Tuesday, June 6, 2017

Nevada's Bold Healthcare Proposal

Did you see this news story? https://www.vox.com/policy-and-politics/2017/6/6/15731622/nevada-medicaid-for-all
"Nevada, with little fanfare or notice, is inching toward a massive health insurance expansion — one that would give the state’s 2.8 million residents access to a public health insurance option.
The Nevada legislature passed a bill Friday that would allow anyone to buy into Medicaid, the public program that covers low-income Americans. It would be the first state to open the government-run program to all residents, regardless of their income or health status."
It's not a done deal yet:
"The bill is currently sitting with Nevada Gov. Brian Sandoval, a Republican. His office did not respond to an inquiry about whether he would sign the bill or veto it."
And some providers don't accept Medicaid:
"In Nevada, Medicaid pays 81 percent of Medicare rates. This has the advantage of keeping Medicaid a relatively low-cost program per person — but also the disadvantage of some doctors deciding not to accept Medicaid’s lower rates."
It is likely that this plan would compete in the marketplace with private insurance, which is sure to raise some hackles in that industry.  However, with insurers bailing out in droves, they can't complain too much, and it does open up some options for people.
Since states vary a lot in their Medicaid plans, it isn't a template for national coverage.  But opens the window for individual states to try it:
"As to whether other states might follow the Nevada example, that largely depends on what outcomes it has. If it increases coverage significantly at little cost to the government, state legislators elsewhere would likely take notice. But if it ends up covering few people or increasing government costs, Nevada could become a cautionary tale."


  1. This is interesting. It could be a backdoor way to arrive at a single-provider system. Up to now, people thought the shortcut would be to expand Medicare, not Medicaid. I still can't see how it works without a universal insurance mandate, like other countries and Romneycare and Obamacare all have -- the very thing that gives Republicans the vapours.

    Unagidon, where are you? We need you?

  2. unagidon here. Didn't notice this one.

    I think this effort to make Medicaid available for most people will fail, for two reasons. First, Medicaid is partially supported by Federal funds (on the average, at about 50 percent). And we know who runs the Federal government right now. Trumpcare cuts funding for Medicaid, even though they have produced the "flexibility" carrot of saying that these diminished funds will be distributed as a string free block grant. I don't think that Nevada is at a point where they can fund a Medicaid expansion on their own.

    Second, I can't find what the Medicaid reimbursement rate is for providers in that state. Medicare typically pays less, or even much less, than Medicare does. I did find a article from a couple of years ago stating that Nevada doctors were looking for a raise in reimbursement levels, since they had not been changed since 2001. But I can't find anything telling me what happened. This should tell us, however, that reimbursement rates are low. Opening Medicaid to millions more people won't work if the providers refuse to accept it. And this is the real problem with Medicaid for all. It pays too low. It relies on the secret subsidy attached to commercial premiums. A massive expansion of Medicaid erodes that subsidy and makes it worthless.

    1. I'm afraid you are probably right. I wasn't seeing how it could fly without a huge infusion of money. And a huge infusion of money isn't what we are seeing from this administration. Well, we are; just not for healthcare.