Nevada legislature passes Medicaid public option

In the midst of all this activity there’s a new idea percolating up in Nevada: letting anyone without health insurance buy into the state’s Medicaid program. This would include people who qualify for Obamacare tax credits, which could be used to pay for the buy-in; in effect, that would make Medicaid a public option — a phrase you might remember from Obamacare deliberations, when it was a Medicare buy-in — for individual insurance purchasers. Because of Medicaid’s low reimbursement rates for doctors and other health-care providers (significantly lower than Medicare), it should provide an economical alternative to private insurance, though at the cost of narrower provider options (a significant number of physicians do not accept Medicaid patients). Medicaid also has a broad range of benefits, with no co-pays or deductibles.

A bill to create this new Medicaid buy-in has cleared the legislature, and is awaiting action by Republican governor Brian Sandoval. It is unclear what he will do, though it is noteworthy that he has long been a staunch supporter of the expanded Medicaid program the Affordable Care Act created. Since the legislation leaves a lot of crucial details — e.g., the pricing of the buy-in and the possibility of cost-sharing measures like co-pays or deductibles — to future state regulation, Sandoval may be in a position to shape the proposal to his own liking. Nevada would also need to secure a waiver from the federal Department of Health and Human Services to implement the buy-in; initial indications are that the feds might not have a problem with it so long as it has no impact on federal Medicaid spending in Nevada.

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Greenbeard said:

This is an unusual one: Nevada's legislature has sent the governor a bill allowing anyone in the state to buy into the state's Medicaid program. That would include people currently buying insurance in the state's exchange, where Medicaid plans would simply be another competing option (the state envisions the ACA's premium tax credits as applicable to those Medicaid buy-in premiums).

Nevada Is Considering a Revolutionary Health-Care Experiment

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In his three-page veto message released Friday night, Sandoval praised the sponsor of the bill for “creativity” in attempting to design a healthcare option for the state’s 2.9 million people, but he ultimately reasoned that there were too many unanswered questions about how the program would work.

He wrote that the legislation was “an undeveloped remedy to an undefined problem” — and that it didn’t get proper scrutiny before it was passed in a short time frame.

The bill was short — just four pages — and its sponsor, Democratic Assemblyman Mike Sprinkle, acknowledged it would require a lot of work if it had become law. That’s why, Sprinkle said, he put an implementation date of January 2019 within the bill’s text. . .

In his message, the governor said the proposal — dubbed Sprinklecare — “does not end the conversation about potential coverage gaps or possible solutions, including Medicaid-like solutions.”

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