Nevada is flirting with the revolutionary idea of allowing any of its 2.8 million residents to purchase Medicaid, the state-run federal health insurance program for the poor, regardless of their income levels, age and health status.
At a time when the Trump administration and congressional Republicans are pressing for legislation in Washington to roll back and severely cut Medicaid coverage as part of the repeal of the Affordable Care Act, the Democratic-controlled Nevada State Assembly late last week passed a bill essentially offering “Medicaid access for all.”
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The proposed new program would allow virtually anyone in need of health insurance --including lower-income people currently enrolled in the Affordable Care Act and receiving federal tax subsidies – to sign up.
Assemblyman Michael C. Sprinkle, chief author of the legislation, wrote recently that it would “give every Nevadan an opportunity to purchase a plan with Medicaid-like benefits” and counteract some of the damage Trump and the GOP are attempting to do to the Medicaid program nationally.
“Passing this bill will revolutionize our state’s antiquated and complicated healthcare system,” Sprinkle said.
The ground-breaking legislation is attracting national attention from health care policymakers and experts, although its fate is far from certain. The bill is currently on the desk of Republican Gov. Brian Sandoval, who hasn’t indicated yet whether he will sign the Democratic initiative or veto it.
Moreover, even if the Medicaid for all bill is enacted, Nevada state officials could encounter major push back from the Trump administration in trying to implement the program.
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Medicaid provides health and long-term care coverage to more than 70 million low-income children, pregnant women, adults, seniors, and people with disabilities throughout the country.
Thirty-one states and the District of Columbia also extended coverage to millions more of low-income adults without children and others under a special provision of the Affordable Care Act. Nevada, one of those states, added about 300,000 more people to the state’s Medicaid rolls, with the federal government picking up most of the tab.
Now Nevada’s Democratic state legislature has voted take the unprecedented step of throwing open the Medicaid door to the hundreds of thousands of other state residents who are still without health insurance coverage.
Here’s a brief primer on what you should know about the plan:
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How would it work? Anyone in the state who lacks health insurance, either through their employers, Obamacare or Medicare for the elderly, would be allowed to purchase coverage under the state-run Medicaid system, which is known as the Nevada Care Plan.
In effect, Medicaid would become a public option of last resort. Anyone with money could buy into the system, and even people who are now receiving subsidized coverage under Obamacare could apply their federal tax subsidies to purchase a Medicaid plan.
The plan would likely be sold on the state-run health insurance exchange, making it competitive with private health insurance plans. Advocates say it should provide an inexpensive alternative to private individual health insurance and a broad range of benefits nearly identical to those under traditional Medicaid.
What makes the plan so unique? There has been considerable talk among Democrats over the years about creating a single-payer government health insurance program or expanding the availability of Medicare to those under the age of 65.
A proposal to create a “public option” as part of the 2010 Affordable Care Act ran into strong opposition from many Democrats as well as Republicans during the congressional debate. But rarely has anyone suggested using the Medicaid program for the poor as a health care coverage tool of last resort.
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How much would it cost? There are no reliable estimates of how much people would have to pay in premiums to acquire Medicaid coverage under this system, or whether they would have to pay co-payments and other out of pocket costs.
However, Medicaid would unquestionably be less expensive than Medicare or many private health care plans. That’s because of Medicaid’s low reimbursement rates for physicians, hospitals and other health care providers.
Medicaid on average pays 66 percent of what Medicare pays a doctor, as noted in an analysis of the Nevada legislation by Vox. Medicaid pays 81 percent of Medicare rates in Nevada.
However, one obvious downside is that many doctors don’t accept Medicaid patients because of the low reimbursement rates. This could prove to be a deterrent to some who might consider turning to Medicaid for coverage.
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What are the biggest obstacles? One obstacle, obviously, is getting Sandoval to sign the bill, but that might not be easy. The Republican governor had clashed frequently with the Democratic majority in the state legislation, although notably he vigorously supported Medicaid expansion in his state when Republican governors and state legislatures in 19 other states opposed it.
Because the legislation leaves unresolved many critical issues, including the price of buying into the system and possible cost-sharing measures, Sandoval might decide to sign the bill but then negotiate the terms of the implementation.
The governor’s office declined to respond to repeated queries from The Fiscal Times about whether he will sign the bill.
The other challenge would be for state officials to go through the legal hoops in Washington. The bill requires the state to obtain a waiver from the U.S. Department of Health and Human Services to move ahead with its experiment. But it’s far from clear whether the Trump administration would grant the request at a time when it is trying to rein in Medicaid spending and encourage states to impose tougher eligibility requirements.
Related: Now It’s Democrats’ Turn to Make a Health Care Push: Medicare for All
Under current Medicaid law, the federal government matches state spending on an open-ended basis. However, the Republican House passed American Health Care Act (AHCA) would gradually roll back the expanded Medicaid coverage and limit the federal government’s contribution to the overall program through per capita caps or block grants to the states.
