By Sam Metz AP/Report for America
Wednesday, May 5, 2021
Lobbyists representing doctors and hospitals clashed with affordable health care advocates on Tuesday in the Nevada Legislature's first hearing on a proposal to create state-run health insurance plans that could compete with private insurance companies on the state's health insurance exchange.
Nevada is one of many states that is considering some form of what's called a "public option" to expand access and make health care more affordable. Washington passed a public option proposal in 2019 and Connecticut and Oregon are also considering similar proposals.
Senate Majority Leader Nicole Cannizzaro, the bill's primary sponsor, told lawmakers who sit on a legislative committee that more than two-thirds of Nevada's 358,000 uninsured residents would be eligible under her public option proposal. She said a public option would leverage the state's purchasing power to reduce health care costs and make high-quality care more widely available.
"Doing nothing is not a solution," she said. "I've heard at the doors of so many of my constituents that affordable health care is something that we've got to tackle."
The percentage of the U.S. population that lacks health insurance has fallen dramatically since the Affordable Care Act passed a decade ago, however in Nevada, roughly 14% of the non-elderly population still lacks coverage, making it one of the states with the highest uninsured rates in the nation. Additionally, Medicaid enrollment has recently skyrocketed and more than 1 in 5 residents are now enrolled.
The U.S. Bureau of Economic Analysis found, in 2018, the average resident spent $5,948 on health care. Surveys conducted by the Altarum Institute found that 48% of adults report health care out-of-pocket affordability burdens — more than the majority of states.
Under the proposal being considered in Nevada, the public option would not be open to most individuals covered under employer health plans and be limited to consumers who purchase health insurance as individuals or businesses with up than 50 employees that purchase it on the "small-group market."
State Sen. Ben Kieckhefer, a Reno Republican, told the committee that he wasn't sure what populations the public option plan targeted because the majority of uninsured residents are already eligible for Medicaid or Affordable Care Act studies, or they're living in the country illegally.
"Who are we bringing in to this market? Are we going to disrupt the small group market so massively that it brings people in?" he asked.
The proposal anticipates adding a low-cost public option to the market will spur competition to drive down costs. It sets a target of reducing average premium costs by 15% within five years of the public option's creation. To give Nevada time to coordinate its plan with the federal government and study implementation, the state-run insurance plan would not be available until 2026.
If passed, all providers who serve public employees under the state plan or Medicaid recipients — meaning most doctors, clinics and hospitals — would be required to accept Nevada's public option as insurance. The plans would be pegged to the cost of local plans with moderately high premiums and monthly payments and be required to cost 5% less. It would set Medicare reimbursement rates as a price floor and require the public option be more affordable.
Requiring providers to accept low-cost plans worried industry groups representing doctors and hospitals.
Lobbyists representing hospitals, doctors' groups and insurance companies said adding patients with insurance plans that reimburse below cost to the Medicaid and Medicare recipients — who providers already treat — would shift cost burdens to hospitals, doctors and patients with private insurance. They said price controls could make it more difficult to recruit doctors to Nevada and exacerbate the state's practitioner shortage.
"The concern is that, by mandating certain providers participate, we may frankly lose certain providers" participating in Medicaid or insurance programs for public employees, said Nevada Hospital Association lobbyist Jim Wadhams.
Sam Metz is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.
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