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Jenny David is a registered nurse and chair of Arizonans Fed Up With Failing Healthcare, a political committee that aims to put the Healthcare Rising Arizona initiative on the 2020 ballot. The initiative calls for a ban on surprise billing and discrimination against people with preexisting conditions by insurance companies, better infection prevention at hospitals and higher pay for healthcare workers. The organization needs to gather 237,645 signatures before July 2, 2020 to quality for the ballot. 

What kind of problems are people having with surprise billing?

Surprise billing happens and I will say that most of the folks we’ve talked to have had this experience, or have known someone who has had this experience. You go to the emergency room and you need to have some emergency surgery. You go to the emergency room where your insurance covers at the in-network rate and then later you get a bill. That’s a surprise, from a provider that was involved in your care who was not in your network, and so your insurance doesn’t cover their full fee. Many people are getting these surprise bills after emergency surgeries. 

I’ve heard of this from people who went in for surgery and the anesthesiologist, for example, wasn’t covered. And all of a sudden, you get a bill from them.

Exactly. In fact, my husband recently had open-heart surgery. We went to an in-network care provider. It wasn’t an emergency. We had time to plan it and we still received bills from folks and we did not have any idea we were going to have to pay them at the out-of-network costs. I think it’s very, very common. This will require patients to be refunded the money if they’re overcharged. It would prevent those surprise medical bills from out of network providers. If they are working at an in-network hospital for you, then they need to charge you at the in-network rate.

Talk about the concerns about controlling infections in hospitals.

We know that hospital-acquired infections kill about 99,000 people a year in the US, at a cost of about $20 billion. It’s a difficult problem. Arizona hospitals scored worse than the national benchmarks. We want to reduce these incidents of infection and this initiative will help to reduce those infections and lower costs. It allows the state Department of Health to be involved in meeting those national standards.

This initiative would give hospital workers a 5 percent pay increase each year for the next four years. That includes the nurses, the aides, the technicians, the janitorial and housekeeping staff, the social workers that work in the hospital, the non-managerial administrative staff. Talk a little bit about the challenges that healthcare workers face in getting decent pay in this state.

I’m a nurse and we work just tremendously stressful days and extremely long hours. All of us are interconnected, between the nursing staff, the food staff, the cleaning staff, all the support staff—we all work really closely together. When one area is understaffed or overworked, then it affects everyone. We have a real high staff turnover. I really believe that between the stress of the job and the pay of the job, it drives the turnover. We get someone trained, and then they stay for a little while, and then they leave. I believe that if the pay was increased, we would have a more stable staff. The stability of the staff I think will go a long way towards providing better patient care, and providing a better standard of living for folks. Hospital workers are stressed out and lots and lots of hospital workers put in extra hours. We work overtime both to cover the holes in the staffing, and also because we need to make more money. I feel if the pay was increased for everyone across the board, I think that would take care of a lot of the staffing problems and burnout problems. Burnout is a huge problem among nurses for sure.

You just mentioned the stress of the job. Has it become a more stressful job in recent years? Is it about the same as it’s always been? Talk a little bit about some of the causes of stress.

I’m a reasonably new nurse. This is a second career for me. I’ve been in my position for five years. I work in labor and delivery. I work in a really high acuity hospital. We deliver about 400 babies a month. We also serve a population that’s heavily folks without insurance, folks who are recent immigrants. We have a high-risk department and so we get moms and babies who are very sick and very ill. So, you just don’t know what’s going to happen from one minute to the next. We’re trained for that. We thrive on it. Everyone who’s in my department is a little bit crazy because we love this fast-paced work environment, and always changing, always changing. But when we’re short-staffed, when we don’t have the tools that we need to cover, it’s exhausting. It’s mentally and physically exhausting. We work 12-hour shifts, which is the minimum, really. You’re scheduled for 12 hours, but you’re usually there for a lot longer. I think in any situation where you could, at any minute, have someone’s life in your hands, that is a stressful situation. Even if everything’s going really smoothly, we’re always right on edge waiting for the next thing to happen and it always does. We’ll have 18 patients in labor at the same time and it’s one of those things where things can go smoothly, but things can go bad very quickly. 

Under the Affordable Care Act, insurance companies are not supposed to be able to discriminate against you based on a preexisting condition. There is a legal challenge going on right now to the Affordable Care Act in the courts, and there are efforts at the congressional level to change or repeal the Affordable Health Healthcare Act, aka Obamacare. Talk a little bit about the initiative’s ban on discrimination against people with preexisting conditions. 

Another thing that we found when we were talking to folks is that virtually everyone, every family has someone with a preexisting condition. People are really worried about those exclusions. In the past, people were excluded from insurance because of asthma, or diabetes, or some other thing. The Affordable Care Act put those protections into place and that protected a lot of folks. What we’re finding now is that is in danger of going away. We also have a state law that recently allowed insurance companies to sell plans that don’t cover preexisting conditions. This is a backup. This is a protection. If these emergency plans or temporary plans become the norm, we will have some protections at the state level to cover those. Really, every family needs this.