News Release

U.S. Department of Health & Human Services                                 

202-690-6343

media@hhs.gov

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FOR IMMEDIATE RELEASE

October 19, 2016

Statement on Arizona Health Insurance Rates

WASHINGTON, DC – Jonathan Gold, Press Secretary at the U.S. Department of Health and Human Services issued the following statement on 2017 Arizona health insurance rate changes.

“It’s important for Arizonans to know that headline Marketplace rate changes do not reflect what most consumers actually pay, because the majority of those who might buy 2017 coverage are eligible for tax credits to keep plans affordable. In 2016, average premiums for the three quarters of Arizona consumers with tax credits decreased by $3 per month, or 2 percent, even though headline rates rose. Meanwhile, for the 53 percent of people in Arizona with employer coverage, premiums have grown at some of the slowest rates on record since the Affordable Care Act was enacted. All Arizona consumers, no matter where they get their coverage, are benefiting from ACA protections like no more exclusions for preexisting conditions, no annual limits on coverage, and no cost sharing for preventive services.” 

BACKGROUND

Since the Affordable Care Act became law, health care prices have risen at the lowest rate in 50 years.  Premiums for the 150 million Americans with employer-sponsored insurance have grown at some of the slowest rates on record. 

The Health Insurance Marketplace is designed for affordability. Two important features of the Marketplace protect Arizona consumers from the impact of rate increases.

• Tax credits go up along with premiums. Tax credits are designed to protect consumers from rate increases and keep coverage affordable, increasing by whatever amount the cost of the second-lowest-cost silver, or benchmark plan increases. So if all premiums in a market go up by similar amounts, 69 percent of consumers in Arizona will not have to pay more, since tax credits will increase in parallel. Last year, despite headlines projecting double-digit rate increases, the average premium increased just $4 per month for HealthCare.gov consumers with tax credits, and 7 out of 10 Marketplace consumers could purchase 2016 coverage for less than $75 per month.  Even if premiums and tax credits rise, the overall cost of the ACA is still below CBO’s original projections. CBO’s recent projections estimate that for 2019 coverage, ACA coverage will cost $49 billion less than originally predicted.

• Consumers can shop around to find the best plan. In 2016, consumers could choose among an average of 10 plans per issuer. Variations in provider network and drug formulary makeup from plan to plan can offer consumers meaningful choice. Prior to the Affordable Care Act, it was almost impossible to shop around for health insurance. Not only were many Americans barred from coverage due to pre-existing conditions, but those who did have insurance through the individual market were often trapped in a plan, since people with even small health problems could be denied coverage or charged an exorbitant price if they tried to switch plans. Today, any Marketplace consumer can purchase any plan during open enrollment, and Marketplaces let consumers compare prices, plan designs, and networks to find the best choice for them.

Current Marketplace rates are well below initial Congressional Budget Office (CBO) projections.

• Independent researchers recently calculated that 2016 Marketplace rates are anywhere between 12 percent and 20 percent below what CBO initially predicted.
• 2017 Marketplace rate increases are subject to a number of predictable upward pressures that will dissipate next year.
• The end of the ACA’s temporary reinsurance program in 2016 puts upward pressure on 2017 rate increases that won’t exist for 2018 and beyond.
• Evidence suggests that some issuers priced below cost for 2014, reflecting the uncertainties of a new market and a desire to offer strongly competitive initial rates. With two full years of experience, many issuers are making one-time adjustments this year to bring premiums in line with observed costs.
• CBO's projections show that the law is working to cover the uninsured, while costing less than expected. Recent estimates find that the law's coverage provisions will cost 28 percent less in 2019 than in CBO's original projections.

Marketplace and non-Marketplace consumers are benefiting from slow health care cost growth since the enactment of the ACA.

• Since 2010, per-enrollee costs in both public and private health insurance have grown more slowly than in previous decades – contributing to lower-than-expected costs in the Marketplace.
• Ten times as many people are covered by employers as purchase insurance in the Marketplace and the average premium for employer-sponsored family coverage rose about 4% in 2015, far below the almost 8% average rate seen from 2000 through 2010.

·         The White House Council of Economic Advisers calculates that the average family premium in Arizona was $2,900 lower in 2015 than if premiums had grown at the same rate as the pre-ACA decade. Part of the progress in slowing cost growth is the Administration’s work to develop new, innovative ways of paying for care that align payment with improved outcomes which can help sustain and build on the slowdown in health care costs

·         This benefits Marketplace consumers as well. CBO has consistently predicted that Marketplace rates would grow faster than employer premiums for the first few years, but then grow at the same pace as employer coverage.

• That means Marketplace consumers will also benefit if slow health care cost growth can be sustained and the Marketplace advances in its stability and reaches a steady state.

The Marketplace is providing 179,445 Arizona consumers with coverage they value, because it improves their access to care and financial security.

• Nearly 4 out of 5 Marketplace consumers are very or somewhat satisfied with their health insurance. Importantly, they are just as satisfied with their coverage as people with employer plans.
• Marketplace consumers are accessing primary, specialist, and other care they need at rates similar to people with employer coverage and far higher than the uninsured, thanks in part to moderate cost sharing.
• The share of families struggling to pay medical bills fell for all income groups between 2013 and 2015, and fell the most for the moderate-income families most likely to have gained coverage through the Marketplace.

·         Only 10.8 percent of people in Arizona went uninsured in 2015, new Census data show, down from 16.9 percent in 2010. That dramatic drop means 410,000 more Arizonans had coverage in 2015.

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When SB1473 (APRN Full Practice Authority) failed to advance through the legislature, it was decided to move forward with a pared-down, strike-everything amendment to HB2236.  This was an effort to remove the “collaboration” language and therefore remove this obstacle to NP/CNM empanelment and reimbursement. 

As part of the proposal we incorporated language presently found in the Board of Nursing rules regarding when it is appropriate to engage in consultations and make referrals.  It is our belief that the language found in HB2236 requires consultation and referrals with physicians only when it is in the best interest of the patient or when the circumstances of the patient are outside the knowledge and experience of the NP/CNM.  In our view this would not prevent referrals to other providers if the NP/CNM has the experience and knowledge to exercise the clinical judgment necessary to make an appropriate referral to a non-physician provider.  We do not believe that this language mandates that NP/CNMs can only refer and consult with physicians.

Although the language of the strike-everything amendment for HB 2236 has been available for more than two weeks, we have recently been informed by the Executive Director of the State Board of Nursing, that she and their lobbyist believe this language in fact would limit all referrals by NP/CNMs to physicians only. 

We do not agree with that interpretation but believe that if the Board is going to take that position it creates a handicap to present NP practice which many feel is not outweighed by the removal of  both “collaboration” and the present requirement that NPs/CNMs establish a relationship with one or more physicians.  

We will request that Senator Barto not move the bill forward.  This is particularly unfortunate since it probably will contribute to the political obstacles that will complicate future attempts  to remove the “collaboration” language and impact efforts on behalf of the consensus model. 

For full information regarding the 2016 APRN Full Practice Authority Initiative, please visit the Top Issues Page.

American Nurses Association Endorses Hillary Clinton for President

SILVER SPRING, MD— The American Nurses Association (ANA) today announced its endorsement of Hillary Clinton for President of the United States. ANA represents the interests of the nation’s 3.4 million registered nurses and is the leading member-based organization for nurses in the United States.

“Hillary Clinton has been a nurse champion and health care advocate throughout her career and believes empowering nurses is good for patients and good for the country,” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of ANA. “We need a president that will make it a priority to transform the country’s health care system into one that is high quality, affordable and accessible.”

As secretary of state, Clinton was an advocate for the rights and opportunities of women and girls, the LGBT community, and young people around the globe.

As a senator, she helped create grants that increased the number of Magnet® hospitals, which are recognized by the American Nurses Credentialing Center (an ANA subsidiary) for demonstrating excellence in patient care. Clinton also supported increased funding for both Title VII and Title VIII programs, which help address the higher education needs of nurses and nursing faculty. Additionally, she championed programs designed to attract more individuals to the nursing field, including efforts to improve the quality of nurses’ work environments.

“Nurses ensure the delivery of quality health care to patients, families and society,” said Cipriano. “By supporting efforts to improve nurses’ work environments, Hillary Clinton shows she understands the impact nursing has on patient outcomes and the quality of care.”

As first lady, Clinton led early efforts to reform the U.S. health care system so that
Americans would have access to affordable, high quality health care services. Notably, she
worked with Republicans and Democrats to help create the successful Children’s Health
Insurance Program, which provides health coverage to more than 8 million children and has
helped cut the uninsured rate for children in half.

ANA and its Political Action Committee (ANA-PAC) endorse candidates who have
demonstrated strong support for nursing and health care issues and who will best serve the
interests of nurses and patients. Endorsement decisions are made based on candidate interviews,
communication with ANA’s constituent and state nurses associations, campaign information, the
candidate’s voting record on ANA priorities, and online polling of the ANA membership for
their preferred candidates. In this year’s poll, held Feb.16-March 1, Clinton garnered the most
votes, beating the next leading candidate by more than 20 percentage points. For more
information about ANA-PAC, click here.

ANA’s endorsement was announced Tuesday, March 22, during a public event in Seattle
with Secretary Clinton and Seattle Mayor Ed Murray. To request pictures from the event, please
email newsroom@ana.org.

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The American Nurses Association (ANA) is the premier organization representing the interests of the nation's 3.4 million registered nurses. ANA advances the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public. ANA is at the forefront of improving the quality of health care for all.