Legislators make case to add public option to NV health exchange by 2026

Premiums for the public option would be 5 percent lower than the premium of the second lowest plan available on the ACA health insurance exchange. (Sean Gallup/Getty Images)

Legislation heard Tuesday would seek to fill coverage gaps behind the state’s high number of uninsured, an estimated 350,000 people, by creating a more affordable insurance option through Nevada’s coverage exchange starting Jan. 1 2026.

“We have heard time and time again that Nevadans need more affordable health insurance,” said Democratic Senate Majority Leader Nicolle Cannizzaro during the hearing on Senate bill 240. “We’ve heard from small business owners, their employees, the uninsured, the underinsured and those who have lost their jobs and insurance as the result of the pandemic. They need health care. And frankly, they need affordable insurance options.” 

If the bill were to pass, not all Nevadans would be eligible to enroll. 

“For individuals who are currently covered under their employer health plans, especially for large employers or multiemployer health plans, this would not be something that would be available,” she added. “We’re talking about the individual and small group market.”

Cannizzaro pointed to the pandemic, which left thousands of people without health insurance when they lost their jobs, as a need to create another option to provide affordable insurance. 

Though Covid created an urgent crisis and underscored deficiencies in health care coverage, Cannizzarro said the years-long timeline for the Nevada Department of Health and Human Services to create and then implement the option was intentional to allow concerns to be addressed and for the state to “get this right.”

The original proposed effective date was 2025.

“I think by building in that time and allowing for this to become a plan effective in 2026, that really is allowing the flexibility that is needed,” she said. “And also hopefully encouraging some creativity on our part as a state to come up with a way to implement that does result in savings to Nevadans.” 

Even before the pandemic, Nevada consistently ranked poorly in its uninsured rates, health care affordability and health care outcomes. 

Of 350,000 Nevadans who currently have no health coverage: 

  • 37 percent are eligible for Medicaid but aren’t enrolled;
  • An estimated 17 percent can’t afford current plans under the  Affordable Care Act;
  • 27 percent have barriers to accessing ACA coverage because of their immigration status;
  • 19 percent are eligible for ACA coverage but aren’t enrolled.

“We know who the people are who are uninsured and now the question is what do we do to try to get them insured,” Cannizzaro said. “That is exactly what we are trying to do.”

Under the bill, premiums for the public option would be 5 percent lower than the premium of the second lowest plan available on the ACA health insurance exchange and “must not increase by more than the Medicare economic index on any given year.” 

Lawmakers have been debating ways to expand health coverage for years.

Former Assemblyman Mike Sprinkle championed legislation in 2017 that was deemed as a state version of Medicare for All, but the bill was vetoed by then Republican Gov. Brian Sandoval.

Sprinkle was expected to bring a more tamed version of the legislation in the 2019 session, but resigned less than two months into the session. 

Cannizzaro introduced the measure to add a public option to the health exchange last week.

Some small businesses, the Culinary Union and progressive advocacy organizations support the legislation. 

Annette Magnus, the executive director for Battle Born Progress said the legislation would make sure “Nevadans always have equal access to affordable, quality coverage — especially if they lose their job and insurance.” 

“Perhaps that is why some insurance companies oppose this legislation,” she said in a statement Tuesday. “They are in fear of losing their grip, ridiculous profits, and power, since they would have to compete for Nevadans’ business if this passes.”

Along with insurers, the Nevada State Medical Association, the Nevada Hospital Association and various chambers of commerce were among those opposed to the bill.  

Cannizzaro pushed back on suggestions by the opposition to create a study or task force to further study the barriers between marginalized communities and health care coverage.lack access to insurance.  

“I’m a little at a loss of words on the comments that we should study this, we should figure out why people aren’t insured, or figure out why people aren’t accessing health care,” she said. “That’s a question that has been raised for as long as I’ve been in this building … it’s a long enough period of time to know we should take action.” 

In addition to creating a public option, the bill also expands Medicaid coverage to include access to things related to maternal care as a way to tackle Nevada’s high morbidity rates for Black and brown mothers. 

“It expands Medicaid coverage for pregnant women with the hope of improving health outcomes and reducing health disparities by expanding access to critical prenatal and postpartum care,” Cannizzaro said. 

There was no action taken on the legislation. 

Michael Lyle
Michael Lyle (MJ to some) has been a journalist in Las Vegas for eight years.  He started his career at View Neighborhood News, the community edition of the Las Vegas Review-Journal. During his seven years with the R-J, he won several first place awards from the Nevada Press Association and was named its 2011 Journalist of Merit. He left the paper in 2017 and spent a year as a freelance journalist accumulating bylines anywhere from The Washington Post to Desert Companion. While he covers a range of topics from homelessness to the criminal justice system, he gravitates toward stories about race relations and LGBTQ issues. Born and mostly raised in Las Vegas, Lyle graduated from UNLV with a degree in Journalism and Media Studies. He is currently working on his master's in Communications through an online program at Syracuse University. In his spare time, Lyle cooks through Ina Garten recipes in hopes of one day becoming the successor to the Barefoot Contessa throne. When he isn’t cooking (or eating), he also enjoys reading, running and re-watching episodes of “Parks and Recreation.” He is also in the process of learning kickboxing.