Las Vegas Sun

March 28, 2024

Editorial: Seeking some creativity

E very two years when the Nevada Legislature meets there seems to be a new challenge facing it that involves health care.

For example, in 2003 and 2005 the Legislature approved funding to build a state psychiatric hospital in Las Vegas. But the facility already is overcrowded, and too many of these patients are ending up in area emergency rooms.

The biggest, and possibly most daunting health care issue looming over this year's legislative session is the lack of health insurance for Nevadans.

At least 450,000 Nevadans lack health insurance, ranking us near the bottom nationally among the states, and another 200,000 rely on the struggling Medicaid system. Still, this situation is not beyond hope and could change for the better if Nevada lawmakers are willing to consider some innovations.

The National Conference of State Legislatures, which provides technical assistance and research for state lawmakers, shows that many states are finding solutions through measures that spread the responsibility of paying for health coverage among providers, insurers, employers and the patients themselves.

A 2003 law in Maine seeks to attain universal coverage for residents by 2009. Last year Massachusetts and Vermont passed measures that also seek universal coverage for all residents. Lawmakers in Illinois and Pennsylvania passed measures in 2006 that guarantee coverage for children. Louisiana Gov. Kathleen Blanco and California Gov. Arnold Schwarzenegger are proposing universal coverage in their states.

In addition, the National Conference of State Legislatures reports, Arkansas, Kentucky, Montana, Oklahoma, Rhode Island and Tennessee have adopted new laws or programs that subsidize or reduce the cost of health insurance for small employers.

Using federal money to subsidize health insurance for small businesses and requiring businesses that do not offer health benefits to employees to pay into a state-run program, from which employees can then purchase coverage at reasonable prices, are hallmarks of these programs and proposals. Some states also penalize residents who refuse to acquire insurance that, in the case of Massachusetts, can cost as little as $3 per month.

Schwarzenegger's proposal, unveiled earlier this month, has gained a lot of attention because it calls for nearly universal coverage for Californians. Some of the provisions are certain to face stiff opposition, such as requiring doctors and hospitals to pay small percentages of their profits to help cover what will result in higher reimbursements from the state's Medicaid program. While these reimbursements will be higher, they still will be less than the care actually costs to provide, meaning that doctors and hospitals still will have lower profits.

Insurance companies likely will fight Schwarzenegger's proposal that would prohibit the companies from refusing to cover people because of age or preexisting conditions and that would require that 85 percent of insurance companies' profits be spent directly on health care services.

In Nevada. subsidizing universal coverage, as Massachusetts will do, would be difficult because Nevada has no state income tax. Massachusetts' program will give a tax credit to residents who pay for health insurance and will withhold money from those who haven't bought any coverage. The withheld money will help pay for the state's program that offers low-cost coverage to those who cannot otherwise obtain it.

Still, some parts of other plans - such as subsidizing insurance for small businesses and asking all stakeholders to pay into one system that would lead to universal coverage through a low-cost health insurance program - could have potential in Nevada. This doesn't have to divide down party lines. Republican governors are taking the lead on this issue - Massachusetts Gov. Mitt Romney is a Republican, as is Schwarzenegger.

It should be clear to Nevada's legislators, whether they're Republicans or Democrats, that people without health insurance must seek medical care in emergency rooms - the most expensive type of treatment there is. Taxpayers and people with insurance are then left to pick up the tab.

The work other states have done in the past two years to curtail such costs provides the governor and the Nevada Legislature with an opportunity to expand health care coverage without having to start from scratch.

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