Reveal and retrace
What has Nevada gained from the Affordable Care Act?
“Repeal and replace” has been the Republican Party’s mantra since the Affordable Care Act (aka “Obamacare”) became law in March 2010. But what would a repeal mean, exactly, for Nevadans? That question can’t be fully answered until the GOP’s proposal for a replacement is finalized, and as of this writing, the U.S. Senate is still considering the American Health Care Act, an alternative to the ACA that the House passed in March. Policy experts say that the Senate is likely to significantly revise the bill, a process that may take weeks or months.
But one thing won’t change between now and then: the benchmark of where we are today. To put a law’s repeal in context, you have to understand the effect it had while active — in our case, what Nevada has gained (or lost) under the ACA, particularly since 2012, when Brian Sandoval became the first governor to accept President Obama’s Medicaid expansion offer. (States that did so got federal funding to cover the cost of making their healthcare programs for low-income residents available to more people.)
Here’s a summary of our status in some key ACA areas.
The Silver State Health Insurance Exchange. Health exchanges were envisioned as websites that would do for individual insurance shopping what Expedia has done for travel bookings, and a way to offset the burden of making insurance mandatory for all. Nevada’s Silver State Health Insurance Exchange got off to a rocky start, technologically, but has been going gangbusters the last couple years. As of January 2017, nearly 90,000 Nevadans had enrolled in a health insurance plan through the Silver State Exchange. Its executive director, Heather Korbulic, says it’s unclear what would happen to exchanges under the repeal proposals she’s seen.
Medicaid expansion. Add to those 90,000 people another 300,000 who’ve gotten insurance through broadened Medicaid eligibility, and you have a total of around 400,000 previously uninsured Nevadans who are now covered by a government-certified plan. Ellen Crecelius, deputy director of fiscal services for the state health department, notes that childless adults account for the bulk of the expansion; in Clark County, as of March, almost 112,000 clients, or 77 percent of the state’s total Medicaid caseload, were adults with no children (57 percent of them, incidentally, reported having no income). Most repeal ideas floated so far include eliminating or reducing funds that subsidize Medicaid expansions such as Nevada’s.
Preexisting conditions. Arguably the ACA’s most popular feature was its ban on insurance companies’ practice of denying people coverage based on prior illness or injury. “Of our exchange consumers, based on research we’ve done, 80 percent have a preexisting condition,” Korbulic said on “KNPR’s State of Nevada” in May. Repeal proponents are divided on whether to keep this benefit in a replacement and, if so, how. Critics of one suggested solution, risk pools, characterize it as grossly insufficient.
Premiums. If it seems like your monthly insurance bill has been going up, you’re not crazy; just about everyone’s has. However, the 11 percent average increase seen last year in Nevada for full-price plans pales in comparison to the 25 percent average increase nationwide. And Medicaid subsidies have risen in sync with the cost of those plans.
Finally, it’s worth noting that the Nevada Legislature is considering several bills that would codify certain ACA benefits in state law. But their passage, funding source, and compliance with federal regulations are far from given. The bottom line is, if you like the benefits you’ve gotten through the ACA, your best bet for keeping them is, simply, not repealing the ACA.