Key Points:

• State lawmakers push legislation to bar pharmacy benefit managers from owning retail or mail-order licenses

• The push has momentum in Tennessee, with a House committee advancing a bill modeled after an Arkansas law

• Industry groups are expected to challenge similar laws wherever they pass

State lawmakers are opening a new front in their battle with pharmacy benefit managers, advancing legislation that would bar the powerful companies that manage prescription drug benefits from simultaneously owning retail or mail-order licenses at chains like CVS Pharmacy and Express Scripts.

The push gained momentum in Tennessee last week when a House committee advanced a bill modeled after a first-in-the nation Arkansas law. More than half a dozen states have considered similar legislation over the past year, a sign of how the debate over pharmacy benefit managers is shifting. 

After years of passing narrower laws aimed at curbing specific PBM practices — spread pricing, pharmacy audits, reimbursement formulas — some lawmakers are beginning to question whether incremental reforms can work as long as PBMs remain vertically integrated with insurers and pharmacy chains. 

“If we ever want to get back to a health care system where the patient and the physician are in control in the pharmacy, you can’t have this monopolistic enterprise,” Tennessee House Speaker Cameron Sexton (R) said in a hearing.

The six largest PBMs manage nearly 95% of all prescriptions filled in the United States, giving them the power to design health plans, determine which drugs are covered and decide how much pharmacies get reimbursed.

Supporters of ownership bans say it creates unavoidable conflicts of interest, allowing companies to steer patients to affiliated pharmacies, control pricing information and retain rebates that might otherwise reduce drug costs. They also say piecemeal regulation can’t adequately check that concentration of influence, and that earlier state laws that were aimed at curbing specific practices have often had limited impact. 

In Pennsylvania, for example, a 2024 law intended to prohibit some forms of steering and preferential reimbursement applies only to certain commercial insurance plans licensed in the state, leaving most Medicaid, Medicare and self-insured plans outside its scope, said Rob Frankil, executive director of the the Philadelphia Association of Retail Druggists, a community pharmacy trade organization. 

“It’s very narrow,” Frankil said. “We need to layer on new legislation, or make that legislation more robust and meaningful.” 

Independent pharmacy advocates say PBMs that own pharmacies can also favor their own stores through network design or reimbursement rates, making it difficult for unaffiliated pharmacies to compete. 

Opponents of tighter restrictions counter that forcing companies to separate those businesses could reduce efficiency and lead to pharmacy closures in some markets.

Many of the more restrictive proposals are modeled after a 2025 Arkansas law that prohibits PBMs and insurers from owning pharmacies, though that measure has been tied up in federal court. 

Proposals in Indiana, New Jersey and Texas failed to advance, while bills in Arizona, New York and Vermont remain technically active but appear stalled. Lawmakers in Pennsylvania have also announced plans to introduce legislation that would include a similar ownership restriction, and an Oklahoma bill is advancing in the House.

Several of the bills have drawn broad bipartisan support. 

The Tennessee legislation has backing from the Republican leaders of both chambers, as well as some prominent Democrats. Louisiana’s proposal last year was a top priority of Republican Gov. Jeff Landry, but it died in the Senate. And a coalition of 39 attorneys general from both red and blue states urged Congress last year to adopt similar restrictions at the federal level.

Federal lawmakers have also introduced legislation with bipartisan sponsorship that would restrict PBM ownership of pharmacies, signaling a growing national effort to address conflicts of interest. If passed, such federal legislation could preempt commerce clause concerns and give states a clearer framework for regulating PBMs, observers said.

Some supporters say it remains unclear whether any of the state measures will ultimately be enacted or survive expected legal challenges, due in part to fierce opposition from chain pharmacies and their parent companies, which say the proposals are anti-competitive.

“This bill is very dangerous for patients’ health and will not lower drug costs for anyone,” Greg Lopes, a spokesman for the PBM trade group the Pharmaceutical Care Management Association, said in a statement responding to the Tennessee legislation. 

“The bill does not improve access to prescription benefits, nor does it provide any safeguards for patients who would lose access to their drugs as a result of the legislation causing mass pharmacy closures. By shutting down pharmacies, the bill would create barriers to access, raise drug costs and make people sicker.”

Industry advocates point to new research suggesting that policies forcing PBMs to divest pharmacies could raise national drug spending by roughly $32 billion and lead to about 44,000 additional hospitalizations, risks they say stem from reduced medication adherence if pharmacy access is disrupted.

CVS Health — which controls roughly a quarter of the U.S. retail pharmacy market — has mounted an aggressive campaign in Tennessee, spending $1.4 million on television ads and sending customers text messages warning that the company could close all 134 of its stores in the state if the measure passes.

“It’s bad for Tennessee, for the more than 1.5 million patients we serve and for the more than 2,000 colleagues who will lose good paying jobs,” CVS Health spokeswoman Amy Thibault said in a statement. 

The company deployed the same tactic in Louisiana last year. Lawmakers abruptly shelved the ownership ban in the waning hours of the legislative session in favor of a less aggressive transparency measure. 

Attorney General Liz Murrill responded by suing CVS, claiming it had illegally used contact information obtained under the guise of prescription and health notifications. The state ultimately filed three lawsuits against the company last year and announced a $45 million settlement with CVS in February. 

CVS said it would have to close its 23 pharmacies in Arkansas if the law there takes effect. CVS Health and other PBM operators, including Cigna’s Express Scripts, have filed federal lawsuits challenging the Arkansas law, arguing it violates constitutional protections.

Industry groups are expected to challenge similar laws wherever they pass, advocates say, a strategy that could delay implementation while courts determine whether states have the authority to regulate PBM ownership structures.

Advocates for independent pharmacies say lawmakers are increasingly willing to consider structural changes after years of passing PBM regulations that failed to alter industry behavior. 

Joel Kurzman, director of state government affairs at the National Community Pharmacists Association, said that in some states audits have found PBMs ignoring key provisions of state law. 

“They’ll pay their fines without admitting wrongdoing,” Kurzman said. “It becomes a cost of doing business, but the behavior doesn’t change.”

Independent pharmacies are also facing sustained closures. In 2023, more than 300 shuttered — nearly one per day. And over the past decade roughly 1 in 3 U.S. retail pharmacies closed, illuminating the pressures on neighborhood pharmacies.

Not every bill is introduced with immediate passage in mind. In some states, lawmakers use the proposals to put PBM practices on the record and build momentum for future legislation, Kurzman said. 

“For years independent pharmacies have been playing defense,” he said. “This is one of the first times we’re trying to put PBMs on the defensive.”

The post States target PBM pharmacy ownership in aggressive new push first appeared on Arizona Capitol Times.

#SunshineWeek is a reminder of something we in statehouse journalism already know: transparency isn’t a slogan — it’s a daily fight.

Open records laws, public meetings and access to information are the tools that make accountability possible. But those tools only matter if someone is using them. That’s where local and statehouse reporters come in. They are the ones filing the requests, sitting through the hearings, asking the follow-up questions and, when necessary, pushing back when access is denied.

The truth is, government doesn’t always open itself. It has to be pressed — consistently, professionally and without fear or favor. That work isn’t glamorous, and it rarely happens on a predictable schedule. But it is essential.

What often gets lost in the conversation about transparency is how uneven access can be. Rules vary by state. Enforcement varies by agency. And increasingly, the barriers are not just legal but practical — delayed responses, high fees, incomplete records. Each of those obstacles slows the public’s ability to understand what its government is doing in real time.

That is why investment in statehouse journalism matters. Reporters who know the process, understand the players and are persistent in their pursuit of records and answers are the difference between information that exists and information that is actually accessible to the public. Transparency is not passive — it requires experience, context and sustained attention.

Sunshine Week is a good moment to celebrate transparency. It’s also a good moment to recommit to it — not just in principle, but in practice. Because the public’s right to know depends on people willing to do the work every single day.

Alison Bethel is the Chief Content Officer & Editor-in-Chief at State Affairs.

The post Sunshine Week highlights the daily fight for government transparency first appeared on Arizona Capitol Times.

As a physician and part-time Scottsdale resident, I’ve watched Arizona’s health care costs climb with growing alarm. When I see health insurance premiums for Arizona families jump 29% in a single year, I think about the small-business owner in Tempe weighing whether to keep offering coverage, or the startup founder in Chandler losing a recruit to a company in a lower-cost state.

That’s why I was encouraged to see Arizona legislators take a hard look at a growing problem hiding behind a well-intentioned federal law: doctors and hospitals staying out of network, on purpose, because it pays better.

In 2022, Congress passed the No Surprises Act to stop patients from getting blindsided by massive bills from out-of-network providers they never chose. The law worked on that front. But it created a backdoor problem now hitting Arizona harder than almost any other state.

When an out-of-network doctor and an insurer can’t agree on payment, the dispute goes to a federal arbitration process called Independent Dispute Resolution, or IDR. Each side submits a number, and a third-party picks one. In the first half of 2025, providers won 88% of IDR disputes nationally, with payment amounts routinely exceeding in-network rates by 400%-600%.

This isn’t a niche issue for Arizona, it’s a crisis. Providers in our state filed more than 216,000 IDR disputes in 2023 and 2024, nearly 9% of all disputes nationwide. Arizona ranks second only to Texas in volume, and providers here won nearly 80% of the time. Nationally, IDR has added an estimated $5 billion in costs to the health care system since 2022.

Arizona’s outsized share of that burden isn’t random. A single radiology company accounts for roughly 40% of all Arizona IDR disputes. These aren’t small practices fighting for fair pay. They are sophisticated operations turning arbitration into a revenue strategy.

In 2026, ACA marketplace premiums in Arizona spiked roughly 29% for silver-tier plans. An unsubsidized family of four now pays an average of $2,189 per month, more than many Arizonans pay for their mortgage. Enrollment has plummeted 17% as a result.

A recent Gallup survey found that roughly one-third of Americans have cut back on daily living expenses to afford health care, and nearly half of middle-income households have delayed major life decisions because of health care costs. These aren’t just personal hardships; they’re drags on workforce mobility and economic growth.

For Arizona’s business community, this is an existential pressure point. The state has worked hard to attract companies from higher-cost markets: semiconductor manufacturing, tech firms and financial services. When employer-sponsored family coverage nationally averages nearly $27,000 a year and is rising faster than wages, Arizona can’t afford a broken arbitration system piling additional costs onto its employers.

Arizona’s HB 2211, introduced by Rep. David Livingston, takes a straightforward approach. The bill would establish that any IDR offer exceeding 300% of Medicare rates or the qualified payment amount constitutes a “clearly excessive fee”, exposing providers to disciplinary action up to license revocation. It also holds insurers accountable, requiring them to pay arbitration awards within the 30-day federal timeline. Balanced guardrails on both sides.

Arizona isn’t alone. In Idaho, the state Senate advanced Senate Bill 1319, which would require freestanding emergency rooms to accept in-network market rates. The pattern is clear: legislators are recognizing that a subset of providers has turned a patient protection law into a profit machine.

The fix isn’t complicated. Arbitration decisions should be anchored to prevailing in-network rates. Providers who operate in a community should be expected to contract with the insurers serving that community’s patients. And states like Arizona should set guardrails that prevent a handful of bad actors from inflating costs for everyone.

Arizona’s economy is booming, but health care affordability is becoming a competitive vulnerability. I’m glad Arizona’s legislators recognized the problem. Now it’s time to finish the job, for patients, for employers, and for the long-term health of our state’s economy.

Dr. Richard Popiel is a health care delivery expert and part-time Scottsdale resident.

The post It’s time to rein in out-of-network billing abuse first appeared on Arizona Capitol Times.

Arizona’s middle housing law took effect on Jan. 1, 2026, requiring large cities to legalize duplexes, triplexes, fourplexes and townhomes within one mile of their downtown cores. Its goal was simple: to expand housing options near jobs, shops, services and existing infrastructure. When the law passed, it was praised by the League of Arizona Cities and Towns, the Governor’s Office and legislators from both parties as a common-sense, bipartisan response to rising housing costs. 

Just three months later, legislators are considering rolling much of that back. 

HB2375, a bill moving through the Legislature, would let cities exempt areas they designate as historic from the middle housing law. That may sound modest on paper, but in Phoenix alone it would immediately exempt 38% of the area where middle housing was recently legalized, sharply limiting the number of homes the law will produce. 

The frustrating part is that HB 375 is unnecessary for historic preservation. The middle housing law does not override historic property protections or demolition restrictions. It still allows cities to regulate the scale and form of new housing, just as they do for single-family homes, to ensure compatibility with neighborhood character. Cities can still enforce ordinary zoning rules such as density, setbacks, lot coverage, and height limits. 

So what is really behind this bill? 

It’s a classic case of Not In My Backyard (NIMBY) politics. In a bid to block new housing, wealthy neighborhoods have hired lobbyists to push HB2375. Historic preservation is the only sympathetic cudgel they could find, and they are happy to mislead residents and legislators about all the ways genuinely historic properties remain protected. 

The irony is that middle housing is itself a historic building form. Duplexes, triplexes and fourplexes were common in American cities in the early 20th century, before zoning laws made them widely illegal. That is why they are often called “missing middle” housing. The groups pushing HB2375 claim to value history, yet they are fighting a law that restores a traditional pattern of neighborhood development. 

The passage of HB2375 would set a terrible precedent. Full exemptions would almost certainly become a fixture of future housing bills, creating a powerful incentive for well-connected neighborhoods across Arizona to lobby their cities for special protection from change. State law does not require objective criteria or independent review boards to ensure cities are creating historic districts in good faith. 

Instead of gutting the middle housing law, legislators should consider expanding the area it covers. To avoid concentrating development in just a few neighborhoods, Flagstaff and Tucson legalized duplexes, triplexes, fourplexes and townhomes citywide. Several historic districts in other cities asked for the same approach, but were shot down in favor of doing the bare minimum to comply with the law.

The ordinances in Flagstaff and Tucson were notably less controversial than those in other cities. The idea that every neighborhood needs to chip in to help address the regional housing shortage is a unifying message, but the idea that favored neighborhoods get to push their share of development onto everyone else is a divisive one. 

Ultimately, HB2375 is a test of whether Arizona lawmakers are serious about lowering housing costs. If we won’t allow even the most basic forms of incremental housing reform in the urban cores of large cities, what hope do we have? 

Tyler Denham is a resident of Flagstaff and executive director of a local housing advocacy nonprofit.

The post Don’t gut Arizona’s middle housing law first appeared on Arizona Capitol Times.

Key Points: 

• Competing ballot measures propose reforms to ESA program

• Disputes center on eligibility, oversight and program administration

• Parents, advocates clash as scrutiny, misspending concerns grow

Dueling ballot measures from public school groups and school choice advocates are both angling to reform the Empowerment Scholarship Account program. 

The two proposals intersect on some broad policy points but differ in their approaches to eligibility and operation. And whatever the case, a sect of ESA parents stands ready to oppose any effort to regulate the program. 

All the while, a microscope stays fixed above the state’s school choice program. 

Audits and reviews return lists of noneducational and luxury items purchased with program dollars, while the attorney general mulls legal action in an ongoing public monies investigation into the Arizona Department of Education. 

“We welcome more people to this fight,” Marisol Garcia, president of the Arizona Education Association, said. “We can all agree now that waste, fraud and review abuse are rampant.” 

After a spike in enrollment with universal expansion, a now $1 billion price tag and unanswered calls for legislative reform, the Arizona Education Association and Save Our Schools Arizona introduced the Protect Education Act. 

Key provisions include a $150,000 income cap, fingerprint cards for tutors, private school teachers and service providers, mandated testing or accreditation for ESA-funded schools, bans on purchasing noneducational and luxury items and a provision directing 90% of unspent ESA funds to public schools. 

The proposal largely applies to students enrolled under universal eligibility and exempts students with disabilities from the income cap and testing requirement.

The Arizona Education Association and Save Our Schools Arizona finalized the language with the Arizona Legislative Council and officially filed it on March 11. 

Less than a week later, a new political action committee, Fortify AZ, filed a second ballot measure aiming at ESA reform. They have been backed by a major national school choice advocacy group, the American Federation for Children. 

Tommy Schultz, chief operating officer of the American Federation for Children, claimed the initiative from AEA and SOSAZ would “gut school choice,” while the alternate ballot initiative would make the program “durable for generations to come.” 

The proposal, dubbed the Arizona Empowerment Scholarship Accounts Reform and Accountability Act, aligns with some provisions in the Protect Education Act. For one, the measure requires fingerprint clearance cards for tutors and service providers who spend unsupervised time with children. 

On the education front, it requires an “approved examination” for students enrolled in a private school and those learning at home or in alternative education settings.

It prohibits the purchase of noneducational and luxury items, permanently bans accountholders who defraud the program and requires a quarterly report on vendor payments, disqualifications and recovered funds to the attorney general.

Unlike the Protect Education Act, the measure includes no income cap, does not direct unspent ESA funds to public schools and adds some novel provisions on curriculum and operation and administration of the program. 

Under the act, the Arizona Department of Education would be required to maintain a list of approved curricula and supplemental material.

And, finally, it adds a requirement for an online marketplace payment system to centralize all expenditures in the ESA program, with specific mandatory functions like fraud detection. 

The last provision comes as the state’s contract with current ESA financial vendor ClassWallet comes closer to an end. The company initially won the state’s contract to run the program in 2019, and again in 2023. Per the latest agreement with the state, ClassWallet would operate for three years, with two opportunities to extend the contract by a year. 

Ahead of its lapse, state Treasurer Kimberly Yee put out a request for information, opening the door for new vendors to submit proposals. 

“The goal of this RFI is to identify the platform best suited to serve the 102,000 Arizona families currently benefiting from one of the nation’s premier ESA programs,” Yee said in a statement. “If there is a financial platform, or updates to the current platform that can provide families ESA program funds efficiently and identify any misspending or misuse, then Arizona taxpayers deserve to use that system.”

Her office clarified ClassWallet would be able to fully participate in the request for information and request for proposal process. 

As the state mulls vendors, the new ballot measure is still subject to a 30-day legislative council review before finalized language can be presented to voters in a petition. 

“Staying on the sidelines is not an option as one of America’s oldest school choice programs faces an existential threat – we are taking the fight to the unions’ turf and, more importantly, to the voters who are clearly on our side,” Schultz said. “We will do what it takes to bring this critical measure to the ballot.”

Garcia took the rival ballot measure in stride. 

“It is clear nationally, we are an embarrassment that a billion dollars is being spent on things that do not educate our communities,” Garcia said. “We are excited that more people want to join this fight, and we’re excited to make the table bigger and have broader conversations about the waste, fraud and abuse of this program.”

The Protect Education, Accountability Now committee as a whole, though, seems a tad skeptical at the outset. 

In a statement, the committee said, “We’re still analyzing this proposal, but it appears to be missing some key reforms that are necessary to prevent out-of-control spending. We welcome all the voices joining our call for common-sense reforms to Arizona’s billion-dollar voucher mess.”

It continues, “Unfortunately, given the reporting that this initiative is backed by a well-funded national special interest pro-voucher group, this does not appear to be a genuine push for voucher reform.”

Meanwhile, AZ Loves ESA, the political action committee originally formed to oppose the Protect Education Act, plans to grow its network to oppose both efforts. 

“We will oppose all ballot measures that attempt to regulate or restrict our current wildly successful and incredibly accountable ESA program,” chair Jenny Clark said. 

The post Dueling ballot proposals compete to reform Arizona’s ESA program first appeared on Arizona Capitol Times.

Key Points: 

• Hobbs stays consistent on granting majority clemency recommendations

• Consultant says clemency decisions unlikely to significantly impact reelection

• Commutations remain rare, but applications rise despite low success rates

Gov. Katie Hobbs continues to keep a steady record in granting most, but not all, of the recommendations sent to her by the Board of Executive Clemency. 

During her time in office, Hobbs has granted 21 clemency requests of the 35 recommended to her office, with three sent this year still pending. 

Whether her approach changes during an election year remains an open question, but a political consultant said Hobbs’ decisions on commutations and pardons are unlikely to weigh heavily on her campaign for re-election. 

“For a Democratic governor in Arizona, it shouldn’t be a massive political calculus that would go into making a rational, well-reasoned decision about a commutation or a pardon,” Chuck Coughlin, political consultant for HighGround, said.

The Board of Executive Clemency is tasked with conducting a two-phase hearing for commutations, or the shortening or altering sentences deemed excessive, pardons, or the complete clearance of someone’s criminal and carceral record, and early release for inmates in imminent danger of death. 

A majority of the board must recommend clemency to the governor who then makes the final say on whether to grant or deny the application, with no deadline. But when the vote from the board is unanimous, the recommendation takes effect if the governor fails to grant or deny it within 90 days. 

In 2023, the board sent nine commutation recommendations – two pardons, four commutations and three releases for inmates in imminent danger of death – to the governor, and she granted seven, leaving two commutations still pending. 

In 2024, the board sent seven recommendations to the governor, including three commutations, three imminent-danger-of-death cases and one pardon. 

She granted two commutations and two releases for imminent danger of death. 

One commutation went to Marilyn Keppler, who was charged with aggravated assault with a deadly weapon or dangerous instrument by domestic violence in 2021 after hitting her husband in the head with a hammer. 

Hobbs commuted Kepler’s eight-year sentence to time served, citing good behavior in prison, participation in programming aimed at personal development, lack of any criminal history and significantly deteriorating physical health. Kepler has since passed away.

The governor also commuted a 292-year sentence levied on Atdom Patsalis for a string of theft charges to a life sentence with the possibility of parole after concluding the sentence was disproportionate to the offense. Because Patsalis had already served 10 years in prison, he was immediately eligible for parole. 

In 2025, Hobbs received 16 recommendations – three pardons, seven commutations and six imminent dangers of death. 

She granted five imminent dangers of death and the sixth went into effect after the 90-day mark. And, the governor granted one pardon for Olayinka Ajiboye, who was sentenced to three years for possession of marijuana and drug paraphernalia. 

Three people saw their sentences commuted in 2025.

One, Demitrius Moore, was sentenced to life without the possibility of release for 25 years for first degree murder, and further sentenced to another 10 years for kidnapping. 

Moore did not kill anyone but was present during a fatal robbery and kidnapping. In 2019, he was paroled from his life sentence to his active sentence. He’s now served 30 years in prison. 

Hobbs commuted the sentence, noting Moore had received a “far more excessive sentence than any other defendant despite having had a far less active role in the commission of the underlying crimes,” according to her annual clemency report to the Legislature. 

She noted he had served as a dedicated mentor. He still has to serve additional time on other counts but he will be parole eligible in five years. 

Bryan Booker, a man who was serving a life sentence without parole for driving a vehicle during a drive-by shooting, saw his sentence commuted to 25 years to life with parole eligibility. 

Hobbs noted Booker was a teenager at the time of his offense and had already served 25 years in prison. 

Hobbs then commuted a 40-year prison sentence for Hope King to two years. King was sentenced to 40 years for attempted murder and child abuse after injuring her infant daughter. But, given a postpartum psychosis diagnosis not raised at trial, Hobbs deemed the sentence excessive. 

Hobbs currently has three new cases – one commutation and two pardons – on her desk as of March 2026. Six cases from years past are still pending. 

Now that Hobbs is entering an election year, Coughlin does not expect her decisions on clemency to play a big role in the general election. 

“I wouldn’t imagine she would have any significant issues, particularly with her Democratic voter base, on what she’s done,” Coughlin said. “I’m sure she’s been thoughtful about exposing herself to undue criticism in a general election environment.” 

He contrasted Hobbs’ situation with a Republican primary. 

“It’s more relevant for Republican candidates who face Republican primary voters – law and order, hang em’ high, not a lot of grace there,” Coughlin said. “I would imagine she wouldn’t have any significant issues, particularly with her Democratic voter base, on what she’s done.” 

Over Hobbs’ time in office, the total of commutations sent to the board continues to increase. In FY2025, the board conducted 260 phase one commutation hearings, jumping from 199 the year prior. 

Gretchen McClellan-Singh, the board’s executive director, acknowledged the increase and noted that the board has already received around 60 applications this year. 

Donna Hamm, executive director of Middle Ground Prison Reform, who often assists inmates in the clemency application process, emphasized the chances of getting a commutation in front of the governor in the first place continues to be slim. 

She likens the process to buying a lottery ticket. 

“The most important thing that I focus on is how slim their chances are of being successful,” Hamm said. “Because statistically, historically, it’s like buying a lottery I tell them, It’s like buying a lottery ticket. You can never, ever win the lottery if you don’t buy a ticket, but your chances are almost nil of winning.” 

Hamm added, too, commutations are meant to be the exception, not the rule. 

“Commutation is supposed to be rare,” Hamm said. “It’s supposed to be for extraordinary cases.” 

The post Will excess clemency hamper Hobbs’ re-election bid? first appeared on Arizona Capitol Times.

Arizona is facing a housing crisis. Working families can no longer afford to live in Phoenix. This crisis has been made worse by a shortage of available housing opportunities. In 2024, the Legislature took an important step forward to remedy this shortage by passing HB2721, which allows “middle housing”— modest homes that are more affordable for working families, such as duplexes, triplexes, and fourplexes — within one mile of a city’s downtown core. The goal was simple: allow more diverse and attainable housing options in areas with good access to jobs, transit, and other services. 

Now, just as cities are beginning to implement that law, rich neighborhood groups and their lobbyists are threatening to undermine our progress toward creating more opportunities for working families. 

Rich neighborhood groups and their lobbyists are pushing HB2375, which will create special exemptions from housing laws just for them. Rather than participating constructively in local planning discussions, these groups are asking the state to shield their neighborhoods from change. 

In Phoenix, we have already had this debate. 

When the state passed its middle housing requirement, the process was contentious, particularly after opposition from the Willo neighborhood, where homes regularly sell for more than $1 million. Of course, the city still had to comply with the state law, and I hoped that the small group of opponents would soon come to see the benefits of the policy for the overall city. 

Unfortunately, the benefits for everyone are being overshadowed by the fears of a few wealthy homeowners who do not want to see any changes to a status quo that benefits their interests. 

The neighborhoods that want special exemptions are precisely the kinds of neighborhoods where additional housing makes the most sense. They are close to downtown jobs, public transit, schools and health care. They provide access to opportunities that many families are currently locked out of because of high housing costs and restrictive zoning. 

Letting these neighborhoods deny new residents access to opportunities would reinforce patterns of exclusion, like red-lining, that have shaped our cities for generations. 

What makes this effort even more frustrating is that the city of Phoenix is already engaged in a thoughtful conversation about expanding housing choices. And the city council directed staff to study how middle housing could be implemented more broadly throughout Phoenix. That work is happening now and it is exactly the kind of planning process communities should undertake when addressing growth and affordability.

Housing policy should not be dictated by whichever neighborhood can afford high-paid lobbyists. It should reflect the needs of the entire community. Phoenix is a city of more than 1.6 million people, all of whom deserve a fair chance at attaining a stable home. Every neighborhood must do its part to ensure all residents have the best housing options possible. 

At a time when Arizona faces a severe housing shortage and a lack of diverse housing options, using disproportionate financial and political power to block new homes, particularly in high-opportunity areas, sends the message that only the rich should have access to these opportunities. And that message is plain wrong.

Anna Hernandez has been a serving Phoenix Councilmember since 2024. 

The post HB2375 is a step backward for housing fairness and just plain wrong first appeared on Arizona Capitol Times.

The post Arizona Capitol Times – March 20, 2026 first appeared on Arizona Capitol Times.

Key Points:

• People diagnosed with ALS or ESRD are put on immediate Medicare coverage, but gaps persist

• A senator and a representative filed legislation to address gaps, but both efforts have stalled

• Opponents say the legislation would raise premiums, supporters say extra cost is manageable

For people diagnosed with amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD) before age 65, Medicare eligibility can arrive early but full financial protection often does not. 

That’s what Kevin Gallagher found when he was diagnosed with Primary Lateral Sclerosis, which is a related neurodegenerative disease. Later, the diagnosis became ALS. 

He lives in Arizona with his wife, Wendy, and they’ve been married for 36 years. She is a nurse practitioner and he trained as a paramedic and EMS instructor in Flagstaff. After he retired, Gallagher was going to teach pilots at a flight school co-owned with a friend. He had been a pilot since the 1970s. But when he got the diagnosis, he wasn’t able to fly anymore. 

When someone receives a diagnosis for ALS or end-stage renal disease, which is the last stage of chronic kidney disease, they are automatically and immediately enrolled in Medicare and supplemental insurance (commonly known as Medigap), regardless of age. However, supplemental insurance coverage that accounts for the remaining 20% of what Medicare plans don’t cover is left up to the states, Gallagher said.  

Eventually, Gallagher learned he wouldn’t be able to buy a Medigap policy because he was under 65, he said. Medicare Advantage was technically available, but it amounts to private insurance and pre-approvals, referrals and a network of doctors, Gallagher said. 

“You get a little bitter for those things and that was kind of a blow to have to get Advantage,” he said. Another surprise that came with Advantage was finding out that policies can be limited by county and zip code. “Since I lived in Maricopa and Maricopa resides in Pinal County, which has always been a mystery to me … there was not a single policy that would cover my ALS doctor and my ALS clinic.”

An ALS clinic completes several appointments in one visit every three months. A team of providers meets with the person and makes a care plan, Gallagher said.

The Arizona couple faced a choice between keeping their house, which was next door to Wendy’s elderly parents, or moving to Phoenix for better coverage.

Gallagher said he did look into neurologists available under Advantage, but none of them specialized in motor neuron or neuromuscular diseases, and one even referred him back to the doctor he had been seeing, saying he was the best in the state.

At that point, the Gallaghers were able to sell their home and rent a house in Phoenix, though it was a difficult decision, he said. Even after finding an Advantage policy, it still had a high copay because his doctor was out of their network and he put off a few treatments that were not covered, such as Botox injections that help control spasticity in his jaw to help him speak.

Once he turned 65, his insurance journey improved. Gallagher got a ventilator for nighttime use, and a respiratory therapist came to his house to show him how to use it. In contrast, Gallagher knows another person with ALS who was prescribed a ventilator, but it took a year of refusals and reapplications just to receive it. When it was granted, it was dropped off on the porch with no respiratory therapist to help, Gallagher said.

It’s a situation many people face if they’re diagnosed younger than 65, resulting in life changes for the whole family, especially when it comes to mobility, Gallagher said. 

“When you see someone that you know from your past and then see him in this situation, it’s a wake up call,” Rep. Selina Bliss, R-Prescott, said.

House Bill 2433 would require insurers to offer Medicare supplement insurance policies to people with ALS or End-Stage Renal Disease, even if they’re not 65 yet. The bill would also prohibit insurers from charging higher premium rates based on age. 

Bliss said her bill wouldn’t cost the state money. 

According to a fiscal note, the Joint Legislative Budget Committee estimated it could increase Insurance Premium Tax collections by $91,300 annually due to 1,055 individuals enrolling in Medigap plans, and potentially raising premiums. 

The bill does not affect the Arizona Health Care Cost Containment System or state employee health insurance. The Department of Insurance and Financial Institutions did not provide an estimate for fiscal impact, according to the document. 

However, there’s about 600 people with end-stage renal disease and about 170 people with ALS in Arizona, according to the organization. 

“For every new diagnosis coming in, one leaves on the other side because the life expectancy is so short,” Bliss said. 

The bill unanimously passed the House Health and Human Services Committee in February, where Bliss serves as the chair. But the bill wasn’t heard in the House Rules Committee, the last stop before the House floor. 

Sen. TJ Shope, R-Coolidge, filed Senate Bill 1191, which is similar to Bliss’ bill, but it did not get heard in the Senate Finance Committee. He said he didn’t have a bill available to file a strike-everything amendment.

Senate Finance Committee Chair Sen. J.D. Mesnard, R-Chandler, said he’s very sympathetic to the issue, but there are many other insurance bills coming through his committee for other causes. He said he did his best to play Solomon and make the best decision. 

“If we add this one, and then we add this one, and we have this … everybody pays a higher premium,” he said. “Where’s the delicate balance because we have a group of vulnerable people and then we have just the affordability of health care for everyone.”

The Arizona Chamber of Commerce and Industry and the Greater Phoenix Chamber of Commerce opposed the bill. The Arizona Chamber of Commerce declined to comment.

Mike Huckins, senior vice president of public affairs and IT operations for the Greater Phoenix Chamber of Commerce, said they generally oppose health insurance and health care mandates that can increase the cost for all employers, employees and other covered individuals. 

“While this bill is well meaning, coverage, pricing and benefits provided by private health insurance should be negotiated between employers and insurance providers,” he wrote in an email. 

Marc Osborn, who spoke on behalf of Blue Cross Blue Shield Arizona during the February committee meeting, said premiums would increase about 30%, or $70 per member per month, based on an actuarial report they conducted. 

“The reason why the cost shift is so significant is that population, the ALS population and the dialysis population will always use their full Medicare supplemental benefits, and so therefore, those costs have to be shifted onto every other post 65 (member),” he said. “While it’s a very needy and deserving population, I appreciate all that, but the cost shifts to some of the most cost-sensitive seniors.”

While 19 other states have passed similar laws, Osborn said their rates are higher and they have different market conditions. 

But Bliss said those claims are false. In a February 2026 actuarial report by Berkeley Research Group, premiums would only increase by about $2 per month. If the bill passed, about 770 Arizonans with ALS or end-stage renal disease would be enrolled for Medigap, Bliss said.

A recent study published in the American Journal of Managed Care showed that the costs were only about three times more expensive for people with ALS and six times more expensive for people with end-stage renal disease. 

Nineteen states already passed similar laws and 12 of those states “boast higher Medigap enrollment percentages than the national average,” while seven have “below average market-wide Medigap enrollment, suggesting the laws are not negatively impacting a state’s Medigap market,” according to a letter written by ALS Arizona. 

The post People diagnosed with ALS, ESRD left with gaps in coverage first appeared on Arizona Capitol Times.

Key Points: 

• Arizona law shields electric utilities from most lawsuits if their equipment sparks a catastrophic wildfire

• Insurers and trial lawyers criticize the law’s wildfire mitigation plans as sparse and lacking detail

• Arizona utilities’ wildfire mitigation plans are under review by the state Forestry Department

A 2025 law shielding Tucson Electric Power, Arizona Public Service and other electric utilities from most lawsuits if their equipment sparks a catastrophic wildfire had just one requirement: The power companies must create comprehensive plans to minimize the risk of fires.

But insurers and trial lawyers who initially argued against the law and negotiated changes to remove their opposition are rebelling now that the plans are being rolled out. They call them sparse, lacking detail and an exercise in “check the box” bureaucracy that will do little to boost protection while leaving homeowners and other Arizonans on the hook if they lose everything in a fire.

In exchange, the utilities will be shielded from lawsuits that could cost them billions of dollars if a town like Payson or Prescott is wiped out by a wildfire caused by their power lines.

The insurers and trial lawyers are also highly critical of the state agency charged with reviewing what are called “Wildfire Mitigation Plans.”

They say that, despite explicit authority in the law, the Department of Forestry and Fire Management failed to write detailed administrative rules requiring the plans written by TEP, APS, and other companies to lay out the specifics of the actions they would take to limit fires. 

Instead, the agency charged with reviewing the plans basically restated the general provisions in the 2025 law in 3 pages of rules it published last month. And despite telling lobbyists for insurance companies, their national associations, and trial lawyers in October that it would consult with them on potential rules and hold a public comment period before they were published, the agency never did so.

Tom Torres, director of the Forestry Department, said the legislation contained a series of details on what the wildfire mitigation plans must contain and the agency essentially adopted those so utilities had them before they filed their plans.

“Our approach to rulemaking was to describe what was required from the legislation. And as we receive the plans and we learn about what is submitted—we’ll learn from that,” Torres said in a Monday interview. “This isn’t to say that our rulemaking won’t be modified in the future, but we felt that the descriptions that were in … the bill were sufficient for us to get started.”

The public will have a chance to weigh in on the plan submitted by APS at an informal public meeting on Wednesday; APS serves about 1.4 million business and residential customers in 11 of Arizona’s 15 counties. Forestry officials will review the plan submitted by TEP’s parent company, Tucson-based UNS Energy, on April 7. Besides 458,000 Tucson-area customers, UNS provides electric services to 105,000 customers in southern and northwestern Arizona through Unisource Energy Services. 

The agency is under a tight timeline to review and approve the plans. Under the new law, if it requests no changes, it must OK one just four months after it is submitted. If it requests changes, the utility gets 90 days to respond, then the Forestry Department is allowed two months to review and approve the modified plan. 

APS’s plan was filed on Feb. 1, meaning it could be approved and the company given the massive liability shield by June 1 if no changes are requested. TEP’s most recent version was filed on March 2, so its plan could win approval by early July.

Torres said the review process has just started and as his staff pores through the plans, they will listen to comments made during the public meetings.

“We’re going to take public comment seriously, and that includes the stakeholders (like insurers). It includes the affected towns and counties, as required by the bill,” he said.

“We are not anywhere near complete with the review of the submitted plans, and we’re taking that responsibility seriously,” he added. “So if stakeholders have comments, and I know that stakeholders will have comments, I encourage them to provide them to us for consideration as we move through the review process.”

Sen. J.D. Mesnard, R-Chandler, added the provision specifically authorizing the Forestry Department to write rules detailing what specifics needed to be included in the utilities’ wildfire mitigation plans. Such administrative rules are frequently needed to put flesh on the bones of legislation that, by its very nature, is general and requires rules to implement legislative intent, but are time-consuming without the exemption Mesnard inserted in the bill.

Mesnard was surprised to learn that the agency had not done so, since the law outlines the agency’s review responsibilities and allows it to charge whatever fees it needs to cover employees’ and others’ review costs.

“I guess I assumed that there would be some level of detail, but figured that the oversight from DFFM would add to what is outlined in the statute itself,” Mesnard said.

The insurance and trial lawyer lobbyists were never told the “rules” had been published and didn’t learn about them until a Capitol Media Services reporter spotted them at the bottom of the agency’s utility mitigation plan website. 

“We consider this to be strikingly insufficient substantively,” Lee Ann Alexander, vice president for policy for the American Property Casualty Insurance Association, said in an email on Monday.

APS pushed hard for the liability shield bill, joined by TEP and other Arizona utilities, because they were worried that a wildfire sparked by their power lines could expose them to massive liability. Utilities in California, Oregon and Colorado have faced major lawsuits after their equipment was found or suspected of causing forest fires that, in some cases, consumed entire communities. 

Pacific Gas & Electric Co. in California was forced to seek bankruptcy protection a year after a hook holding up a transmission line broke in 2018, sparking a fire that destroyed the northern California town of Paradise and killed 85 people.

In 2025 alone, Arizona and seven other states passed laws limiting utilities’ liability for wildfires, according to the insurance association. 

Alexander pointed out that the rules adopted by a California agency for utilities creating wildfire mitigation plans run to 255 pages. Her group pushed for specific, detailed items to be included in the Forestry Department’s rules, but most were not adopted. 

A spokeswoman for APS, Yessica del Rincon, said the company has a “rigorous and comprehensive” wildfire mitigation strategy that includes modern technology like artificial intelligence and high-definition remote cameras to detect smoke to monitor its system. 

The company’s wildfire mitigation team includes former wildland firefighters, foresters and meteorologists.

“The plan shows APS’s commitment to proactive, industry-leading wildfire risk management, and we look forward to demonstrating our thoughtful approach during its review by the Arizona Department of Forestry and Fire Management,” said a company statement provided by del Rincon.

The filed plan outlines ongoing efforts by APS to trim back trees and other vegetation, upgrade power line equipment such as fuses and automatic shutoff switches, and to shut off power to vulnerable lines during high wind events. Those so-called “Public Safety Power Shutoffs” are required elements of the plans that must be included in the 2025 law.

Despite research showing they are highly effective in preventing fires, most utilities view Public Safety Power Shutoffs as a last resort, since they are highly disruptive to customers and carry their own risks, according to a research paper from the Pacific Northwest National Laboratory, a U.S. Department of Energy facility.

The wildfire mitigation plans filed by APS and TEP both discount the use of PSPS’s, saying they’d rarely be used.

“The Companies use a backstop approach where only under the most severe drought and extreme wind conditions would PSPS be triggered,” the plan filed by TEP and Unisource says.

Joseph Barrios, corporate communications manager for Unisource and TEP, said the companies work year-round to reduce wildfire risk. 

“The companies’ wildfire mitigation plan describes the standards and significant measures we use to reduce wildfire risks through robust operations, maintenance, system hardening, public safety preparation and prevention programs,” Barrios wrote in a statement provided to Capitol Media Services. 

APS’s plan notes that its “wildfire mitigation toolkit” includes widespread grid modernization, distribution system hardening, feeder coordination studies, hazard tree risk assessment and defensible space around poles programs, among others

“We rely on all these tools first and only use a PSPS when the conditions in certain areas of our system warrant this intervention,” its plan says. “If APS needs to initiate a PSPS, efforts are made to limit the number of customers affected and the amount of time they are without power.”

In a lengthy interview last week, Alexander said administrative rules that fill legislative gaps are critical, especially because homeowners and businesses, as well as insurance companies, are losing their ability to recover damages from electric companies.

Insurers opposed the bill because it prevents them from recovering what they pay their clients for losses from utilities. Alexander noted that means everyone’s premiums could rise after a major wildfire, to say nothing of the large number of uninsured people — both homeowners and those who own businesses – who will lose as well.

That means getting the wildfire mitigation plans right affects everyone.

“It will not necessarily stop fires to have a robust wildfire mitigation plan,” Alexander said. “But you’re sure going to get a lot closer to a place that people should feel comfortable if it’s robust and is detailed, and gives dates and timelines and specific processes, rather than just what may appear to be a ‘check the box’ plan that complies with the specific items outlined in the statute.”

She said that by comparing the size of the APS documents to those filed by utilities in other western states “it seems hard to imagine” that they will hold the power companies to account. Once a plan is approved by the Forestry Department, it becomes nearly impossible to sue a power company for sparking a fire under the 2025 law.

“To us, it does look very thin, and it proves the point to us you need to have a rulemaking,” she said. “You’ve got to have some very strict standards.”

The plans created by APS and TEP are strikingly lacking in detail when compared to those written by utilities in other states. APS’s plan runs 69 pages and contains no details on investment in new equipment, details of its inspection programs or other items contained in plans for Utah and California utilities. TEP’s runs just 26 pages. 

But Barrios said comparing the two is not reasonable, noting that each utility has “unique risk mitigation considerations” based on location and other factors. 

And he noted that while California utilities are required to list all their internal processes and procedures in their plans, “our plan complies with Arizona’s statutory requirements and the Department of Forestry and Fire Management has raised no concerns.”

PG&E, a utility that serves much of California, has a wildfire mitigation plan that runs 593 pages, plus a 66-page appendix. Rocky Mountain Power, which supplies 1.2 million customers in Utah, Wyoming and Idaho, uses 153 pages to detail its 2023-2025 plan — and notes it planned to invest $446 million over that time to replace fire-prone equipment and trim vegetation to help protect its customers.

The plans filed with DFFM by APS and TEP contain no details on how much money they might need to spend and only general outlines of how they plan to upgrade their systems. 

Barry Aarons, a lobbyist who represented trial lawyers who opposed the bill as it moved through the Legislature, said the final bill’s definition of the mitigation plans left a lot of wiggle room for utilities.

“This is what our worst nightmare was — they were going to decide what a ‘reasonable plan’ was, and DFFM was just going to hold some hearings and tell them what a great group of people they are for filing their reasonable plan,” Aarons said.

“And it’s not enough,” he said. “They have to have stakeholder meetings. They have to actually sit down with all the interested parties and go over their plans, line by line, and determine whether the plan is enough to make sure that they are living up to their part of the agreement that was made.”

The initial bill contained not only the sweeping liability protection for utilities but limited the ability of homeowners or business owners to recover anything but actual damages, things like use of a destroyed car or lost business. 

Facing strong opposition, Mesnard crafted an amendment that took those items out, making the bill more palatable, if not tasty for the opponents. People or businesses can still join in a class-action lawsuit to recover incidental damages — but only if the utility doesn’t follow its approved mitigation plan.

Christian Slater, spokesman for Arizona Gov. Katie Hobbs, a Democrat, said she stood up for ordinary Arizonans by fighting for the changes that eventually made it into the bill. Those included ensuring the wildfire plans were reviewed by experts at the Forestry Department rather than by the Arizona Corporation Commission, which oversees regulated utilities like APS and TEP, or by the boards of publicly owned utilities like the Salt River Project.

“The administration will continue working on a common-sense approach that ensures corporations are doing their fair share to prevent wildfires and protects Arizonans from potential negligence,” Slater said in a statement.

Aarons said it is critical for the Forestry Department, part of Hobbs’ administration, to ensure that his group and others who represent homeowners and others who are losing the right to sue are heard as they were promised during talks on the bill.

“There’s a lot more work that needs to be done, and their promises need to be kept,” Aarons said. “You’ve got to do rule making, got to have stakeholder meetings, got to do all of that — or else this whole thing was a sham.”

The post Insurers say Arizona’s wildfire mitigation plans are not enough first appeared on Arizona Capitol Times.