Our Turn: Nevada had - and wasted - the perfect Obamacare solution
Daniel Derksen and Will Humble | AZ We See It
Even if the governor vetoed it, Nevada's plan to allow anyone to buy Medicaid coverage may be the way forward for Arizona and the nation.
Last week, the Nevada state Legislature handed Gov. Brian Sandoval an innovative opportunity to replace the Affordable Care Act at the state level. Unfortunately, he didn’t take advantage of the opportunity.
The Nevada Legislature sent Sandoval a bill that would have allowed any Nevadan to “buy in” to their state’s Medicaid program. On Friday, he vetoed the legislation. Had he signed it, and the Centers for Medicare and Medicaid Services approved the plan, any Nevadan could buy Medicaid coverage — regardless of income.
Why we need 'Medicaid for Many'
Assembly Bill 374 would have directed the Nevada Department of Health and Human Services to ask for a CMS Waiver (called an 1115 waiver) to allow any Nevadan to buy a Medicaid managed care plan. Nevadans eligible for an Affordable Care Act tax credit (called an advance premium tax credit) or cost-sharing reductions based on income could have used them to help pay their share of the premium.
Polling shows that most Americans want reasonably priced health insurance regardless of having a pre-existing condition. Nevada’s Medicaid plan would have done that, avoided a complicated health-system overhaul and could be tailored to fit other state programs.
“Medicare for All” is getting a lot of national attention again these days. Perhaps it’s time to add “Medicaid for Many” to the discussion, as the U.S. Senate is poised to vote on a bill in the next few weeks. Medicaid infrastructure exists in all states.
How it could work in Arizona
Arizona’s Medicaid program, called AHCCCS, operates through a CMS-approved 1115 Medicaid waiver. Medicaid is re-channeled through private health insurers through a multiyear bid process. Insurers compete for the Medicaid business, and are assured of enrollees for several years. Consumers are not subjected to the yearly volatility of changes in price, plans and benefits.
Insurers have time to build a contractual network with participating clinics, physicians, hospitals and other health providers; consumers can make sure their provider is participating. Arizona’s Medicaid program has the eighth lowest per-person expenditures of the 50 states, with two million AHCCCS enrollees among our population of seven million.
To make Nevada’s approach work in Arizona, our Medicaid 1115 Waiver needs amendment and CMS approval. With ACA tax subsidies and cost-sharing reductions, the out-of-pocket costs per person would be less than plans currently offered in Arizona’s Marketplace, with far less year-to-year volatility in pricing.
Let's take this debate nationally
Medicaid payment to hospitals and physicians tends to be lower than even what Medicare pays. To assure that there are enough hospitals, clinics, physicians, dentists and other health providers in the network, insurance vendors offering Medicaid plans would have to negotiate more reasonable payment rates with providers.