Nevada's Legislature Just Passed a Bold Health Care Model

June 6th 2017

Larry Buhl

Nevada's legislature took a bold step toward single-payer health care on Friday.

The state passed a bill that would allow the its nearly 3 million residents to buy into Medicaid, a public program designed to cover low-income people, regardless of their income.


Nevada’s brief, four-page bill says that anyone who qualifies for tax credits under the Affordable Care Act (ACA) could use those credits to buy Medicaid coverage, instead. Those who don’t qualify for ACA tax credits could use their own money to buy into Medicaid.

The bill’s author Democratic Assemblyman Mike Sprinkle admits that details need to be worked out, such as how much enrolling in the Nevada Care Plan would cost individuals.

Despite using Medicaid expansion as part of the ACA, nearly one out of every 10 Nevada residents still lack health insurance.

The bill is sitting on the desk of Republican Gov. Brian Sandoval, who hasn't indicated whether he would sign it.

An end-run around Washington?

American flag

With the fate of the Affordable Care Act, or Obamacare, in flux, states are stepping up to offer their own versions of public health care options. Democrats in the U.S. Congress have seen Republican’s failure to pass a viable alternative to Obamacare, as an opening to a “Medicare for All” plan, which would open the public health care program for anyone over 65. But that idea, has long been opposed by Republicans, is likely to go nowhere until Democrats re-take one or both chambers of Congress.

Unlike Medicare, Medicaid is administered at the state level, meaning states can generally disperse the funds in any way they see fit. The idea is that Medicaid-for-all would be an economical alternative to private insurance. It would have drawbacks: many doctors do not accept Medicaid patients due to the lower reimbursement rates.

And while other states might replicate the idea, the chances of passage in Republican legislatures – who are notoriously hostile to expanding Medicaid generally – are nil.

Gerald Kominski, director of the University of California, Los Angeles (UCLA) Center for Health Policy, told ATTN: that Nevada’s plan is good because it’s “a public option that was not passed in the original ACA” and that it doesn't require passage of the U.S. Congress.

But he added that Congress could doom the plan if Republicans get their way.

“Paul Ryan has been clear that he wants to cap Medicare and Medicaid, and if that happens then the Nevada plan would fail because they’re counting on Medicaid money that might not exist in the future,” he said.