Emergency Medicine Doc Is Running for Congress

Amish Shah, MD, MPH, a Democrat in Arizona’s state legislature, was 7 years old when his grandmother had a heart attack in his family’s home, and was taken to the hospital.

Shah, who was born and raised in Chicago, the son of two engineering students from India, said he still remembers following his parents into the intensive care unit.

“She was connected to all these lines and tubes and monitors, and it felt like I wasn’t supposed to be witnessing this,” he said of his grandmother. A sign on the ICU door said no one under 16 was allowed in, but his parents wanted him there, he noted.

Shah remembers being fascinated watching a physician who was able to manage another human life and ultimately save it.

“And that was, to me, really like a moment of wonder,” Shah told MedPage Today in an interview.

That experience sparked his interest in the sciences, and led to a 20-plus-year career in emergency medicine.

In 2016, Shah’s frustration with the state of politics and the state of medicine led him to a political forum in Scottsdale, where he ended up getting “drafted” to run for office. In 2017, Shah ran for the Arizona State House of Representatives and won. He was re-elected twice more. Now he’s running for Congress against Rep. David Schweikert (R-Ariz.).

Shah has reportedly knocked on more than 22,000 doors, speaking face-to-face with voters to learn what matters to them, and has had more bills signed into law than any other Democrat in over a decade.

This interview has been edited for brevity and clarity.

Many of the bills you’ve introduced were inspired by constituents. Tell me about your bill to address prior authorization.

Shah: A Republican constituent, whose son had muscular dystrophy, told me he was filling out prior authorization forms on his son’s behalf, so that physicians could help him get the care he needed. His son’s doctor had to hire either one or two full-time employees just to keep these requests moving. So, I introduced a prior authorization bill. (The bill creates a uniform request form for all private insurers in the state.)

That sounds like it could be meaningful for a lot of physicians. Another issue that’s front and center in medicine are the recent cuts to Medicare.

Shah: I cannot stress this enough, those Medicare cuts have to stop. If you continue to cut Medicare, then physicians won’t take Medicare, and then seniors have less access. Over the last 20 years, they’ve cut Medicare to the point where it pays so much lower than other insurance that there isn’t an incentive for physicians out there to continue to be able to take it. So, it will become an access problem if we don’t get on top of it.

Another challenge for physicians nationally is the opioid crisis. How has that impacted you? What can be done to address the crisis?

Shah: I remember this 29-year-old who had just gotten a promotion at work, who picked up a pill that was laced with fentanyl, and wound up in the emergency department. I had to pronounce him and tell his family. And it was heartbreaking.

A Republican introduced this bill to lower the threshold for charging someone with a felony for trafficking in fentanyl to 9 g. I was the only Democrat who voted “yes” on that bill. And the reason why is because I knew 9 g would kill 4,500 people. When you stay very, very connected to the population you serve, I think that it leads to better decisions.

Another thing that’s important in Arizona is that we do need more funding for border security so that we don’t have as much fentanyl trafficking and opioid trafficking from the Southern border.

There also needs to be more education to reduce demand. Fentanyl is an opioid, and even in microgram amounts, it can kill you. That’s what makes the drug so dangerous.

In addition to addressing the opioid crisis, you’ve also passed bills to ensure people have access to pain medications when appropriate.

Shah: There’s people who have chronic pain, and that’s legitimate, and then there is opioid use disorder, and those are different issues, and you need to know the difference between those two. I helped pass a bill to let people get pain medication after hours. That idea actually came from a physician in rural Arizona, where there are no 24-hour pharmacies anywhere within a 50-mile radius. He had a case where a kid broke his leg. It was 6 p.m. on a Friday. Guess what? He would have to be admitted to a hospital for pain control because of the lack of open pharmacies. So that bill in particular was born out of another real constituent story where we were able to solve a problem.

The American College of Obstetricians and Gynecologists named you the Women’s Health Champion/Legislator of the Year. How did you earn that honor?

Shah: In 2022, a bill was introduced to ban mifepristone [Mifeprex] — commonly known as the abortion pill. I’m strongly pro-choice. I believe that people should make those decisions with their physicians. So, I went to some of my colleagues on the Republican side of the aisle whose trust I’d already earned. I explained to them first medically why this was not a good direction for Arizona to go in, because, on principle, we cannot start legislating one pill at a time. Secondly, mifepristone is not just used for abortion. I told them there are also endocrinological uses for the drug. And they ended up voting with the Democrats and killing the bill.

What impact has Medicaid expansion had on Arizona residents?

Shah: Medicaid expansion happened in 2013 under Republican Gov. Jan Brewer, before I came to the legislature.

Before expansion, people came to me in the emergency department crying, because I’d diagnose someone with a broken bone and set it, and refer them to an orthopedic surgeon. And they would say, “There’s no way I can afford it. I have no Medicaid, and I have no insurance.”

It was heartbreaking. When expansion happened, a lot more people were eligible for health insurance. Today, around 30% of Arizonans are on Medicaid. It also pushed a lot of money into our local hospitals, especially rural ones, so that they could stay afloat.

For my part, I got a bill through the legislature to expand Medicaid coverage for adults to include preventive dental care. The woman who helped me push this forward was a Republican who was also a dentist.

You are also a strong proponent for universal healthcare. Why is that important?

Shah: People have to get covered and there are many, many ways of getting there. I spent some time at the University of California Berkeley, looking at comparative health systems. There are places that do it really well with a multi-payer system like in Germany, and hybrid systems like in Singapore. Other places have single-payer systems, and they’ve had some issues. But the key to all of this is that everybody actually has coverage, so that they can get the care they need, and not have to worry about going into bankruptcy or losing their home.

How is climate change impacting Arizonans and what can be done to address it?

Shah: In Phoenix, temperatures reach 115, sometimes 120°F, and they’ve been rising for the last 20 to 30 years. If you’re barefoot and you just happen to walk on the asphalt, you end up with burns on the ends of your feet. Also, people whose air conditioners break and those who are unsheltered will end up in the hospital.

We all have to work together to reduce carbon emissions and make sure that the planet doesn’t warm. I have solar panels on my roof, I drive two electric vehicles, and I follow a plant-based diet, which reduces carbon emissions. So, I talk about those things that we need to individually do to stop this worldwide trend.

You also started Arizona’s first Vegetarian Food Festival. Tell me more about that.

Shah: You really have to make sure that people understand what healthier choices are, and a lot of this comes down to education. The more I speak to people, for example, through this festival, the more they understand. A healthy diet will keep you free of diabetes, hypertension, heart disease, cholesterol, cancer, and switching to plant-based diets will help mitigate all that.

Also, people live in areas where it’s not easy to just go to a Whole Foods or other grocery store. The most convenient places to shop aren’t even actual supermarkets with produce. They’re gas station stores, where all you have are chips and snacks and that’s not nutrition. So, what I’d really love to do is be able to help everybody have access to healthier food across the country.

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