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.
Nevada continues to see improvements under the ACA, with exchange health insurance enrollment doubling from 2014 to 2016 and monthly Medicaid enrollment increasing by 83 percent.
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. This ranking was based on health indicators related to:
- Access (50th)
- Prevention & Treatment (51st)
- Avoidable Hospital Use & Costs (18th)
- Healthy Lives (36th)
- Equity (39th)
If 275,161 more adults 56,128 more children gained health insurance, Nevada would improve to the level of the best-performing state. Nevada’s Scorecard includes additional details on how the ratings are calculated.
The state fared better in the 2015 edition of America’s Health Rankings, which placed Nevada 38th in the nation. Again, its high percentage of uninsured population proved among its biggest public health challenges – Nevada ranks 48th for this measure. The state ranks 50th for public health funding and 47th for its number of primary care physicians.
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 in Nevada rank against one another.
How has Obamacare helped 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.
Plan rates, carriers for 2017 open enrollment
Nevada’s federally supported state-based exchange will continue using HealthCare.gov for 2017 open enrollment. All carriers that offered exchange plans to Nevadans will continue to do so in 2017. They include:
- Health Plan of Nevada (UnitedHealthcare’s HMO)
- Prominence (formerly Saint Mary’s HealthFirst)
- Anthem BCBS (HMO Colorado/HMO Nevada)
- Anthem BCBS (PPO, also called Rocky Mountain Hospital and Medical Service, Inc.)
Rates for Nevada’s on- and off-exchange plans remain under review. Final plan offerings and premiums for 2017 will become available on or before Nov. 1, 2017, when open enrollment begins.
At ACASignups, Charles Gaba calculated the overall weighted proposed rate increase for Nevada’s entire individual market to be 15.02 percent for 2017 – lower than the national average so far.
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.
On March 31, 2016, effectuated enrollment for Nevada’s exchange was 79,876. Of those enrollees, nearly 90 percent were 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 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 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.
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: