Nevada weighs public option as blue states eye health care reform

Nevada’s Democratic-controlled legislature is racing to finish work on a bill that would create a government-run health insurance plan in what may be the most ambitious effort to overhaul health care policy in any state this year.

Legislators are working on a bill to create a public option that would compete with private insurers through the state-run insurance marketplace, established under the Affordable Care Act. The measure would require companies that provide Medicaid services to offer public option plans, a notion supporters say would increase access to affordable care.

“People are struggling to ensure they will have access to health care if they get sick,” state Sen. Nicole Cannizzaro (D), the state Senate majority leader and the bill’s lead sponsor, said during committee testimony earlier this month. “Now is an opportune moment to take advantage of the state’s considerable bargaining power to make health care more affordable and more accessible.”

The bill would set up publicly available plans that would cover either 70 percent or 80 percent of health care costs. Health care providers that accept either state employee health insurance plans or Medicaid patients would also be required to take on patients on the public option.

About 350,000 Nevada residents still do not have health insurance, a decade after then-President Obama signed the Affordable Care Act into law. Supporters of the public option say about two-thirds of those who are uninsured would be eligible for the public option plan.

Opponents of the measure worry about the costs a public option would impose on hospitals, providers and patients who have private health insurance.

“The most important concern that we have is cost. Cost on implementation, cost on creating, cost on managing this new public option. The second biggest issue that we have is access to care,” Tom Clark, a lobbyist who represents the Nevada Association of Health Plans, told a state Senate committee hearing in testimony on the bill earlier this week. “Health care costs for all Nevadans will increase. Access will decline.”

Some experts believe the public option might not have the sweeping effect its supporters envision. The vast majority of those who remain without health care coverage in Nevada are already eligible for Medicaid or for subsidized health plans under the Affordable Care Act. More could be covered if Nevada followed a path like California and allowed undocumented residents to access those options.

In testimony before the state Senate this week, several opponents of the bill revisited that theme: If people are not signing up for the plans for which they are already eligible, adding a public option is a solution to the wrong problem.

“If your goal is to reduce the number of uninsured in the state of Nevada, I am not sure that this bill is going to have a really dramatic impact,” Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, who has not been involved in the legislation, told The Nevada Independent.

Because the government would set reimbursement rates for care at levels below those set by private insurance companies, with the goal of making premiums more affordable, opponents also said they feared the new plan would leave gaps in hospital budgets.

“Any shift in patients from commercial plans to a public option that would almost certainly reimburse at a far lower rate threatens the ability of hospitals like Sunrise to offer services the most vulnerable members of our community rely upon so heavily,” said Connor Cain, a lobbyist who represents Sunrise Hospital and Medical Center in Las Vegas.

Prominent progressive groups have rallied to the proposal. The powerful Culinary Workers Union backs the bill, too, after an amendment would allow them to offer their own health care plan on the state exchange.

Only one other state, Washington, has implemented a public option plan, after Gov. Jay Inslee (D) signed a version into law in 2019. The first open enrollment period that included the public option began earlier this year.

Progress toward reducing the number of uninsured has been low — fewer than 1,900 Washington residents signed up for one of the public option plans, known as Cascade Care, offered by five different private insurers, out of 222,000 people who signed up for new plans this year.

Cannizzaro is running up against a ticking clock to get her legislation passed: Nevada’s legislature is set to adjourn June 1. The state is one of a few remaining that holds legislative sessions only biennially, making next week the last time for two years that legislators have a chance to pass the bill.

But Nevada’s move may presage a wave of public option proposals in blue states. Lawmakers in Colorado, Connecticut, New Mexico and Oregon considered public option bills during sessions this year.

“There’s momentum from a number of other states that are looking at public options and looking at responding to the needs that states are having,” said Liz Hagan, director of policy solutions at United States of Care, a health care reform organization. “We’re going to continue seeing a lot of states trying to push the envelope in the innovative space of what they can do under the Affordable Care Act.”