Nevada became the second state in the nation to enact a state-managed public health insurance option on Wednesday, with Gov. Steve Sisolak’s signature transforming a bill that hadn’t even been made public until six weeks ago into law.
Though Sisolak voiced his intent to sign the bill last week, his signature formally ends a more than four-year-long quest to establish a public option in Nevada, though, in many ways, work on the public option is just beginning. Under the new law, Nevada’s public option plan won’t be available for purchase until 2026, giving state officials time to conduct an actuarial study of the proposal to determine whether it will accomplish proponents’ goals of increasing health care access and affordability and at what cost. It also provides time for state officials to transform the still relatively broad-strokes concept into a workable policy and return to the Legislature in 2023 with any changes that may need to be made to the law.
“I’m always looking for ways to expand health care opportunities in Nevada for Nevadans, and that’s what this legislation does,” Sisolak said during a bill-signing ceremony in Las Vegas. “By leveraging the state’s existing health care infrastructure and reducing costs, it is my hope that Nevadans will have improved access to comprehensive insurance.”
Senate Majority Leader Nicole Cannizzaro, who’s expecting her first child this summer and sponsored SB420, nodded to the effect it could have on the state’s youngest residents.
“This bill will help to open up some more doors in critical investments in prenatal and maternal care and Medicaid for Nevada moms and babies right here in our Silver State,” she said Wednesday.
Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) smiles after Gov. Steve Sisolak signed SB420 in Las Vegas on Wednesday, June 9, 2021. (Jeff Scheid/The Nevada Independent)
Heather Korbulic, who as head of the state’s health insurance exchange will have a key role in the development of the public option, said in a statement that she plans to “bring all stakeholders together to outline the actuarial study and conduct a meaningful analysis of the public option as it relates to every aspect of health care throughout the state.”
“In the meantime I’m going to continue to focus on getting Nevadans connected to Nevada Health Link where we have an open enrollment period that runs through August 15th and — thanks to the Biden administration — almost everyone eligible is getting financial assistance,” she said, in a nod to the American Rescue Plan’s expansion of exchange subsidies.
Richard Whitley, director of the Department of Health and Human Services, in an interview last week said the public option isn’t “a single solution” but “does definitely enhance the opportunity for individuals to gain access to health care.”
“I think that as an option for coverage, it definitely enhances that overall framework,” Whitley said.
Under the new law, insurers that bid to provide coverage to the state’s Medicaid population will also be required to bid to offer a public option plan, with ultimate decision-making authority left to the state to decide how many plans to approve. The plans would resemble existing qualified health plans certified by the state’s health insurance exchange, though the legislation would require the public option plan or plans to be offered at a 5 percent markdown, with the goal of reducing average premium costs of the plans by 15 percent over four years.
The public option concept first surfaced during the 2017 legislative session, when former Assemblyman Mike Sprinkle (D-Sparks), introduced a bill to allow Nevadans to buy into the state’s Medicaid program, nicknamed Medicaid-for-all. While an amended version of that proposal, instead establishing a Medicaid-like plan, cleared the Legislature, former Gov. Brian Sandoval ultimately vetoed it.
Sandoval, a health care advocate who earned plaudits from Democrats for being the first Republican governor in the nation to opt into Medicaid expansion under the Affordable Care Act and fought to protect the federal health care law in 2017, said at the time of his veto that the public option proposal was “moving too soon, without factual foundation or adequate understanding of the possible consequences.”
Sprinkle proposed a narrower version of his vetoed bill during the 2019 legislative session, nicknamed Medicaid-for-some, that failed to advance after he resigned from the Legislature facing allegations of sexual harassment. Cannizzaro revived the proposal in the waning days of that session in the form of an interim study of yet another public option proposal — this time to allow Nevadans to buy into the state Public Employees’ Benefits Program rather than Medicaid.
That study, which was carried out by the health policy firm Manatt Health, was released with little fanfare in January as lawmakers geared up for the legislative session during some of the pandemic’s darkest days.
The study — which looked at both a PEBP buy-in proposal and a state-sponsored qualified health plan proposal — found that a 10 percent reduction in insurance plan premiums would translate to between zero and 1,500 uninsured individuals gaining coverage in the first year of the plan’s existence, while a 20 percent reduction would reduce the state’s uninsured population between 300 and 4,800 people. There are about 350,000 uninsured Nevadans.
“These enrollment figures highlight that a 10 percent or 20 percent reduction in premiums may not be enough to substantially encourage the currently uninsured to enroll in coverage for the first time,” the study concluded.
For the next couple of months, the public option remained in the background as lawmakers tackled other health care policies. But the public option resurfaced in mid-April when Cannizzaro confirmed she was working on legislation behind the scenes and started meeting with health care industry representatives to present the concept.
In late April, the proposal was introduced as SB420, this time with the goal of leveraging the state’s purchasing power with Medicaid managed care contracts with insurers to compel insurance companies to provide affordable public option plans, too. Unlike some previous iterations of the proposal, the plan would not be offered by a public insurer — such as Medicaid or PEBP — but by private insurers.
Proponents, including progressive groups like Battle Born Progress, the Progressive Leadership Alliance of Nevada and Planned Parenthood Votes Nevada, threw their weight behind the bill, arguing that the proposal would make health care more affordable and accessible. Opponents, including the Nevada Hospital Association, the Nevada State Medical Association and the Nevada Association of Health Plans, countered that it would do just the opposite, going so far as to destabilize Nevada’s already-fragile health care system.
Specifically, health care providers argued that a provision in the bill setting the floor for rates for the public option plans at Medicare rates — which providers say are better than Medicaid rates but not as good as those paid by private insurance plans — would act as an effective cap. They also pushed back on a section of the bill requiring doctors who contract with Medicaid, the Public Employees Benefits Program and workers’ compensation to participate in at least one public option plan.
Instead, opponents of the bill argued that the state should focus on targeting people who are uninsured but either eligible for Medicaid or for subsidies through the state’s health insurance exchange. Together, those two groups represent more than half of uninsured Nevadans. To that end, they proposed an amendment in the final days of the session to scale back the bill to just an actuarial study of the public concept proposal and to look further into how to get Nevadans already eligible for Medicaid or exchange plans insured. But that amendment that was never seriously entertained by Cannizzaro.
While many of the groups that testified in support of and against SB420 were Nevada-based organizations, the bill also attracted significant national attention, including support from the Committee to Protect Health Care, the Center for Health & Democracy and United States of Care and opposition from the Partnership for America’s Health Care Future, a coalition of some of the health care industry’s biggest names — including the American Hospital Association, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America — as well as the Koch-backed Americans for Prosperity and LIBRE Initiative. Many of those organizations devoted dollars toward their efforts, sending mailers and running ads in support of or against the proposal.
Sisolak’s signature on the public option bill comes as interest in establishing a national public option, as President Joe Biden promised on the campaign trail, appears to be dwindling. Individual states, however, have continued to pursue their own public option proposals. Washington, the first state in the nation to enact public option legislation, has started to offer plans for sale this year and a bill creating the “Colorado Option” passed out of the Colorado legislature on Monday.
ELKO – Assemblyman John Ellison, R-Elko, expects there to be at least one special session of the Nevada Legislature that worries him before he terms out, although the 2021 legislative session that ended May 31 was his last regular session.
“I am a sitting assemblyman until after November 2022. There will be subcommittees and special sessions. One of them will be redistricting, and I heard this will really turn things around. It will change boundaries, and all of rural Nevada will feel the hit bad,” he said.
With new figures from the 2020 U.S. Census, the Nevada Legislature will be establishing new state senate and assembly districts based on population, and Ellison said Tuesday that he did not think “anyone in rural Nevada will like it.”
He said that with so many people moving to the Las Vegas area from California, that just pushes Clark County’s population up more, meaning more representation for Clark County rather than rural northern Nevada.
Ellison said in a phone interview that he expects a special session on redistricting in late summer or in the fall. The Nevada Legislature’s website reports that the U.S. Census Bureau will release redistricting data in legacy format by Aug. 16 and in final format by Sept. 30.
Census figures for 2020 released earlier state that Nevada’s population grew 15% to more than 3.1 million and the reapportionment continued to allow Nevada four seats in the U.S. House.
Nevada’s last redistricting ended up in court in 2011, and the Nevada Legislature remained at 21 senators and 42 assembly members, with two assembly districts within each senate district.
Ellison’s district current extends to the Idaho and Utah borders, to Golconda to the west and includes White Pine County to the south, including Ely and ending in Caliente, with pieces of the district reaching to Lincoln and Nye counties.
Driving to Ely takes three hours and to Caliente, five hours, It also takes a long time to reach places like Jarbidge for special events, but Ellison said state Sen. Pete Goichoecea, R-Eureka, has an even larger district and “he’s on the road constantly.”
Still on the job
Meanwhile, Ellison said he is still awaiting interim legislative committee assignments, and he is continuing to help people in his district with their concerns, especially unemployment compensation issues with the state.
“I’m still doing my job seven days a week until after the election,” Ellison said.
A posting on his legislative page that said he was “honored and privileged to have been your sitting Assemblyman for the last 12 years” raised concerns among those he had been helping in the district that he would no longer be active, according to Ellison.
“I couldn’t have done this without your continued support. I will miss being your Assemblyman and representing you in the Nevada Assembly,” the posting also says because it was his last regular session.
Ellison said he already has heard from several people who have talked to him about seeking his two-year assembly seat when his term is up. He also heard from supporters who want him to seek Goicoechea’s seat when the senator is termed out. Goicoechea was re-elected for a four-year term in November 2020.
Ellison said serving in the Nevada Legislature is not a money-maker. He estimated he has spent $12,000 out of his own pocket already this year. He said freshmen lawmakers are often stunned to realize that legislators are paid a salary for only the first 60 days of a regular session, which runs 120 days every other year.
“If they are in it for the money, they are in for a rude awakening,” he said.
According to the Nevada Legislature’s website, the minimum daily salary for legislators is $130 with increases equal to a percentage increase for classified state employees. They also receive a per diem allowance paid every day the Legislature is in session that is intended to cover lodging, meals and incidental expenses equal to the federal rate for the Carson City area.
“That’s why I live in my fifth-wheel” during legislative business in Carson City, Ellison said.
In addition, legislators receive a salary and a per diem allowance and travel expenses for attending conferences, committee meetings, training sessions and seminars where the legislator officially represents the state or its Legislature, the website states.
Looking back at the 2021 session, Ellison said he was thankful that the compromise on mining taxes kept the net proceeds tax in place because small towns need that money for their infrastructure.
“Mining stood firm. They did a great job,” he said.
The compromise adds an excise tax of 0.75% on mines with gross revenues between $20 million and $150 million and 1.1% on mines making more than $150 million, as well as maintaining the net proceeds tax on minerals capped at 5%.
Ellison also said there “are so many issues out there” that impact citizens, and now that the Democrats control both houses in the Nevada Legislature “everything is about green” issues that often overlook rural concerns.
“The people have to get educated on what’s going on,” he said, adding that he tried to keep those in his district updated but the 2021 session was “so screwed up” with so many freshmen, COVID-19 restrictions, and committee meeting delays.
He said Republican lawmakers fought threats to people’s rights and were able to kill bills that were money bills requiring a two-thirds majority.
ELKO — Development of the Elko Community Health Center, a 30,000-square-foot facility in the East End Mall, is continuing this spring.
The health campus is being developed and operated by Community Health Development Partners, according to Sarah Carroll, vice president of marketing and communications. She said the company aims to provide quality, affordable healthcare to the places and people that need it most.
CHDP focuses on increasing access to specialty medical care in rural, medically underserved communities.
“We are committed to local collaboration,” stated Carroll. “CHDP has partnered with Elko-based Braemar Construction as the general contractor and worked to source local talent to see construction through to completion.”
Jesica Ford, an Elko-based nurse and recent recipient of the nationally recognized “DAISY Award,” has been hired as Chief Nursing Officer for Elko CHC. Dr. John Gull will serve as Medical Director for the facility.
Gull, Dr. Shane Draper, Dr. Quinn Lindstrom, Dr. Andrew Geisler, Dr. James Pappas and Dr. Erik Smith intend to practice at Elko CHC in their respective fields of otolaryngology, podiatry, physical management/pain management, orthopedics and sports medicine and pediatric dentistry.
“In addition to the specialty care provided by the physicians mentioned, Elko CHC is expected to offer specialty medical practices such as cardiology, gastroenterology and ophthalmology,” Carrol wrote.
The remaining physicians who will practice at the 17-bed ambulatory surgery center will be announced soon, along with a variety of open staff positions.
In addition to the ambulatory surgery center, the Elko CHC campus will include offices for physicians; a community space for CHDP’s partner nonprofit, Community Health Development Foundation; and a medical imaging center operated by High Desert Imaging.
The campus is set to open before the end of the year.
Sage Elementary Health and Science Fair:
ELKO – Summer-like temperatures in the mid-90s will return next week, along with the city’s water conservation program.
“The City of Elko Water Department would like to remind Elko residents that from June 15 through September 15 outdoor water conservation practices are mandatory within the City of Elko.”
Elko City Water Code requires that:
Residents are to water lawns on designated days before 10 a.m. or after 6 p.m. in order to avoid watering during the hottest time of the day when evaporation is extreme.
ELKO — A gubernatorial proclamation hails Nevada’s mineral industry as integral to the state’s past and vital to its future, and declares June 6-12, 2021, as Nevada Mineral Industry Week.
“The State of Nevada calls upon educators and state officials to recognize and bring attention to Mineral Industry Week, as an opportunity for Nevadans to learn more about the history of mining in the Silver State and the role it plays in the development of the culture and economy of its people …” the proclamation states.
The proclamation presents statistics related to mining that demonstrate the industry’s contribution to the state and globe.
Nevada produces 20 metals and minerals, accounting for about 11 percent of the nation’s nonfuel mineral production.
As a gold producer, Nevada is fifth in the world, after countries — China, Australia, Russia and Canada. Nevada also is a global leader in the production of diatomite and gypsum.
The industry supports about 15,000 direct employees and about 30,000 related jobs. More than 2,200 Nevada business rely on the mining industry.
The Nevada Mining Association further points out in a YouTube video celebrating Nevada Mineral Industry Week that mining is the state’s original STEM industry, forging careers in science, technology, engineering and math for about 150 years.
The proclamation also recognizes the mining industry for being engaged in Nevada communities through “volunteer work projects, donations to non-profits, and educational programs such as scholarships, mineral workshops for teachers, classroom presentations, career fairs and many other earth-science programs … “
Looking to the future, the proclamation states that “Nevada metals and minerals are required for renewable energy production and utilization, which includes silver for solar panels, copper for electric vehicles, and lithium for batteries …”
Gross proceeds of metals and minerals through mining operations statewide produced $8.1 billion.
Nevada Mineral Industry Week corresponds with the Elko Mining Expo, hosted for the 36th year in Elko.