Nevada May Become First State To Offer Medicaid To All, Regardless Of Income

Jun 13, 2017
Originally published on June 13, 2017 6:45 pm

Nevadans will find out this week whether their state will become the first in the country to allow anyone to buy into Medicaid, the government health care program for the poor and disabled.

Earlier this month, Nevada's legislature, where Democrats hold the majority, passed a "Medicaid-for-all" bill, and it's now on Republican Gov. Brian Sandoval's desk awaiting his signature or veto. If he does not act by Friday, it will automatically become law.

State lawmakers hope the proposal will give Nevadans a cheaper health insurance option as premiums for individual health insurance rise. The move comes as Republicans in the U.S. Congress are working to roll back the expansion of Medicaid that happened under President Barack Obama.

"With the uncertainty and mixed messages coming from our current federal administration in regard to health care and health care accessibility, there is an absolute need for states to become more reliant on providing insurance options to its citizens," said Assemblyman Mike Sprinkle, who sponsored the bill.

Under the proposal, Medicaid coverage would be offered alongside commercial insurance on Nevada's state-run health exchange starting in 2019. Sprinkle says he's not sure what the coverage would cost. The state would conduct an analysis of the Medicaid program to determine the size of premiums.

They would likely be lower than traditional insurance premiums, because Medicaid reimburses doctors less than most insurance plans and also pays lower prices for prescription drugs.

"If the expansion goes away, I really think this is going to be a viable option for those who lose coverage," Sprinkle says. He estimates about 300,000 Nevadans may enroll.

He says that if the Republican health care bill becomes law, people could use the tax credits in the bill to buy into Medicaid. And if it doesn't, they could still use their tax credits and subsidies from the Affordable Care Act, or Obamacare, to buy in.

To be able to sell policies on the exchange, Nevada would have to get approval from the Centers for Medicare and Medicaid Services in the form of a waiver. Sprinkle says he has had discussions with CMS officials who were open to the idea.

CMS administrator Seema Verma has said she wants to allow states to experiment with their Medicaid programs and make it easier for them to get waivers.

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Republicans in Congress are debating whether to roll back the Obama era expansion of Medicaid that gave many more Americans health coverage. Nevada lawmakers are taking a different approach. They've passed a bill that would open up the state's Medicaid program even more to any resident who wants to buy it. The law, which is now in the governor's hands, essentially creates a public option for health insurance in the state. NPR's health policy correspondent Alison Kodjak is here to talk more.

Hey there, Alison.

ALISON KODJAK, BYLINE: Hey, Audie. How are you?

CORNISH: So Medicaid is traditionally for poor or low-income people, the disabled - right? - children. How would Nevada's expanded system work?

KODJAK: Well, so I talked to the assemblyman in Nevada who proposed this. What he wants is for anybody in the state to have the option to buy into Medicaid. They could buy a policy alongside any other insurance policy that's offered on the Affordable Care Act exchanges. And what he is hoping is that this would be a cheaper option for people because Medicaid reimburses doctors less than most insurance plans and Medicare does.

And it also gets the cheapest prices on drugs. So he's hoping that these plans would be cheaper and offer a new option for people.

CORNISH: All right, you're talking about price, which brings us to the big question of who's going to pay for it, right? It's a joint program, state, federal funding. But you have to administer it, right? That costs money. So do we know how Nevada is going to tackle that?

KODJAK: Well, they don't expect to have to pay for the health care of these people 'cause that's going to be covered, hopefully, by the premiums that the people who buy in pay. There will be some additional administrative costs. And Mike Sprinkle, the assemblyman who proposed this bill, says what they intend to do is come up with a premium and add 1 to 2 percent on it to cover additional costs in the Medicaid program that this will bring on.

So that way, they won't have to ask for additional tax money from either the federal taxpayers or the state taxpayers.

CORNISH: Now, how could Nevada's plan be complicated by the Trump administration's goal of rolling back the Medicaid expansion?

KODJAK: Well, the one thing they would need is they will probably need a waiver, meaning permission from the Trump administration. The Health and Human Services Department runs Medicaid and also runs the Obamacare exchanges. So they would have to ask for permission from them to make this offer. But because they don't need extra funding from the federal government or the state government for this plan to go through as they envision, they're hoping that that will be an easy ask and that the government will grant that permission.

And he has said he's had some talks with CMS, the Center for Medicaid and Medicare Services, and that they seemed open to the idea.

CORNISH: They're open to it. But would they really go along with that? What does your reporting say?

KODJAK: Well, what we've seen so far is that under the current administration, what they have been leaning toward are waivers that really put more requirements on people to get Medicaid, not really looking to expand it. They want people to have to work for their Medicaid, to perhaps pay into Medicaid. The different states who have waivers pending now are putting those kinds of restrictions in place.

So this would be a little bit of a different direction. But Seema Verma who runs CMS has said she's open to having states experiment with the program and see how it goes.

CORNISH: Before I let you go, I want to ask you about the bill being signed because this has been a tough political question for a lot of Republican governors, especially about expanding Medicaid. What are we expecting from Governor Brian Sandoval?

KODJAK: Democratic Assemblyman Mike Sprinkle seems optimistic that Governor Sandoval is going to sign that bill. Governor Sandoval was an early adopter of Medicaid expansion among Republican governors. And like many of them, he doesn't seem to want to take that insurance away from so many people in Nevada.

CORNISH: That's NPR's Alison Kodjak. Alison, thanks so much.

KODJAK: Thank you, Audie. Transcript provided by NPR, Copyright NPR.