested proposition, with taxpayer watchdog groups and medical professionals fiercely debating its merits.

The measure passed with 63% of the vote, according to Channel 3 News.

The proposition involves a $935 million property tax increase over 30 years to expand the Maricopa County Special Health Care District’s outpatient facilities and replace the public teaching hospital, according to the official publicity pamphlet. The increase marks the third largest tax proposal in state history, according to the Arizona Tax Research Foundation (ATRA), which opposed the measure.

Included in the district is a Level One Trauma Center, the only one serving both children and adults in the state. The center serves policeman and firefighters injured while on duty, according to the pamphlet.

The district also includes the Arizona Burn Center, the state’s only verified facility of its kind and the second largest in the nation, according to its website.

Other facilities in the district include two behavioral health centers, a health care facility for those with HIV/AIDS, and 11 family health centers spread across the Valley. Patients also have access to pediatric clinics and dentists.

The organization that oversees the health care district, known as the Maricopa Integrated Health System (MIHS), is a so-called safety net hospital that serves the poor, uninsured, and underinsured, providing low-cost services to those who need them. The facilities were built more than 40 years ago, and operate with outdated technology, according to advocates of the proposition, reports the Arizona Capitol Times.

The teaching facility is the county’s only public teaching facility, providing education to more than 400 doctors each year. Advocates also say the district functions as an economic engine, employing thousands and educating doctors who often stay in the state after completing their education.

Opponents of the measure, including the ATRA, said the measure costs too much. Critics argue that no expansion of the facilities is needed because other doctors can absorb overflow patients. Opponents mentioned the passage of the Affordable Care Act (ACA) and said government should stop making changes related to healthcare until dust settles with the new rules.

About 90% of MIHS patients are covered by state-funded health care, known as the Arizona Health Care Cost Containment System (AHCCCS), according to the Arizona Capitol Times. Advocates cautioned that insurance reimbursement rates for these patients are low, which reduces the number of doctors accepting the coverage.

Meanwhile, Arizona ranks 43rd in the nation for its doctor to patient ratio, putting it well below national average for an adequate number of doctors to serve the population, according to the U.S. Census Bureau.

Do either of these Arizona medical propositions affect you?

Image by CGP Grey via Flickr

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