The Nevada state legislature has been working in fits and starts toward an innovative healthcare reform effort, and finally reached the milestone of passing it. The idea seems obvious in its simplicity—the option for everyone to buy in to Medicaid. Medicaid would become the public option on the state's health insurance exchange, if Republican Gov. Brian Sandoval signs the bill into law.
Nevada’s bill to allow a broader Medicaid buy-in is short, running just four pages. It would allow any state resident who lacks health insurance coverage to buy into the state Medicaid program, which would sell under the name the Nevada Care Plan.
“There is no way people can be productive members of society and take care of their families if health care is a privilege and not a right,” says state Assembly member Michael Sprinkle, who introduced the measure. “That’s really where this bill started, thinking through, how do we make health care a right in our state.”
Under his bill, people who qualify for tax credits under the Affordable Care Act would be able to use those credits to buy Medicaid coverage instead. People who don’t qualify for anything would be able to use their own money to do the same. The plan would likely sell on Nevada’s health insurance marketplace, making it a public option to compete against the private health insurance plans also selling there.
The buy-in coverage would be pretty much identical to the coverage traditional Medicaid provides, although it would not cover emergency medical transportation (a benefit of the program tailored to the low-income population it traditionally serves).
Things like premium levels or deductibles and copayments haven't been determined, expected to be hashed out with the governor's office and an existing legislative working group should Sandoval decide to approve the plan. It would also require a waiver from the Trump administration, and that's a big unknown. But the administration and congressional Republicans have continued to insist that what they're doing to Medicaid is to change it to provide more state "flexibility," so this plan would kind of force them to show whether they really care about state flexibility or that's just an excuse to gut the program financially.
It's an intriguing idea, though, and one that could bring a public option to any state that wanted to try it, which could happen much, much faster than waiting for the federal government to get to the point where Medicare for all is politically feasible. In fact, a number of states turning to the Medicaid option might just help break down some of that political opposition. If politics in the United States ever becomes rational again.
Remember, Canada got to a single-payer system through its provinces, with Saskatchewan and Alberta leading the way. Because the Medicaid program is a federal/state partnership, it offers states much more leeway for structuring something like this. Because of that degree of flexibility, there is some disparity among the states in what they choose to prioritize, so the actual structure of a Medicaid-for-all program—what's covered underneath it, what costs, deductibles, etc. would be—would likely vary from state to state. There are lots of variables here for its potential success, a primary one being whether healthcare providers would accept a big new influx of patients coming in with the low reimbursement rates Medicaid offers. But if Nevada moves forward with this and does it successfully, it could pave the path to truly universal health care.