While Nevada was not a supported of the Affordable Care Act initially, the state ultimately opted to expand its Medicaid program and create it’s own health insurance marketplace, rather than defaulting to the federal government. Both of these actions have been major pluses for Nevadans, as more low-income residents have access to coverage, and uninsured individuals could view local, subsidized health plan options through Nevada Health Check sooner than those using the federal exchanges.
Nevada was one of the 20 states involved in filing a lawsuit attempting to remove the ACA. As the Supreme Court deemed the law constitutional in June 2012, Nevada moved forward with the necessary implementations. The law requires all Nevada private individual health insurers to offer coverage to anyone regardless of their health starting in 2014, to not rescind policies on unjust grounds, to allow dependent children to stay on their parents’ plan until age 26, and to include a core set of benefits in all health plans.
Nevada Health Link: The Marketplace
The health insurance exchange is required by the Affordable Care Act in each state, providing a subsidized addition to private individual health plans. Through Nevada Health Link, visitors can purchase coverage for themselves and their family, or if they are a Nevada small business owner, for themselves and their quaint work force. Each marketplace plan must contain a basic set of benefits and coverage in order to be sold as Qualified Health Plans (QHPs), including essential health benefits and minimum essential coverage, or a plan that pays at least 60 percent of your total medical costs. These plans are an important resource for low-to-moderate income residents eligible for premium and cost sharing subsidies, so they can fulfill the individual mandate.
Nevada organized and created a website for Nevada Health Link from 2011-2013, making coverage available by October 2013. Each plan from the various insurers selling coverage are similar in coverage levels and benefit selection, but vary by premium for each applicant. When the exchange was still being organized, it anticipated it would select EHBs in the following way:
The Plan Certification and Management Advisory Committee will review the ten possible Benchmark plans for Nevada. They will suggest that the state’s package of essential benefits include one of the benchmark plans plus any supplemental coverage to guarantee all ten categories have been fulfilled. The Board of the Silver State Health Insurance Exchange will review the Committee’s recommendation, and send these to the Nevada Division of Insurance. Nevada will forward a recommendation after internal reviews to the Secretary of Health and Human Services, who will ultimately decide on the essential benefits.
The ten Essential Health Benefit categories that must be covered by each Nevada Health Link policy include:
- Ambulatory patient services
- Emergency care
- Maternity and newborn care
- Mental health and substance abuse disorder care, including behavioral health treatment
- Prescription medications
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric care, including oral and vision services
Visit Nevada Health Link for more information about the program.
Many states opposed to health reform, like Nevada, emphasized the massive debt their state government will experience when taking on the expansion. Along with other anti-health reform states, Nevada state agencies made estimates for how much it would cost to take this step. State officials had previously estimated that if they did expand their Medicaid program, it would cost about $575 million over the first five years.
Nevada is contributing greatly to its needy population by expanding Medicaid, as 21 percent of the entire population is without health insurance – approximately 563,000 people. The benefit of doing so is that the federal government supports every state who chooses Medicaid expansion for the first seven years, giving grants and paying for 90 percent of the program costs in the first year, gradually tapering off until 2020. There are currently an estimated 308,000 Nevadans enrolled in Medicaid, with natural caseload growth to increase to about 334,000.
The state projects that 49,000 Nevadans will enroll in Medicaid once the individual mandate is in place, with 20,000 new child residents applying for Nevada Check Up. These figures are for those already eligible but not yet enrolled. Insuring this amount of residents who currently qualify in both programs would cost the state $71 million combined. Medicaid expansion could add an estimated 72,000 individuals to the program if every eligible Nevadan enrolled.
Nevada decided to expand anyway, creating an opportunity for thousands of low-income uninsured residents to obtain healthcare and coverage. Medicaid expansion under the ACA allows adults with or without children earning up to 138 percent of federal poverty to obtain coverage. Those who earn 138 percent FPL or greater qualify for large subsidies on the exchange.
Benefits of Health Reform
For those who still need a bit of persuasion that getting access to health care and health insurance is a better idea than depriving people of it, here are a few reasons health reform works in the favor of the people. While it is true that the individual mandate may seem harsh, there will likely be minimal repercussions for those who do not decide to get a health plan. If your religion is the reason why you are not in favor of buying health insurance, the ACA permits you to speak your mind and get a waiver.
Also, health insurance isn’t so bad after all. If you do decide to buy a plan, in 2014, you have your pick of any plan within your budget regardless of your gender, condition, or medical history. Look-back periods, elimination riders, and premium increases over 10 percent will no longer exist, thus paving the way for a more fair, healthy nation. Of course, this is not a miracle law, and it has had a rocky implementation, but giving people access to health insurance who were previously declined is a milestone. On the Medicaid side, offering coverage to a higher number of low-income Americans who wish to be insured will help immensely.
Essential benefits are also a great deal of help to those who formerly had trouble finding maternity coverage, mental health benefits for a certain condition, or managing their chronic illness. Already in place is the large set of preventive health benefits, now included for free with all health plans. This has helped improve access to routine exams, birth control, mammograms, screenings for other common age-appropriate cancers and illnesses, immunizations, prenatal care, and many more benefits to help insured persons of all ages.