2018 enrollment update
Nevada health insurance at a glance
- Nevada was rated 46/50 on overall health
- Obamacare decreased uninsurance rate to 12.3%
- Two insurers leaving Nevada exchange
- Nevada exchange enrollment: 75,408
- Nevada legislators were split on healthcare reform
A wide range of issues plays a role in the overall health of a state’s residents. Nevada struggles with many public health challenges, but it’s also the only state with a Republican governor that ran its own exchange in 2014, and one of just a few where Medicaid was expanded. Although Nevada continues to have a state-run exchange, they have been using HealthCare.gov for enrollment since 2015 (there are four other states in 2017 that have state-run exchanges but use HealthCare.gov for enrollment: Arkansas, Kentucky, New Mexico, and Oregon).
If you live in Nevada, there are numerous factors that could impact your own health outcomes and that might be of interest to you in terms of the state’s approach to healthcare and healthcare reform. Here’s a summary:
Nevada health ratings
Unfortunately, in terms of overall public health when compared with the rest of the nation, Nevada tends to have lower performance than most states.
The Commonwealth Fund’s 2015 Scorecard on State Health System Performance rated Nevada 43rd out of the 50 states and District of Columbia. And in 2017, Nevada fell to 46th place. This ranking was based on health indicators related to:
- Access (48th — in 2017)
- Prevention & Treatment (51st)
- Avoidable Hospital Use & Costs (19th)
- Healthy Lives (36th)
- Equity (44th)
Trust for America’s health has also analyzed data on the incidence of specific illnesses and health indicators in Nevada, and ranked the state on a variety of health-related metrics. The details are available in the 2016 listing of Key Health Data About Nevada.
Within the state, there are differences in health factors and outcomes from one county to the next. The Robert Wood Johnson Foundation has created this interactive map that lets you see how the sixteen counties (and independent Carson City) in Nevada rank against one another.
How has Obamacare helped Nevada residents
In 2013, a fifth of Nevada residents (20.3 percent of the population) were uninsured. By 2015, that number had fallen by 39 percent, to 12.3 percent.
Medicaid enrollment in Nevada increased by 90 percent from 2013 to May 2017 – the second highest percentage increase in the US, second only to Kentucky. Clearly, the expansion of Medicaid has played a major role in reducing the number of Nevada residents without health insurance.
2018 individual health insurance exchange insurers
Nevada’s federally supported state-based exchange will continue using HealthCare.gov for 2018 open enrollment. But there will be substantial changes in terms of the participating insurers (for reference, most of Nevada’s population is in Clark and Washoe counties):
- Health Plan of Nevada (UnitedHealthcare’s HMO) will continue to offer coverage in Clark, Nye, and Washoe counties
- Silver Summit is joining the exchange for the first time, and will offer coverage in Clark, Nye, and Washoe counties
Two existing exchange insurers are leaving the exchange at the end of 2017: Prominence (formerly Saint Mary’s HealthFirst) and Anthem. Prominence offered coverage in seven Nevada counties in 2017, but will exit the ACA-compliant individual market altogether at the end of 2017. Anthem will continue to offer an off-exchange catastrophic plan in Nevada, but no exchange plans.
As of early August 2017, Carson City and 13 rural Nevada counties had no insurers slated to offer coverage in the Nevada exchange for 2018. The Nevada Division of Insurance issued a press release on August 7 press noting that they were “working with [their] state partners on a plan to help consumers shop the Exchange market at open enrollment for the 2018 Plan Year and remain optimistic that there will be coverage for consumers on the Exchange throughout the state.”
For more detailed information about Nevada’s exchange, please see our Nevada health insurance exchange page.
Nevada enrollment in qualified health plans
In 2014, four carriers participated in the Nevada exchange 2014: Anthem, Health Plan of Nevada, Saint Mary’s Healthfirst (Prominence) and Nevada Health Cooperative. Unfortunately, technological problems with Nevada Health Link resulted in 2014 enrollment well below what the exchange had predicted for the first open enrollment.
Utilizing HealthCare.gov’s enrollment platform and the state’s extensive outreach activities, has helped improve the Nevada exchange experience and enrollment numbers. Enrollment grew nearly 20 percent between 2015 and 2016 – and was more than double 2014.
89,061 people enrolled in private plans for 2017 through the Nevada exchange during open enrollment. For perspective, enrollment during the 2016 open enrollment period reached 88,145. So enrollment grew by 1 percent in Nevada’s exchange — in contrast with the average across all states that use HealthCare.gov, where average enrollment was down about 5 percent in 2017 (due in part to the Trump Administration’s decision to reduce advertising and outreach in the final days of the 2017 open enrollment period).
By March 2017, effectuated enrollment in Nevada’s exchange stood at 75,408, with 85 percent of those enrollees receiving premium subsidies.
Nevada is the only state that allows off-exchange enrollments year-round, with a waiting period. Native Americans and anyone who is eligible for Medicaid/CHIP can enroll year-round through Nevada’s exchange.
Nevada and the Affordable Care Act
In 2010, Nevada’s U.S. Senators were split on healthcare reform. Democratic Senate Majority Leader Harry Reid voted yes and was an ardent supporter of the ACA from the get-go. But Republican John Ensign voted against the ACA. In the U.S. House, two Nevada Democrats – Dina Titus and Shelley Berkley – voted yes, while one Republican – Dean Heller – voted no.
Reid did not run for reelection in 2016, and was replaced in the Senate by Democrat Catherine Cortez Masto, who supports the ACA. Heller has replaced Ensign and is now the Senior Senator from Nevada. He would still rather see the ACA replaced with tort reform and market-based overhauls, although he was one of the Republican Senators who was openly critical of some aspects of the Senate efforts to repeal the ACA in the summer of 2017. Heller has repeatedly said that Republicans need to focus on solutions rather than just calling for the ACA to be repealed, and he voted no on both the Obamacare Repeal Reconciliation Act and the Better Care Reconciliation Act in late July 2017.
In the U.S. House, Nevada’s delegation now includes three Democrats and one Republican.
At the state level, Nevada has a Republican governor, a roughly equally divided Senate (but with a slightly Democratic majority), and a Democratic majority in the Assembly. Governor Brian Sandoval is generally opposed to the ACA because of “the individual mandate it places on citizens, the increased burden on businesses and concerns about access to health care.” But in 2012, Sandoval became the first Republican governor to accept federal funding to expand Medicaid starting in 2014, and he’s also continued to urge the Trump Administration to ensure that any changes to the ACA don’t pull the rug out from under the hundreds of thousands of people who have gained coverage in Nevada as a result of the ACA — mostly via Medicaid expansion.
Nevada was also the only state with a Republican governor that opted to run its own exchange in 2014. Unfortunately, Nevada Health Link ran into crippling technical problems early in open enrollment and never fully recovered. In May 2014, shortly after the first open enrollment period ended, the Nevada exchange board unanimously agreed to switch to Healthcare.gov‘s enrollment platform but continue to exist as a supported state-based marketplace. That is still the structure Nevada uses as they head into the fifth open enrollment period in the fall of 2017.
Nevada Medicaid/CHIP enrollment
Nevada’s acceptance of federal funding to expand Medicaid eligibility to 138 percent of poverty has played a significant role in reducing the state’s uninsured population.
Enrollment in Medicaid is year-round, so that number continues to change, making an ever-growing dent in the state’s uninsured rate.
Medicare enrollment in Nevada
Historically, 86 percent of Nevada Medicare recipients qualify for coverage based on age alone – slightly higher than the national average (84 percent) – and 14 percent qualify as the result of a disability.
Nevada Medicare recipients who want additional benefits beyond what original Medicare offers may choose a Medicare Advantage plan instead of traditional coverage. Nearly 34 percent select a Medicare Advantage plan in Nevada, whereas 31 percent of all Medicare recipients are enrolled in a Medicare Advantage plan.
Medicare Part D plans are also an option for Nevada Medicare beneficiaries who want to stand-alone prescription drug coverage. About 60 percent of Nevada Medicare enrollees also have a stand-alone Rx plan compared with 45 percent of all Medicare enrollees.
State-based health reform legislation
Here’s a summary of recent Nevada bills related to health reform: