Universal health care not a priority

Monday, April 17, 2006 | 7:24 a.m.

Assemblywoman Sheila Leslie has a simple answer for why Nevada is unlikely to follow - at least not anytime soon - Massachusetts' lead in passing a landmark law requiring all residents of the state to have health insurance.

"Everybody in Nevada wants somebody else to pick up the tab," the Reno Democrat said. "Problems don't get solved here until it's a crisis of epidemic proportions."

By that standard, many Nevada lawmakers and others apparently do not consider having nearly one in five residents without health insurance - a dismal ranking that places Nevada near the bottom nationally - to be a crisis of that magnitude.

Yet.

Although other states already are closely examining Massachusetts' answer to one of the most vexing health and economic issues facing the United States and its aging population, Nevada is not among them.

The Massachusetts law, signed last week by Gov. Mitt Romney, requires all residents to have health insurance, to be funded primarily through existing Medicaid funds and the $720 million a year that the state now sets aside to pay the hospital bills of uninsured patients.

Additional funding might come via a $295 annual fee per employee for businesses with fewer than 10 workers. Although Romney eliminated that provision, legislators have vowed to reinstate it.

Hailed by supporters as a way to provide health coverage to 95 percent of Massachusetts' 550,000 uninsured residents - all but the small percentage who fail to comply with many government programs - the measure also is expected to reduce overall medical costs and improve hospital efficiency.

The plan drew bipartisan support in the legislature as well as widespread backing in the business community, the latter growing after a proposed 5 percent payroll tax on businesses that failed to offer health insurance to employees was scuttled.

"This was basically a confluence that was a once in a lifetime opportunity," said Anne Dufresne, communications director for Massachusetts Senate President Robert E. Travaglini. "Both parties recognized that if we blew this opportunity, it might never happen again."

That opportunity is not yet on Nevada's political horizon.

"There is a big divergence between Nevada and Massachusetts," Leslie said. "They have been working on this for quite some time and have taken a lot of steps along the way."

Leslie, a member of the Legislative Committee on Health Care, pointed to expanded coverage of Medicaid and other programs in Massachusetts as factors that make a mandatory plan feasible there. Nevada, however, traditionally ranks near the bottom in coverage for such programs.

The percentage of residents without health insurance also is much higher in Nevada than in most other states.

In 2004, the most recent year for which data is available, only five states had a higher percentage of uninsured residents than Nevada's 18.5 percent rate, according to U.S. Census Bureau figures. That translates to more than 400,000 Nevadans without health insurance.

The uninsured rate in Massachusetts, where the population is nearly three times that of Nevada, was 11.7 percent.

While that is well below the national average of 15.7 percent, Massachusetts has seen its share of uninsured residents rise steadily since 1999, when it was 8.9 percent.

That trend prompted federal officials to give Massachusetts lawmakers until July to develop a plan to halt the increase or risk losing $385 million in annual Medicaid funding.

Federal Medicaid officials, however, insist that reports that the funds were in serious jeopardy were overblown.

"While that (losing funds) was a possibility, the funds were not contingent exclusively on this program," said Mary Kahn, spokeswoman for the Health and Human Services Department.

"The administration encourages states to find ways to cover the uninsured, and then we make sure it is consistent with the goals of the Medicaid program."

One reason that Nevada has not faced similar scrutiny, despite its high rate of uninsured, is because it has not requested as much Medicaid money as some other states, Kahn said.

All states must use Medicaid funds to cover certain groups, including children not covered with private insurance and most uninsured people living at or below the poverty level. States also can seek federal funding for optional programs to expand coverage.

Nevada, which has chosen to focus primarily on mandatory programs, has budgeted about $1.3 billion for Medicaid this year, compared to the more than $7 billion that Massachusetts spends on required and optional programs.

Beyond the humane objective of providing adequate health care for residents, the Massachusetts measure also aims to alleviate some of the burdens placed on the state health care systems by the uninsured.

Patients without health insurance often use hospital emergency rooms for illnesses that could better be handled by routine doctor visits. As a result, states are forced to eat millions of dollars in unpaid medical bills from uninsured patients.

Various government programs - all ultimately funded by taxpayers - reimburse hospitals for treatment of uninsured patients, said UMC spokeswoman Kristina Zemaitis.

While the economic, medical and social consequences of the health insurance issue are as severe - if not more so - in Nevada as in most other states, Leslie and other legislators do not expect the Massachusetts plan to serve as a model for the Silver State.

Sen. Joe Heck, R-Henderson, a physician, said the state should focus for now on fixing other health care issues before considering mandatory insurance.

"Right now we have a lack of providers and a shortage of doctors and beds," Heck said. "I don't think going around penalizing businesses is the silver bullet to solve our health care problems."

Businesses, however, would not be the only ones penalized under the Massachusetts bill.

Individuals with access to health insurance who elect not to get it will be required to pay a fee equal to half the cost of an annual health insurance plan. While some Nevada legislators say that idea is not likely to fly here, they think it has merit.

"The word mandatory is already a taboo in Nevada for most policymakers," Leslie said. "But this ... seems like a reasonable consequence for not getting coverage."

Even so, the absence of the kind of business backing found in Massachusetts would be a formidable obstacle to any similar plan in Nevada, Leslie said.

"We haven't seen willingness from the business sector to pay for that kind of program here," Leslie said. "That's part of that Nevada mentality where we want services but don't want to pay for them."

Christina Dugan, vice president of public affairs for the Las Vegas Chamber of Commerce, said the issue is more complicated than that.

"We're open to policies and issues that add people to the insurance rolls." Dugan said. "Our concern is the penalties that can be placed on businesses."

Costs such as the proposed annual $295-per-worker fee for small businesses, Dugan argued, are an added burden that could discourage some small firms from expanding.

Small-business owners in Massachusetts, state Senate president aide Dufresne noted, were among the most reluctant to embrace the legislation.

"They have some concerns, and rightfully so, that affordable insurance policies have yet to be put together," Dufresne said. "Some skeptics think insurance companies will have a problem offering these affordable policies."

It is important to see how such issues are resolved before the Las Vegas chamber can decide whether to support a similar bill in Nevada, Dugan said.

One possible solution for some Nevadans that has received support among business leaders and legislators alike is a plan by Assemblywoman Barbara Buckley, D-Las Vegas.

The proposal would use existing state resources to help provide health care coverage for small-business employees who want it. Employers and workers also would contribute to the plan, with the state providing a match that could be gradually increased annually.

A similar program passed during the 2005 legislative session fell apart when federal funds counted on to help bankroll the initiative failed to materialize.

"I think we should focus on getting health care for people who want it first," Buckley said. "Nevadans are by and large independent and don't like the government forcing things on them."

Jan Gilbert of the advocacy group Progressive Leadership Alliance of Nevada (PLAN) said while there has not been much organized support for a mandatory health insurance initiative, there are groups dedicated to expanded health insurance coverage.

"When someone comes up with creative programs such as the one championed by Assemblywoman Buckley, we show our support for them," Gilbert said.

"We support all state programs that access federal dollars. One thing that is attractive about the Massachusetts plan is that almost everyone is covered through insurance, and that seems to be a less expensive option."

Although there is speculation that other states may seek to quickly imitate the Massachusetts law in tackling their own health care challenges, some observers expect most states to adopt a wait-and-see approach.

"I don't think this will open the floodgates," said Richard Cauchi, program director of the National Conference of State Legislators. "Other states will likely see what works, then seek a broad consensus and do what makes sense internally."

Some state legislators elsewhere, however, are not waiting to see how Massachusetts' program works before moving ahead.

A Maryland lawmaker has introduced a measure that would require all employers to either pay 4.5 percent of payroll as health benefits or contribute toward a health insurance fund. Illinois, Maine and Tennessee are among eight other states exploring some type of major health insurance reform.

Hawaii, which leads the nation with more than 90 percent of residents insured, already requires businesses to provide health insurance. California legislators passed a bill requiring that state's largest employers to offer health insurance in 2003, but voters later overturned that law.

Nevada, though, clearly will not be among the first wave of states to examine whether Massachusetts helps to solve a problem common to most.

There are no current plans, legislators say, to introduce a comparable measure in next year's session. That means that unless there is a change of heart, it likely will be at least 2009 before similar legislation is even considered in Nevada.

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