After its troubled launch in 2013, Nevada’s health insurance exchange is kicking off its latest enrollment period on Nov. 1 with some long-sought stability and none of the drama that plagued the program in previous years.
Underneath its calm waters, however, are some troubling undercurrents. More than 2,000 miles away at the U.S. Supreme Court, the healthcare law that serves as the linchpin behind Nevada’s exchange — the Affordable Care Act — is facing the biggest threat to its existence since the late Sen. John McCain’s dramatic thumbs down on the U.S. Senate floor three years ago.
It’s a mixed-bag situation for Nevada’s Silver State Health Insurance Exchange. After spending many of its years stuck doing damage control, the program has finally notched a solid string of wins.
Last year, the exchange finally freed itself from the yoke of its hybrid model with Healthcare.gov. The split has given the exchange much-needed flexibility with its operations as a state-based exchange as well as the added benefit of lowering the costs for running the program.
This year, the exchange has also added more coverage options through its Nevada Health Link portal, doubling the number of qualified health plans available in the state to 50.
The additional options include two new carriers — Friday Health Plans statewide and SelectHealth in Clark and Nye counties. Every rural area also has access to a qualified health plan, a big change from just three years ago when Nevada was staring at the prospect of bare counties without any coverage options through the exchange.
It’s a far cry from the star-crossed years that marked the start of Nevada’s health exchange. Following a disastrous launch, the state unceremoniously fired embattled contractor Xerox thanks to a multitude of access and billing issues that hamstrung the exchange. Meanwhile, constant efforts to challenge and water down the Affordable Care Act — also known as Obamacare — led to some carriers bailing out as well as steep cost hikes for the Nevada exchange’s remaining health plans.
“We all remember the Xerox days,” said Heather Korbulic, executive director of the Silver State Health Exchange. “Fast forward to today and we’re seeing a successful transition this year where we’re operating autonomously (from Healthcare.gov).”
Nevada exchange reaps benefits of split from Healthcare.gov
The switch to a state-based exchange from the previous hybrid model could not have come at a better time for Nevada. The increased autonomy immediately paid dividends for the state earlier this year when COVID-19 started to make its presence felt in the state.
As job losses mounted and Nevada hit a record 28.2% unemployment — the highest ever recorded by any U.S. state and higher than even the Great Depression — the health exchange quickly opened a special enrollment period for people who suddenly needed health insurance. The special enrollment period ended up adding 6,000 more people to the exchange.
“The pandemic is probably the worst time to not have access to comprehensive health insurance,” Korbulic said. “With the loss of employer-sponsored coverage for a lot of Nevadans, there were a lot of people interested in the exchange.”
The autonomy of a state-based exchange also comes with other benefits.
As a hybrid exchange that was subject to Healthcare.gov’s policies, Nevada used to have an enrollment deadline of Dec. 15. This year, the deadline has been extended to Jan. 15, giving Nevadans an extra month to enroll and find a qualified health plan.
Anyone who enrolls within that period will have health insurance coverage starting on Feb. 1, according to the exchange. Nevada also added a window shopping option on the exchange, which became available on Oct. 1.
So far Nevada has seen consistent numbers for enrollment and retention. There are about 77,000 people enrolled in the state’s health exchange right now, according to Korbulic. The number does not include the hundreds of thousands of Nevadans that are also benefiting from the Medicaid expansion that came with the ACA.
“The really good news is that for the most part, we’ve been able to keep (our numbers) pretty consistent over the last 10 months, which is sort of not normal from previous years,” Korbulic said. “Usually, we see people fall off in October because they either no longer want to pay or they’ve managed to get a job (with benefits).”
In addition to having more insurance carriers joining the exchange, the program is also seeing a relatively “minimal” cost increase for the coming plan year, Korbulic said. The average rate increase across the qualified health plans in the exchange amounts to about 4.2%. That’s a marked improvement from the 27% increase seen just three years ago as the state struggled with the possibility of seeing bare counties without insurance options in Nevada.
Plans will also continue to be affordable for individuals and families with lower incomes.
“If you have or are eligible for subsidies on the exchange, the rate increases have very little impact on you,” Korbulic said.
‘Obamacare’ facing potential repeal at Supreme Court
The progress enjoyed by the Silver State Health Insurance Exchange, however, comes amid the backdrop of yet another legal challenge against the healthcare law that buttresses the various exchanges nationwide.
This is not the first time that the Affordable Care Act has come under siege. In 2017, Korbulic expressed concerns that exchanges such as Nevada’s will potentially “wither on that vine” following relentless efforts by the Trump administration and the ACA’s opponents to defund or kill parts of the law barring an outright repeal.
The ACA managed to survive a serious threat that year following a dramatic vote on the U.S. Senate floor. At the time, Sen. John McCain made a theatrical thumbs down motion against a “skinny repeal” of key parts of the law as Senate Majority Leader Mitch McConnel stood next to him with his arms crossed.
Now the ACA is facing another challenge in the Texas vs. Azar case, which has made its way to the U.S. Supreme Court. The recent death of Justice Ruth Bader Ginsburg adds even more uncertainty to the ACA’s survival. In 2012, the ACA narrowly survived a 5-4 Supreme Court ruling when Chief Justice John Roberts joined the high court’s liberal wing to uphold the law.
Korbulic described the Texas vs. Azar case as a serious threat that could strike down the healthcare law in its entirety.
“This is the second-closest we’ve been to a full ACA repeal,” Korbulic said of the latest legal challenge to Obamacare.
A repeal of the law would be a disaster, not just for the exchange but for many Nevadans covered by Medicaid, according to Korbulic.
While the Nevada Legislature codified some of the protections from the ACA into state law, such as coverage for pre-existing conditions, the state would still stand to lose billions of dollars infederal money if the ACA is repealed. An executive order signed by President Donald Trump also does not guarantee coverage for pre-existing conditions the same way that the ACA does, according to groups like the Kaiser Family Foundation.
Another key protection that could be lost if the ACA is repealed would be protections against lifetime medical caps on insurance payments, Korbulic said. Prior to the ACA, insurance companies could stop paying out benefits once the cost of care for a patient reached a certain threshold.
Ultimately, everything boils down to cost, not just for states but consumers as well.
“If the ACA is overturned and the state no longer receives the billions of dollars that we receive in Medicaid matching or subsidies … it dramatically changes the game in terms of cost,” Korbulic said. “Also, even if insurance companies are required by state statute to cover pre-existing conditions, those rates are probably going to be so high, it would be so unaffordable that many people will lose coverage.”
A repeal would also boot out a large number of Nevadans from Medicaid, the health insurance program for extremely low-income families. As of September, Nevada had about 256,397 people covered under the ACA’s Medicaid expansion, according to Suzanne Bierman, administrator of the Nevada Department of Health and Human Services. Nevada has about 631,000 people covered by Medicaid overall, according to the Kaiser Family Foundation.
Regardless of what happens at the Supreme Court, people who sign up on Nevada’s health exchange for the upcoming plan year will be covered. It is “very unlikely” that any supreme court ruling will impact plan year 2021, but the ongoing drama surrounding the ACA is admittedly causing a lot of confusion, according to Korbulic.
“Insurance carriers on the Exchange have signed contracts in which they have agreed to participate for the full plan year,” Korbulic said. “We anticipate that any adverse decision against the ACA will take a significant amount of time to interpret and implement.”
What happens after that is more uncertain. In addition to the Supreme Court, the winner of the upcoming presidential election as well as the party that ends up controlling the Senate and the House of Representatives will have more of a say on the future of the healthcare law and the exchanges that depend on it.
“There aren’t a lot of levers that we have control over,” Korbulic said.
Nevada Health Link is offering up to 50 individual qualified health plans through five insurance carriers for the 2021 plan year. Those carriers include:
* Health Plan of Nevada (HPN)
* SilverSummit (Ambetter)
* Anthem HMO Co.
* Friday Health Plans
Health Plan of Nevada, SilverSummit and Friday Health Plans will be offering the same plans that they had last year. Here is a breakdown of the plans’ availability by area:
* All 50 plans are available to Nevada residents in Clark County and Nye County from all five insurance carriers.
* 45 plans are available in Washoe County from HPN, SilverSummit, Anthem HMO Co., and Friday Health Plans.
* 35 plans are available in Carson City and rural counties Churchill, Douglas, Elko, Esmeralda, Eureka, Humboldt, Lander, Lincoln, Lyon, Mineral, Pershing, Storey and White Pine from SilverSummit, Anthem HMO Co. and Friday Health Plans.
* Six carriers will offer 21 Qualified Dental Plans to Nevada residents statewide. They include Alpha, EMI, Delta, Liberty, Best and Rocky Mountain.
To enroll or for more details about available qualified health plans in the state, visit the Nevada Health Link website.