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January 29, 2015

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Health Care:

Nevada waits to hear the verdict on health insurance

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Two-year-old Miles Russell II takes a tour of the Martin Luther King Health Center with his dad, Miles Russell, during its opening Monday, June 11, 2012, in Las Vegas. The Affordable Care Act included $728 million in grants for community health centers like the Martin Luther King Health Center, which expects to treat 11,000 patients annually.

To those who support the law, it’s called the Affordable Care Act, the hard-fought legislation that reforms a broken system of health care costs that grow too fast and private insurance that covers too little.

Or, in the words of Vice President Joe Biden: “A big (expletive) deal.”

To opponents, it’s Obamacare, and also a big deal. It’s an unconstitutional, anti-business law that inserts too much government into health care, with an over-reaching mandate that forces people to buy a private product.

Perhaps as soon as Monday, the entire debate over health care, its costs and government’s reach in everyday lives may be reignited.

By the end of the month, the U.S. Supreme Court will decide its case on the landmark federal health care law. The court may uphold it. It may uphold part of it. Or it may do away with the thing entirely.

But now, unlike when the bill passed in 2010, the debate is much more than philosophical. Millions of dollars have been spent implementing the legislation. Thousands of Nevadans already are relying on benefits they didn’t have before it was passed. And millions more are anticipating coverage to kick in two years from now.

For Nevada, health care issues are particularly acute. Almost a quarter of non-elderly Nevadans — 545,000 people — don’t have health insurance. That’s the fourth highest rate in the country, according to the Kaiser Family Foundation. Nevada’s children — 16 percent of whom are uninsured — rank worse. The Silver State has the second highest rate of uninsured children in the country.

But getting those people health insurance would come at a cost.

So far, here’s how the Affordable Care Act has — and will — affect Nevada:

MLK Health Center

The Martin Luther King Health Center, a 31,000-square-foot facility offering general medicine and OB/GYN clinical services, celebrates its opening Monday, June 11, 2012, in Las Vegas. The Affordable Care Act included $728 million in grants for community health centers like the Martin Luther King Health Center, which expects to treat 11,000 patients annually. Launch slideshow »

• The Affordable Care Act included $728 million in grants nationally for community health centers, like the Martin Luther King Health Center in Las Vegas, which opened Monday. Officials expect to treat 11,000 patients a year there.

• The state Department of Health and Human Services projects that the law will cost Nevada $574 million between 2014 and 2019. That cost is mostly attributable to tens of thousands of people who are now eligible for Medicaid but who aren’t enrolled. The law’s individual insurance mandate will force them to enroll at an expense that will be borne by the state, not the federal government.

• Almost 750 Nevadans who had been rejected by private insurance companies for having pre-existing health conditions, like diabetes or cancer, are on a federal health insurance plan that was created by the new law. That subsidized health insurance plan is projected to cost $5 billion until 2014, when private insurance won’t be able to discriminate against pre-existing conditions. Nevada’s portion of that is $61 million, and has cost the federal government $13.7 million so far.

• More than 22,000 young adults in Nevada now have health insurance because of the bill, according to the federal Department of Health and Human Services. The federal law allows parents to keep their children on their insurance until they are 26.

• Under the contested law, insurance companies can’t cap lifetime or yearly benefits for the uninsured.

• The federal government has invested millions in community health centers and programs to promote health, in accordance with the new law.

The legal challenge to the law focuses on the mandate that all Americans have health insurance.

Some insurance companies, like UnitedHealthcare, the largest private insurer in Nevada, announced that even if the legislation is thrown out, they will keep some of the new policies in place. UnitedHealthcare, for instance, will still provide preventive health care without co-pays, offer coverage for dependents up to age 26 and eliminate lifetime benefit caps.

If the law is struck down, however, UnitedHealthcare said it likely would not continue providing coverage for children with pre-existing conditions.

With the Supreme Court decision pending, Nevada officials were reluctant to talk about the legislation.

“As the governor has noted before, he believes the federal health care legislation has serious constitutional questions,” said Mary-Sarah Kinner, Gov. Brian Sandoval’s spokeswoman. “He looks forward to the court’s decision.”

Nevada, like other states, challenged the constitutionality of the law after it was passed. Gov. Jim Gibbons initiated the court challenge and Sandoval, a former federal judge, supports the challenge and has said he believes the law is unconstitutional.

The central, most controversial piece of the legislation is the mandate that all Americans have health insurance or face a penalty from the IRS. That provision, if upheld by the U.S. Supreme Court, won’t go into effect until Jan. 1, 2014.

Nevada, despite suing to halt the law, has already made significant progress — and spent a considerable amount of federal dollars — preparing for it.

The Silver State Health Insurance Exchange, created by a bill passed by the Nevada Legislature in 2011, is meant to be a health insurance marketplace, where individuals and businesses can find affordable coverage options. It’s a massive undertaking, requiring an appointed board and staff to navigate the law and federal regulations, some of which are still being passed.

To help with the cost, Nevada has received $21 million in federal grants to establish the exchange.

But it’s not just the state government spending resources to implement a law that may not exist after next week.

A central argument against the health care legislation — one advanced by Republican presidential hopeful Mitt Romney — is that it has hurt the economy, scared businesses into laying off workers and prevented them from hiring.

Tim Wulf, the owner of two Jimmy John’s Gourmet Sandwich Shops in Reno, said “Obamacare was the straw that broke the camel’s back.”

He sold off a third franchise he owned, cut employment at his stores and scuttled plans to expand in the market, he said, in part because of the potential costs and uncertainty in the health care bill.

The best estimate he could come up with was that providing health care to his 94 part-time employees, at its peak, would cost about $80,000 a year.

“Entrepreneurs are planners. They want to pencil out costs. This seems like a moving target,” said Wulf, a former economics professor who spoke with media on a conference call organized by the Romney campaign. “We don’t know what the rules are.”

He now has 68 employees. Almost all are part-time and don’t have health insurance through his company. The stores, he said, are doing well.

But he said there’s still too much uncertainty for him to want to expand.

Other business owners said health care costs had become an increasing burden long before Obama’s health care legislation.

“For the last six or seven years, we’ve been getting less coverage for our employees and having to pay more,” said Ron Nelsen, owner of Pioneer Overhead Door in Las Vegas.

Nelsen, an Obama supporter, has five employees, all of whom he provides with health insurance. One year, his health insurance costs spiked 28 percent.

This year, for the first time, costs leveled off and he received a small business tax credit to help purchase health insurance.

“We bought a little bit better policy for the same price as last year,” he said.

Nelsen dismissed concerns about federal overreach, blaming the insurance companies for increasing costs.

“I need the sheriff to protect me from a bully,” Nelsen said. “For the last 10 years, the bully has been the insurance companies. ... Yeah, I need a sheriff every once in a while. Government is helping regulate a private enterprise that may have gotten out of hand.”

So, what happens to the coverage, the planning and the money already spent after the U.S. Supreme Court releases its opinion?

Not many are willing to even speculate.

“All of those questions have to be answered,” said Marilyn Wills, the governor’s consumer health advocate.

“We can’t comment until the Supreme Court releases its decision,” said CJ Bawden, spokesman for Silver State Health Insurance Exchange.

Instead, business owners, government administrators and patients already relying on coverage are collectively holding their breath, waiting for the decision.

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  1. With or without President Obama's new healthcare act, there is on the horizon a problem that few even discuss.

    "Obamacare will make a bad situation worse" at


    In a report on how to fight pandemics, the March 2012 Discover magazine says the secret to fighting them is "knowing their real cause: disease factories built by people. Ironically, hospitals turn out to be highly efficient disease factories. They allow the proliferation and spread of dangerous germs among patients, and the evolution of those germs to extreme levels of virulence."

    In that same vein, the Journal of the American Medical Association warned us 12 years ago:

    "America's healthcare system is the third leading cause of death in the U.S., causing between 230,000 and 284,000 fatalities per year, behind only heart disease and cancer."

    The report didn't say the third leading cause of death is poor health. It said the healthcare system itself. In other words, our country's third leading cause of death is the army of good-intentioned doctors, nurses, and others whose ultimate duty is to help us avoid death.

    AHA will bring an estimated 32 million more people, mostly young adults, into the healthcare system and countless others into it more often. It's obviously supposed to do that, because Mr. Obama wants to spread the health around.

    Moreover, every day for the next 18 years, 10,000 Baby Boomers will reach age 65 and become eligible for Medicare; many of them will seek healthcare services before losing their employer insurance, and many others who'd had no insurance and had put off healthcare will put it off no longer.

    Finally, we have a obesity epidemic that is growing, especially among the young for whom obesity has jumped from 9% of the adolescent population in 2000 to 23% in 2008, and threatening to overwhelm our health care system. The main threat is the costly diabetes that is often obesity's side effect.

    The upshot is that millions more will interact with the healthcare providers who are, according to JAMA, our nation's third leading cause of death.

    These providers, unless there is a huge increase in their already insufficient number, will be stressed by the increased demand for services. Their error rate is likely to rise.

    Could our healthcare system then become the second leading cause of death? Or even, in the greatest of ironies, the first?

    Do we really know what we're doing? A tsunami is coming.

  2. ACA is only a first step to solving the biggest problem facing Americans. It does not do enough. Eventually, we will have to find a way to Medicare for all. Only this will save us, each and every one of us from dying broke, even those who are currently enrolled in Medicare. Health care costs are rising so fast that Americans have not gotten a raise in ten years. The ACA has begun to slow down the rate of medical cost inflation, but only a little.

    If the Supreme Court throws out the law, then Medicare for all will come sooner, because there will be nothing to prevent HC costs from becoming 40% of GDP, which means all of us will pay more for health care than housing.

  3. The law will stand under the lower court's rulings. The system has failed us yet again by design this time. The ruling will be tied where the lower court rulings will stand.

  4. Conservatives feel that health care is a tool to make money and that the patient exists for the benefit of the medical provider, particularly the executives that run the medical system and can acquire over $100 million/year as income.

    Conservatives believe that it is okay to bankrupt a person, to take their life savings, house, retirement savings in return for a medical procedure. If the procedure works they come home to nothing. If it doesn't, they don't come home but own what the person worked for all their life.

    It is hardly possible to save for retirement anymore because of the procession of one economic recession after another, eating up savings in the unemployment period and paying for uninsured medical costs. Only a few have savings left at the end of their working career.

    It's time to make America a place to live, not sweat and die for the privileged.

  5. Love reading the spin doctors, breaking a person over the cost if healthcare is a conservative way, both parties are equally culpable for the cost and who pays. Healthcare is for profit; all aspects of the healthcare providers and it are those businesses dictate the healthcare costs that are set by insurance industry and the government. It is the system that is flawed where nobody is willing to fix what is broken. If liberals really cared about that the cost is what is breaking people, they'd pass tort reform long ago and wouldn't have passed laws that helped drive the cost up and they surely wouldn't of allowed deregulation of the industry.

    I don't suspect most of the people really understand or they haven't looked at the costs that are paid to lawyers, insurance companies and the cost to government; remove those factors and wall streets, costs will plunge.

  6. Mr. Wiggin, the tea party call for tort reform has one small problem:

    Passing tort reform doesn't actually reduce the cost of providing health care.

    Nevada passed tort reform in 2004, yet the cost of insurance and the cost of care in the state has still grown exponentially.

    Nevada proves you wrong, Mr. Wiggin.

  7. Good post, Political_Pragmatist. If any of you haven't been to your doctor lately, be prepared when you do go and the an EOB for the visit. You will be surprised to find out some things that were always paid for previously, whether in full or in part, are now not covered by your insurance. Just last week I was speaking with the billing department of the community health organization that I go to and the woman told me that daily they are getting "declines" from insurance companies for things that were never questioned before. They do not know if this is because of the ACA or something else, but there is definitely changes occurring daily.

    About 15 years ago, I had a wonderful doctor in Chicago that was on a state-wide committee of doctors who were trying to figure out what to do about the rising cost of health insurance and the most recent changes that insurance companies were making, ie your visit was coded by time - a 20 minute visit, 40 minute visit or 60 minute. THe doctors hated this because they felt, when being forced to have to decide how long to see a patient, they could not give the quality of time needed for each patient. The general consensus of this committee at the time was the insurance industry will someday single handedly destroy our health care system either by making things so expensive that patients will not be able to afford routine procedures, ie a damn stress test, or just deny the test altogether. Not to mention, rising premiums for employers and employees. We're going back to that now, especially for stress tests. Gone are the days you walk on a treadmill with things attached to your chest. It is all nuclear medicine these days and quite expensive.

    And recently, if you all remember reading this, guidelines have changed, thanks to the Insurance companies on who and when should get certain procedures done, whether a stress test or mammograms or even PET scans. It's almost as if all the "preventive testing" is going by the wayside. The burden is going to be on the doctor to decide - should this person get this test because odds are the insurance company will not approve it. Yes, the doctor has the final say in the decision along with patient history but now you have insurance company interests involved in a patient getting quality care. And something perhaps that could save their life. You don't need obvious symptoms.

  8. Shame on Jimmy John's for hiring part time workers instead of full time workers just so he can save money on his health insurance. It is short sighted to think that a part time worker will ever provide the same level of service and loyalty as a full time worker who feels his employer values him.

  9. Ms. Ruth,

    Yes and no. He has to hire what he can afford. He runs a couple of sandwich shops. Insurance would cost you $80,000 per year. Think about how many people he would have to fire to cover that in a sandwich shop?

    It is not like he is making millions and trying to cheat the employees. He has to do what he can to stay open and keep his 63 employees paid.

  10. The problems in health care will not be resolved by spending more for insurance. Some of the problems can be resolved by insisting that insured (and uninsured) seek medical care only when necessary and that there are serious copays. I've had doctors tell me to come back over and over again so they can see the progress of things. Well, if it's resolved, I'm not coming back. If it's getting better, I'll do more of the same--I asked the doctor a few questions when I was there. If it gets worse, I'll consider a different doctor. Why keep going back--for a 5 minute "consultation" that costs $300 or so. MD's need to get used to one-call-does-it-all whenever practical, just like a free clinic would. Consumer-driven insurance plans provide for major medical issues like surgery and serious chronic conditions. The premiums are low and affordable for many employers. But that means many people will pay out of pocket for running to an MD and/or getting an RX for every little thing. Those who don't smoke, eat to obesity, drink to cirrhosis will get to pay their out-of-pocket max for a few years and then insurance will kick in.

  11. Every American should be entitled to the same type of health care coverage offered to EVERY congressman and woman, which we, the taxpayers, pay.

    My health care insurance premium is over $570 a month for myself, and each year the benefits are less, with the premium going up. Now, after meeting a large deductible, I still must pay @ the 80/20 rate.

    Prescription drugs are SO HIGH that I must choose which ones I can do without until I meet my deductible, putting my health at risk. Even though the doctor's office has samples to provide, some won't unless you beg for them. And, my co-pay on my prescription drugs are now off the charts!

    The insurance and pharmaceutical industries are OUT OF CONTROL. Yet, they have the largest lobbying groups. Lobbying should be outlawed as it unbalances the "free market" so many defend.

    The root of the healthcare crisis in this country has to do with insurance companies, their "managed" care and the multi-billion dollar drug industry.

    I want the same coverage as my congressional "representatives" (who do not represent ME, but I continue to pay the price for theirs, and THEY get it all, for life). AND - No one asked me if I wanted any of my tax money to pay for Dick Cheney's new heart.

    ps - I am not obese, not a smoker, take care of my health, and I have never shot a friend in the face, nor made millions in a war created to do such for the few in charge.

  12. orca: You didn't read it or check it out. A low premium for major medical assistance and preventive care. Non-routine visits for sneezes, sniffles, flu, cold, infection, injury are up to you--until you meet your annual out-of-pocket limit. This means you don't run in at the first sniffle but you do go in for whooping cough. And everybody saves a lot of money, except the doctors. Your insurance company does not pay all sorts of people to decide or deny coverage--cause you know it isn't covered. But when you get a serious illness or need surgery, you're covered--might be 80% covered, but you're covered. If you need vaccines, annual physical, preventive tests, you're covered.

  13. Al, your medical plan sounds offensive--high premiums to cover what every body else has and the cost to administer it. We should shoot for LOW PREMIUMS with limited coverage. IF you have serious health issues, you might want a more expensive health plan.... But if we could cut your premiums in half, you could use the savings for that 20% that's not covered. But only if you don't run to a doctor twice a week whether you need to or not. I read somewhere that most Americans (seniors?) are on 10-12 prescriptions. I'm hitting 60 but on zero RX. Oh, many things have been prescribed but I refuse to take much of it. And that keeps my bp about 110/70, my cholesterol good--175 with high trygs and hdl. Reasonable blood glucose, not pre-diabetic. I'm getting a bit chubby but think dna has something to do with that. Have COPD thanks to parents who chain smoked. I do take some OTC for the lungs but I rely on some home remedies to keep my air passages open--might not be able to stay off the meds forever though. Anyhow, what I'm saying is that too many people run to the doctor when they can resolve things without doing that. As for the cost of an RX--thank Congress and the drug companies. Americans pay for all the R&D so the drug companies (with American taxes) can ship the stuff to every third and fourth world nation with indigents--we're paying for HIV/AIDS RX's for most of Africa, malaria treatment and vaccines... Might sound humanitarian but what it really means is that Americans cannot afford their prescriptions.

  14. @Roselenda

    The plan is the CHEAPEST plan offered by my company. Each year the premiums INCREASE and the excuses are: "aging population of the insured" and "more females" - HA! Don't you think I haven't shopped? Pre-existing conditions limit my options outside of a "group" plan.

    Running to the doctors??? Another big HA! I make my choices based on economics, NOT necessity! I am a responsible consumer.

    Without details, you don't know the half of it. Put the blame where it belongs: Pharmaceutical companies and their lobbyists (executives paid more than casino execs!) AND the outrageous "free market" system of the insurance companies!

    If Foreign Aid was abolished, Lobbying was abolished, and "insurance" (insuring they line their own pockets) companies abolished, there would be enough money for a national government plan for all ...just like our so-called congressional "representatives" have.