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How Could Health Care Changes Impact Nevada?

House Speaker Paul Ryan uses charts and graphs to make his case for the GOP's plan to repeal and replace the Affordable Care Act on March 9.
J. Scott Applewhite/AP

House Speaker Paul Ryan uses charts and graphs to make his case for the GOP's plan to repeal and replace the Affordable Care Act on March 9.

Lawmakers in Carson City, as across the nation, are in something of a holding pattern when it comes to health care policy.

As Congress and President Trump try to repeal the Affordable Care Act and replace it with the American Healthcare Act, or AHCA, there is a lot of uncertainty as to what will happen to health care.

One person at the front lines of these discussions in Nevada is Heather Korbulic, Executive Director of the Silver State Health Insurance Exchange. The exchange operates Nevada Health Link, the online marketplace of approved health insurance plans for the state.

Korbulic said 89,000 people got healthcare coverage through the exchange during the last open enrollment period. She said those people would be dramatically impacted by changes proposed in the AHCA. 

"Some of the areas of most concern to the exchange and related to our consumers are related to continuous coverage incentives, which would eliminate the mandates around the individual mandate," she said.

Under the Affordable Care Act, commonly called Obamacare, people have to buy health insurance or a pay a tax penalty, otherwise known as the individual mandate. Korbulic said without that mandate, younger, healthier people are more likely to drop out of the exchange. 

"In order to have a healthy risk pool, you have to have healthy people in the pool," she said.

She said without a healthy mix of younger, healthier people and older, sicker people, premiums will go up for people in the exchange.

Another area of the proposed health care bill that has Korbulic concerned are any changes in tax credits. Currently, people can get a tax credit to pay for health insurance. The credit is calculated based on several factors, including income, location, age and whether a person smokes.

However, under the AHCA, currently under consideration in the Senate, the tax credit will be a flat rate based on age. Korbulic said a 40-year-old making $30,000 a year could see a more than $400 increase in premiums because of the flat rate, but a person over the age of of 60 making the same amount could see a $6,000 jump in premium costs.

"I think you’re looking at a scenario where consumers are going to have less affordable access, and so that will likely mean they’re going to be priced out of the market," Korbulic said. 

She also said rolling back the ACA will have an impact not just on consumers, but for health care providers, insurance companies, clinics and hospitals. University Medical Center -- a public hospital in Clark County responsible for caring for people without insurance -- is, for the first time in many years, operating in the black. The hospital credits the increase in people with insurance, both private and the Medicaid expansion, for improving its bottom line.

Korbulic pointed out that the bill is a draft at this point and many things could change as it makes its way through the Senate. Because there is not a final bill, she is not exactly sure how things will change. She is also not sure what the state would do in response to changes made by the AHCA. She did affirm, though, that any changes to ACA will have an impact to Nevada.

"I think it is safe to say that the Affordable Care Act has brought billions of dollars to our economy and if those dollars were to go away we would see dramatic impacts to our entire health care system," she said.


Heather Korbulic, Executive Director, Silver State Health Insurance Exchange

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Casey Morell is the coordinating producer of Nevada Public Radio's flagship broadcast State of Nevada and one of the station's midday newscast announcers. (He's also been interviewed by Jimmy Fallon, whatever that's worth.)