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.
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:
Robust health insurance market
Three carriers will participate in Nevada’s health insurance exchange in 2016; however, there are 13 carriers in the state’s individual market. Several offer both PPO and HMO options, and Anthem also administers a multi-state plan. Nevada’s individual market health insurance carriers are as follows:
- Aetna (HMO from Aetna Health, PPO from Aetna Life)
- Anthem (HMO and PPO) – available on exchange
- Celtic (PPO)
- Coventry (HMO and PPO)
- Freedom Life (PPO)
- Golden Rule (PPO)
- Health Plan of Nevada (HMO, UnitedHealthcare subsidiary) – available on exchange
- Hometown (HMO and PPO)
- Humana (HMO and PPO)
- Multi-state plan via the OPM (HMOs from Anthem) – available on exchange
- Prominence (HMO and PPO) – available on exchange
- Sierra (PPO)
- UnitedHealthcare (PPO)
- WMI Mutual (PPO)
Across all the carriers, the weighted average rate increase for 2016 will be 9.58 percent, assuming nobody shops around and switches to a new plan for 2016.
Nevada Health Cooperative is a Consumer Oriented and Operated Plan (CO-OP) created under the ACA with a federal grant of just under $66 million. The federal government awarded $2 billion in grants to 22 CO-OPs, and Nevada was one of the states that chose to participate in the program. But Nevada Health CO-OP struggled financially and announced in August 2015 that it would cease operations by the end of the year. Nevada Health CO-OP had about a third of the market share within the Nevada exchange in 2014 and 2015.
Nevada health ratings
Unfortunately, in terms of overall public health when compared with the rest of the US, Nevada ranked near the bottom in the Commonwealth Fund’s 2014 Scorecard on State Health System Performance. Nevada placed 46th out of the 50 states and District of Columbia – the same ranking it received in 2009. Nevada’s Scorecard includes details on how the ratings are calculated.
The state fared better – but still below average – in the 2014 edition of America’s Health Rankings, which placed Nevada 39th in the nation. Key challenges for Nevada include a high percentage of uninsured residents, low per capita public health funding, a low high school graduation rate, low rates of immunization coverage among children, and a high rate of violent crime. The state earns positive marks for low rates of infectious disease, obesity and physical inactivity. In the past year, it saw the rates of preventable hospitalizations and poor physical health days decrease significantly.
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 2015 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 in Nevada rank against one another.
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 has been 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 is still in the Senate, but Heller has replaced Ensign as Junior Senator from Nevada and would still rather see the ACA replaced with tort reform and market-based overhauls. He has said that Republicans need to focus on solutions rather than just calling for the ACA to be repealed; he recognizes that the status quo wasn’t working. In the U.S. House, Nevada’s delegation now includes three Republicans and one Democrat.
At the state level, Nevada has a Republican governor, a roughly equally divided Senate, and a moderate Republican 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 – and is still one of only a few – to accept federal funding to expand Medicaid starting in 2014.
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.
How did Obamacare help Nevada residents?
In 2013, a fifth of Nevada residents were uninsured. By mid-2015, a year and a half after the bulk of the ACA was implemented, that number had fallen by 24 percent, to 15.2 percent.
Medicaid enrollment in Nevada increased by 73 percent from 2013 to August 2015 – 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.
Nevada enrollment in qualified health plans
The exchange in Nevada had four carriers participating in 2014: Anthem, Health Plan of Nevada, Saint Mary’s Healthfirst (Prominence) and Nevada Health Cooperative. For 2015, Time/Assurant joined them. But for 2016, Nevada Health CO-OP will not be selling policies, as the carrier is closing at the end of 2015. Furthermore, Time/Assurant is exiting the individual health insurance market nationwide and will not participate in the 2016 open enrollment period.
As of June 2015, there were 60,879 people enrolled in qualified health plans (QHPs) through Nevada’s health insurance exchange. Of them, 81.7 percent were receiving advanced premium tax credits and 56.3 percent were receiving cost-sharing subsidies.
In late 2013, the Kaiser Family Foundation estimated the potential exchange market in Nevada to be 249,000 residents, and that 155,000 of them would probably be eligible for premium subsidies. Unfortunately, technological problems with Nevada Health Link resulted in 2014 enrollment well below what the exchange had predicted for the first open enrollment. Officials hope to make up ground in the coming years, utilizing Healthcare.gov’s enrollment platform and the state-based exchange’s outreach activities.
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. The ACA called for Medicaid expansion in all states, but the Supreme Court ruled in 2012 that states could opt out, and 20 states have not yet moved forward with any type of Medicaid expansion.
In early 2014, the Kaiser Family Foundation estimated that 49 percent of Nevada’s 621,000 uninsured residents would be eligible for expanded Medicaid or CHIP starting this year, largely due to the more generous eligibility guidelines under the ACA. As of August 2015, net enrollment in Nevada Medicaid/CHIP had grown by 241,064 people since late 2013 – an increase of 73 percent. Enrollment in Medicaid is year-round, so that number continues to increase, making an ever-growing dent in the state’s uninsured rate.
Medicare enrollment in Nevada
Historically, 84 percent of Nevada Medicare recipients qualify for coverage based on age alone and 16 percent qualify as the result of a disability. Medicare spends about $9,691 per Nevada enrollee each year, and the state ranks 35th in overall spending with $3.3 billion annually.
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 32 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 34 percent of Nevada Medicare enrollees also have a stand-alone Rx plan compared with 43 percent of all Medicare enrollees.
State-based health reform legislation
Here’s a summary of recent Nevada bills related to health reform: