- Nevada this week became the second U.S. state to pass a public health insurance option plan after Gov. Steve Sisolak, a Democrat, signed the bill into law on Wednesday.
- The state will bid out the business to private insurance carriers instead of doing the work in-house, and will rely heavily on Medicaid managed care organizations, at least at first as it tries to spur participation. Medicaid MCO’s will be required to submit a bid.
- The plan requires premiums to be 5% lower than the benchmark silver Affordable Care Act plan in each ZIP code and, ultimately, premiums must be reduced by 15% over a four-year period. At the same time, reimbursement to providers must not go below Medicare rates.
With a public option unlikely to gain traction in a closely divided Congress, action has shifted to the states.
Besides Nevada, Washington is the only other state to enact a public option insurance plan, though a handful of others are interested in creating an affordable health plan option for residents ineligible for Medicaid but unable to afford a marketplace plan. Insurance under Washington's option went live this year.
Coverage under Nevada’s plan won’t begin until 2026 as the state seeks a waiver from the federal government to enact the plan and capture the savings it could generate for the federal government.
Medicaid MCOs must submit a "good faith proposal," in response to an eventual RFP. Currently there are three Medicaid MCOs in the state of Nevada: Centene, UnitedHealthcare and Anthem Blue Cross Blue Shield.
President Joseph Biden is a proponent of a public option instead of the more disruptive "Medicare for All" proposal, which would dismantle the Affordable Care Act Biden helped usher in under former President Barack Obama a decade ago. Still, Biden left a public option out of his recent $7 trillion budget proposal.
The insurance lobby is strongly opposed to a public option and previously expressed concern over Nevada's plan via an opposition letter dated May 3 addressed to Cannizzaro and the state's Health and Human Services Committee.
Trade group AHIP took aim at the way in which the bill requires premiums for the public option plan to be lower than certain competitive plans on the exchange. AHIP characterized it as arbitrary "government rate setting."