A wide range of issues play 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
There are 13 carriers in the individual market in Nevada. Several offer both PPO and HMO options, and Anthem also administers a multi-state plan. Three carriers will participate in the exchange in 2016:
- 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 finanancially 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. They rated Nevada 46th out of the 50 states and District of Columbia – the same ranking they gave the state in 2009. Nevada’s Scorecard includes details on how the ratings are calculated.
The state fared better – but still below average – in the 2013 edition of America’s Health Rankings, which placed Nevada 37th in the nation. Nevada’s rating is helped by a low incidence of infectious diseases and binge drinking, a moderate prevalence of diabetes, and a decline in the number of cardiovascular deaths. (Both binge drinking and tobacco use have declined in recent years in Nevada.)
But the state struggles with a low high school graduation rate, low per capita public health funding, and a high violent crime rate. Nevada has seen a dramatic increase in the percentage of children living in poverty over the last decade – from about 9 percent to nearly 23 percent.
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 2014 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 the ACA 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 69 percent from 2013 to June 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 QHPs
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. And Time/Assurant is exiting the individual health insurance market nationwide, and will not participate in the 2016 open enrollment period.
60,879 people had effectuated (in force) private plan coverage through the exchange as of June 2015. 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 June 2015, net enrollment in Medicaid/CHIP in Nevada had grown by 230,924 people since late 2013 – an increase of 69 percent. Enrollment in Medicaid is year-round, so that number continues to increase, making an ever-growing dent in the state’s uninsured rate.
State-based health reform legislation
Nevada’s legislature has been active on health and healthcare reform, including passage of a bill that allows correctional officers to apply for Medicaid on behalf of an inmate who is due to be released. Programs like that are a good complement to Medicaid expansion, as newly-released inmates are often eligible for Medicaid, but may not be aware of it. Here’s a summary of recent Nevada bills related to healthcare reform: