Nevada Public Option Takes Proactive Approach, Experts Say

by Peter Johnson

Nevada lawmakers recently passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which will go into effect in 2026.

Nevada's public option bill will require any carrier that participates in the state's Medicaid managed care program or individual exchange to provide a silver- or gold-level public option plan. Premiums for those plans will be set 5% lower than the benchmark silver plan sold on the state Affordable Care Act exchange, and both individuals and small group purchasers will be able to buy into the plan.

Any provider that has a network agreement with the state employee health plan or a Medicaid plan will be required to join the public option plan’s network. Payer industry groups opposed the plan.

"We urge you to address Nevada's uninsured rate by building on the strength of the private market. A government run public option will hurt people who are left behind in the individual market," said Jeanette Thornton, a senior vice president at America's Health Insurance Plans, in testimony submitted to Nevada's legislature on May 4.

Kathy Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, says that Nevada's public option goes further than Washington's, which launched this year.

"It's using some really important leverage to get participation from both plans and providers. It goes way beyond what Washington did by actually requiring plans that are offering Medicaid to make a public option offer. It's a little bit more ambitious," she says.

David Anderson, a research associate at the Duke University Margolis Center for Health Policy, says that he thinks the Nevada plan has a more realistic chance of creating a sustainable downward trend in costs.

"It's aggressive, and it's also very well thought out," Anderson says. He adds that the small-group buy in is one of the most important parts of the bill.

"Fully insured small group is a reasonably good-size market. It has a good amount of stability and fairly low risk," he says. "Fundamentally a carrier is a risk management entity, so low premium levels overall shouldn't do much [to lower profitability] because they should be able to extract that out of their provider network…. [It's] a market segment that they do pretty well in."

From Health Plan Weekly