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Arizona health insurance exchange / marketplace

AZ Governor signs law prohibiting state-run exchange; subsidies on the line for 156k residents pending King v. Burwell outcome

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Arizona law prohibits creation of state-run exchange

The outcome of the King v. Burwell Supreme Court case is particularly important in Arizona.  In April, Governor Doug Ducey signed House Bill 2643 into law, effectively banning the state from creating a state-run exchange.  If the Supreme Court rules in favor of the plaintiffs in King v. Burwell, subsidies would disappear in 34 states – including Arizona – that don’t have state-run exchanges.

By February 22, private plan enrollment in Arizona’s exchange had reached 205,666 people, and 76 percent of them are receiving premium subsidies.  Vox’s Sarah Kliff wrote an article about Arizona’s new law, and the title is particularly apt: “Arizona passes new law promising to let the Supreme Court wreck its health care system.”

The state could pass another law at a later date undoing HB 2643, and there’s always the distinct possibility that the Supreme Court will rule that subsidies are legal in every state. But the passage of HR 2643 is a legislative hurdle that the state will have to contend with if the Supreme Court rules that subsidies are only available in the state-run exchanges.

Gov. Ducey told reporters that he signed the bill because he’s “no fan of [Obamacare]” and “not in favor of a state exchange.”  He also said that the state will have a “plan of action” in the even of a Supreme Court ruling against subsidies in the federally-run exchange, although it’s unclear at this point what that plan would entail.

Still not insured?

The 2015 open enrollment period, when anyone could sign up for insurance, ended February. 22 (this included a one-week extension for people who had been unable to finish the process by February 15).  There was an additional special enrollment period (March 1 and April 30) that aligned with the tax filing season and provided an enrollment opportunity for people who weren’t previously aware of the tax penalty for not having health insurance.

Now that the general open enrollment period and the special enrollment period are over, enrollment individual plans is closed for the year, both on and off-exchange.  But depending on your circumstances, you may still be able to enroll in 2015 coverage:

  • If you have a qualifying life event, you get a 60-day special enrollment period to select a health plan.
  • If you qualify for Medicaid, you can sign up at any time.
  • If you’re Native American, enrollment continues year-round.

The next general open enrollment starts on November 1, for coverage effective January 2016.

2015 plans and premiums

Three more insurers are participating in the Arizona marketplace for 2015: UnitedHealthcare, Assurant Health, and Phoenix Health Plans. In total, 13 insurers are participating in the second year of enrollment, up from 10 in 2014. Nationally, the number of participating insurers is up about 25 percent.

A Kaiser Family Foundation analysis shows premiums down 10 percent in the Phoenix area, but flat or up in many other parts of the state. Visit and enter your ZIP code to see the specific insurers, plans and premiums available where you live.

While rates increased in 2015 for some Arizona residents, the baseline is better than in many other areas. In 2014, Arizona’s premiums were among the lowest of states using the federal exchange in 2014.

What happened during 2014 open enrollment?

Arizona saw positive effects during the first year with the Obamacare marketplace in operation. The state’s uninsured rate dropped by 2.9 percentage points, state hospitals have seen uncompensated care costs drop by nearly one-third, and the state added health care-related jobs.

Just more than 120,000 Arizona residents signed up for qualified health plans (QHPs) during open enrollment for 2014. An additional 101,282 people qualified for Medicaid or the Children’s Health Insurance Program (CHIP).

Among Arizona residents selecting a QHP, 77 percent qualified for financial assistance, compared to 85 percent nationally. A report released in June by the U.S. Department of Health and Human Services showed the average monthly premium, after tax credits, for Arizona consumers was $113. Among states using the federal marketplace, the average was $82. Twenty-six percent of Arizona enrollees pay $50 or less per month after subsidies.

Twelve percent of Arizona residents selected a bronze plan (20 percent nationally), 60 percent selected a silver plan (65 percent nationally), 14 percent selected a gold plan (9 percent nationally), 13 percent selected a platinum plan (5 percent nationally) and 1 percent selected a catastrophic plan (2 percent nationally). Twenty-one percent of Arizona enrollees were between the ages of 18 and 34.

Arizona and Medicaid expansion

Medicaid expansion was passed by the Arizona Legislature with some Republican support and was approved by Brewer. The Medicaid decision allowed people earning less than 138 percent of the federal poverty level — about $15,000 for an individual — to gain health coverage. About 300,000 are eligible under the expanded criteria.

Some Republican legislators and conservatives challenged Medicaid expansion. They first launched a petition to put Medicaid expansion on the November 2014 ballot. The referendum push failed, prompting a legal challenge. The suit claimed that because the tax plan to fund the state’s portion of expansion costs was passed with less than a two-thirds majority, it was unconstitutional. Oral arguments were made in mid-December 2013, and a judge dismissed the case in early February 2014.

A group of conservative Republican representatives appealed the decision, and the Arizona Court of Appeals ruled that the case could proceed. The Arizona Supreme Court heard the case in November 2014 and later ruled that the case could proceed. Gov. Doug Ducey is said to be reviewing the decision and consulting with legal experts on how to proceed.

In February 2015, the Arizona legislature passed Senate Bill 1092, which requires the state to seek an annual waiver from CMS to allow additional restrictions on Medicaid eligibility.  The waiver request would include requirements that enrollees be working or involved in job training or school, and it would also limit an able-bodied person’s eligibility for Medicaid to no more than five years.  The bill excludes pregnant women, those caring for young children, and people with disabilities.  Governor Ducey signed the bill into law in March.  The bill is largely symbolic, as CMS is unlikely to approve such a waiver.  But under state law, Arizona must now request one each year.

Arizona health insurance exchange links

Cover Arizona

Arizona Department of Insurance: Health Insurance Exchange

Office of Health Insurance Exchange