UPDATE: The Senate Committee on Health and Human Services voted to amend and pass SB420 on Tuesday, which would create a public health insurance option.
It may have to pass through the Finance Committee, but ultimately it would go to the Senate floor for a full vote.
Original Story: Lawmakers are trying to solve Nevada's high number of people without health insurance. Senate Bill 420 would create a public option.
"When you go and you talk anecdotally to people at the door, health care accessibility and health care affordability are some of the top things that come up in conversation," Sen. Nicole Cannizzaro, D-Las Vegas said.
Lawmakers say roughly 350,000 Nevadans do not have health coverage. That is about 11 percent of the population.
"Nevada is one of the states that did engage in Medicaid expansion under the ACA," Cannizzaro said. "Yet despite that, we're still seventh in the nation in terms of uninsured rates."
Cannizzaro and others started the process to craft the bill, during the 2019 legislative session with an actuarial analysis to see if the plan would be viable. Under the plan, people who would qualify would select the silver or gold plan from the Silver State Health Insurance Exchange but with a five percent discount. Insurance companies that provide Medicaid coverage would also have to offer the public option. The state would leverage its purchasing power and set up a trust fund, using federal dollars to help drive down premium costs by 15 percent over four years. It is a premium-based plan.
"What this means is that Nevadans will still be paying their health care costs but we're going to help bring those costs down so it is actually affordable," Cannizzaro said. "At the end of the day, this isn't something that is government-funded health care. It's health care that is seeking innovative solutions to help bring down those costs for every day Nevadans."
Opponents say the bill does not reduce costs. Instead, it puts the burden on others who have private insurance. Especially, large groups like those who buy employer-sponsored insurance.
"This is a proposal to create an entirely new public program that is going to cost shift dramatically in the market and drive up some people's insurance rates while also putting downward pressure on reimbursement rates for providers," Sen. Ben Kieckhefer, R-Reno said.
Others say the legislation would hurt health care providers because it could decrease the amount of money they are reimbursed.
"When you're getting paid lower than your costs, you can never expand, you can never grow and policies like this just hurt access and hurt care," Assem. Robin Titus, R-Smith Valley said.
Kieckhefer doubts that the plan would move the dial on Nevada's uninsured rate, pointing out that more than half of the state's unemployed population already qualifies for Medicaid or subsidies through the health exchange.
According to the Guinn Center, 17 percent of the state's uninsured population is having affordability issues on the exchange and they are not eligible for tax credits. 27 percent cannot buy insurance because of their immigration status. Immigrants have to have five years of residency before qualifying for Medicaid. 19 percent are eligible for subsidies through the health insurance exchange but are not enrolled. 37 percent are eligible for Medicare.
"More than a third of them are eligible for Medicaid and unenrolled," Kieckhefer said. "It doesn't get cheaper than free so nothing we could do is going to get them to sign up through this bill."
If SB420 passes, it would also make some changes to Medicaid. It would increase the eligibility for pregnant women, allowing them to earn up to 200 percent of the national poverty rate. The first plan year would begin in 2026.
