Arizona's public health feels the weight of federal orders

Yahoo

10-03-2025

Protesters gather at the Arizona Capitol on March 4, 2025, in opposition of recent executive orders targeted at the LGBTQ+ community, among other actions related to immigration and U.S. involvement in the Ukraine War. Photo by Brian Petersheim Jr. | Cronkite News
In Arizona – home to roughly 34,000 federal employees – President Donald Trump's orders can impact a massive workforce of health care professionals and the individuals who rely on their services.
Health care in the United States is a market commodity rather than the right of citizenship, available to those willing to pay. This model leaves others only with the basic package, historically creating worse health outcomes for people of color, members of the LGBTQ+ community, immigrants, people of lower socioeconomic status and those living in rural communities.
Public health depends on government regulation and support. It is about improving the quality of life of the population as a whole, focusing on minimizing gaps in health outcomes.
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On his first day in office, Trump signed orders terminating diversity, equity and inclusion programs across the federal government.
A wave of other directives followed, freezing funds for medical research and eliminating gender-affirming hormonal therapy, vaccine requirements and jobs in the public health sector.
The new anti-DEI directives prohibit specific words – such as socioeconomic, ethnicity, systemic, women, trauma, Black, Hispanic and disability – in grant applications for federal money.
According to Rachel Gur-Arie, an assistant professor at Arizona State University's Edson College of Nursing and Health Innovation, the directive slowed the application process and research.
'I might have to change the title of my proposal. I might have to change how I frame the whole proposal,' Gur-Arie said. 'It's like not being able to call a pineapple a pineapple. You call it a fruit that's yellow with a thorny top.'
The linguistic censorship will take researchers away from community engagement, Gur-Arie added, 'because researchers are going to have to constantly make sure they're translating the needs of the community into a language that is acceptable under this new kind of paradigm.'
Spokespeople from the Arizona Department of Health Services and the Arizona Health Care Cost Containment System (AHCCCS), the state's Medicaid program, declined to comment on the actions targeting DEI.
'If you stand your ground around the federal government right now, I'd say watch your back,' said James G. Hodge, a professor at ASU's Sandra Day O'Connor College of Law, while addressing the Rural Health Forum in Phoenix last month.
Trump dedicated his first weeks in office to funding freezes, firings and buyouts. None of these directives offers a roadmap for the process or elaborates on when it might end.
'It's very difficult to understand the impact of an order that is so non-specific and so broad that it encompasses virtually every federal grant that has ever been issued,' said Zaida Dedolph Piecoro, health policy advisor at Arizona Gov. Katie Hobbs' office, during the forum.
While some sectors, such as the military and immigration enforcement, appear to be exempt from workforce reductions, public health workers are facing firings that lack precision. In one case, employees managing the country's bird flu response were fired, then reinstated shortly after.
'The answer right now is that we really need to wait for the courts to sort through some things … because there's just so much uncertainty,' Dedolph Piecoro said.
Some organizations that work with underserved communities and rely on multiple funding sources encourage everyone to prepare for the worst.
'We've been here before,' said Shomari Jackson, director of systems change at the Young Women's Christian Association (YWCA) in Phoenix. Jackson works with underserved communities in the north Valley ranging from those with disabilities to older adults. 'The pendulum always swings in favor and then swings away. It seems like it's swinging a lot faster and harder this time, but the YWCA's mission doesn't change.'
The state's political leaders responded in mixed ways. Democratic lawmakers are pushing back against the cuts, raising concerns about their long-term impact on public services.
Attorney General Kris Mayes is a part of a multistate coalition that has filed a second motion against the Trump administration over its federal funding freeze. Despite multiple court orders, hundreds of millions of dollars in grants from the Federal Emergency Management Agency (FEMA) remain blocked.
'The Trump administration is blatantly ignoring court orders and continuing to withhold critical FEMA funds that states rely on,' Mayes said in a press release. 'This is illegal, dangerous, and puts lives at risk.'
Many Republicans support the reductions, and Arizona's GOP members in Congress favor the changes.
Trump proposed tax cuts and signed an order to 'reduce the scope of the federal bureaucracy,' which included requiring the Administrator of the Centers for Medicare and Medicaid Services to terminate the Health Equity Advisory Committee.
'We have over 2 million Arizonans who are on AHCCCS,' said Beth Kohler, the CEO of the Arizona Association of Health Plans, in an interview to The Arizona Republic's political podcast The Gaggle. 'It's a $22 billion program.'
Arizona, a Medicaid expansion state, could lose significant funding due to federal budget reductions.
'We heard that the Centers for Medicare and Medicaid Services plan to cut the navigator budget from $98 million to $10 million,' said Daniel Derksen, director for the Arizona Center for Rural Health, during the forum. 'That means that there'll be fewer people available to help people with eligibility and enrollment, both for Medicaid but alsoand other marketplace plans.'
Derksen said he is very anxious about the Affordable Care Act expiring in December and the talks of the potential cuts to the Federal Medical Assistance Percentage (FMAP), a formula that decides how much the federal government reimburses each state for Medicaid expenditures relative to the average per capita income.
By law, FMAP cannot go below 50% and is almost 65% in Arizona.
'The state cannot absorb any federal cost shifts for Medicaid. It is extremely difficult in the state of Arizona to increase revenue,' Dedolph Piecoro said. 'I believe now it takes a 60% threshold at the ballot to do anything that will increase revenue or, you know, act of God, I'm not sure.'
According to Dedolph Piecoro, it would be 'virtually impossible' to backfill the federal funding portion of Medicaid.
According to Derksen, '500,000 Arizonans (could lose) their Medicaid coverage if those proposed cuts go through. Between the Affordable Care Act cuts and the Medicaid cuts, we can double the number of uninsured, which I estimate right now at 750,000. … To me as a family physician, (it) is unconscionably high.'
On Feb. 10, Arizona families who rely on gender-affirming care received an email from the largest provider of gender-supporting services in the state, Phoenix Children's Hospital, announcing it is 'indefinitely pausing gender-affirming medical care, specifically puberty-blocking and gender-affirming hormonal therapy.'
The decision to halt the services was a direct response to the Jan. 28 directive titled 'Protecting Children from Chemical and Surgical Mutilation.' The executive order prohibits gender-affirming care for people under the age of 19, yet according to Tami Staas, a mother of a transgender son and the executive director of the Arizona Trans Youth and Parent Organization (AZTYPO), adults are affected as well.
'I heard from a family of ours that their 20-year-old child, who was a patient at the Phoenix Children's Hospital, was told at their last appointment they have to be stepped off their hormones,' Staas said. 'What we're seeing is preemptive compliance without an executive order at this point.'
Cronkite News spoke to a representative at Phoenix Children's but could not independently confirm whether the hospital served and subsequently stopped serving adults as well.
'Phoenix Children's is bound by all federal laws and regulations for the provision of care to its patients. For this reason, Phoenix Children's is indefinitely pausing hormone therapy services within the Gender Clinic to ensure we are in full compliance with the recent executive order,' the hospital said in a statement sent to Cronkite News.
Staas, whose organization provides families of transgender children and youths up to 24 years old with peer support and helps parents cover costs for things such as name changes, saw the immediate effect of this decision.
'They were terrified for their kids,' Staas said. 'I talked to one family. Their child was on blockers and they had an appointment that week. Their appointment was canceled and they didn't know what they were going to do.'
Puberty blockers do not cause permanent changes. Stopping treatment allows the body to resume puberty based on the gender assigned at birth and can result in breast development or facial hair growth that can exacerbate dysphoria, according to Staas: 'They would become extremely suicidal and the fear of losing your child, that's what they're dealing with.'
One San Tan Valley mother, who spoke on the condition of anonymity due to fear of retaliation, remembers her 18-year-old transgender daughter was 'thriving' just months ago.
The daughter, who started counseling at a young age and eventually started hormonal therapy at the age of 16, had found a good balance of estrogen and progesterone supplements for her.
'She looks amazing, she's thriving. She feels like herself now,' the mother said, referring to her daughter before the order. 'Her mental health is definitely stabilized. She's had three years now of no self-harming, no suicidal attempts, no suicidal thoughts and stuff … and then this blow … I'm scared, she feels targeted. She's terrified.'
The family is considering moving back to California or leaving the country: 'I have no problem taking her wherever it'll be safe.'
Prisma Community Care in downtown Phoenix announced Feb. 14 that it stopped providing gender-affirming hormone therapy to anyone under the age of 19. But it lifted its suspension only two days later.
Staas said she already saw families establishing care elsewhere: 'People looking to international care. Not only Mexico but Europe and other places. We have families who've established care with LA Children's, and what LA Children's does is they require a visit once a year in person, and then they'll do once a month telemed.'
However, California hospitals are also caught in a legal tug-of-war, discontinuing and restarting targeted services as Trump pushes new rules on hospitals while courts continue to block them.
Children's Hospital Los Angeles, which initially paused hormone therapy services, lifted the restrictions after a federal judge temporarily blocked Trump's order on Feb. 13.
The administration's attempts to ban gender-affirming care are not the only ones affecting the health of young Arizonans. Schools and universities requiring COVID-19 vaccines for in-person attendance can lose federal money under a Feb. 15 order mandating institutions develop a plan to end restrictions.
'Schools aren't really requiring that right now, but if you attempt it on COVID-19 vaccines, the executive order says, 'oh, well, we'll start stripping all of your Department of Education funds quickly,' Hodge, the law professor, said.
Hodge urged health professionals not to hide under a rock for the next four years but to look for other ways to meet health care goals.
'Get innovative, figure out how to accomplish public health objectives without necessarily running up against an administration,' he said.
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