Access to Care & The Affordable Care Act
AzHHA believes that all Arizonans should have access to affordable, comprehensive healthcare where patients can receive the “right care at the right time.” While there are significant policy disagreements on how to achieve this goal, we believe certain principles should guide all reform efforts. These include making healthcare coverage more affordable, ensuring healthcare coverage is comprehensive, ensuring adequate provider reimbursement so as to promote network adequacy, and incentivizing innovation.
In California v. Texas, certain states and individuals filed suit in federal court alleging that the ACA is unconstitutional. The district court and, upon appeal, the U.S. Court of Appeals for the 5th Circuit ruled that the individual mandate is unconstitutional. A coalition of states led by the California Attorney General petitioned the U.S. Supreme Court to hear the case, which was granted. AzHHA joined a group of 35 other state hospital associations in filing an Amici Brief with the Court that explains our position that the beneficial programs of the ACA have greatly improved the delivery of healthcare.
In the opinion issued by the Supreme Court, California v. Texas, on June 17, 2021, the Supreme Court ruled that the case could not proceed because the plaintiffs did not have legal standing to challenge the law. The Court did not address the underlying questions of whether the ACA’s individual mandate is constitutional and, if not, whether the rest of the law would stand. Therefore, the ACA’s constitutionality remains an open question and legal challenges brought by plaintiffs under different circumstances in the future are a possibility. Learn more about the litigation and potential ramifications if ACA is struck down.
The escalating price of prescription drugs threatens the affordability of healthcare in Arizona and across the nation. Over the previous five years, brand name drug prices have increased at 10 times the rate of inflation, a trend that has left one-in-four Americans unable to afford the medications they need. This places patients and the providers who care for them at risk.
Outrageous drug prices force too many patients into rationing their drugs or leaving their prescriptions unfilled. Arizona’s hospitals see the consequences up close with patients coming back through their doors sicker than when they left. Not only do patients feel the sting of soaring costs at the pharmacy counter, but the high cost of drugs threatens the ability of hospitals and health systems to acquire needed drugs for patients in their care.
To address rising drug costs, AzHHA supports the aggressive oversight of drug manufacturers and bi-partisan market-based reforms that boost competition, strengthen transparency and encourage innovation.
For more information, visit The Campaign for Sustainable Rx Pricing.
A high-quality healthcare delivery system depends on access to well-trained staff, including physicians, nurses and allied health professionals. Arizona has had a shortage in these professions for many years, especially persistent outside of Maricopa and Pima counties, and it has only been made worse by the COVID-19 pandemic. According to a recent analysis of the Bureau of Labor Statistics data, Arizona ranks 48th among 50 states in the number of healthcare workers per capita. Two of the state’s rural metropolitan statistical areas rank in the lowest 10.
AzHHA is working to address workforce shortages across the spectrum, from growing the pipeline to recruitment and retention. Current proposals include establishing a statewide graduate nurse transition training program to support new graduate nurses as they transition to experienced professionals, increasing preceptorships to train additional nurses, and adding financial support to help nurses pay back the cost of their education. You can learn more about workforce issues from the American Hospital Association 2022 Health Care Talent Scan.
Surprise Medical Bills
A patient receiving care at an in-network hospital may unknowingly or unexpectedly be treated by an out-of-network physician. This can occur in the emergency department or inpatient setting, and is often related to radiology, anesthesiology or pathology services. In these instances, physicians may balance-bill patients for charges that exceed the amount the health plan agrees to cover. As a result, the patient receives an unexpected, or “surprise” medical bill.
While the hospital does not control the billing activity in these instances, AzHHA believes hospitals and healthcare systems must advance a policy environment that protects consumers from the financial risk of large, unexpected medical bills. At the same time, physicians and other medical professionals must be adequately reimbursed. To achieve these dual objectives, we support public policy reforms that prohibit balance billing in concert with an arbitration approach for negotiating fair reimbursement. We oppose the implementation of a pre-set default rate, such as a percent of the Medicare rate.
In December 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021. The Act protects patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network clinicians at in-network facilities and holds patients liable only for their in-network cost-sharing amount. Health care providers and insurers can access an independent dispute resolution process if needed, and there is no pre-determined benchmark reimbursement amount. The Departments of Health and Human Services, Treasury, and Labor are tasked with issuing regulations and guidance to implement a number of the provisions.
Site Neutral Case
AzHHA joined an Amici Brief on February 23 with 32 other state and regional hospital associations asking the U.S. Supreme Court to hear a case regarding the constitutionality of a Centers for Medicare and Medicaid Services (CMS) final rule which significantly reduced reimbursement rates for off-campus provider-based departments (PBDs). The brief explains these cuts, amounting to approximately $600 million per year, threaten the vital role PBDs play in communities across the country, as they are often the only point of access to care for vulnerable individuals living in rural areas. Read more about the Site Neutral case and Amici Brief here.