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April 20, 2014

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Nevada Legislature 2013:

Lucky No. 11? Legislature may take another stab at capping ER bills

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Steve Marcus

A patient stands in the emergency room lobby after being treated for a moped accident at Sunrise Hospital Monday, March 25, 2013.

Having an emergency and going to the hospital might be less financially burdensome if the Legislature passes a constitutional amendment this year.

Assembly Speaker Marilyn Kirkpatrick, D-North Las Vegas, wants emergency room bills to be constitutionally capped, a move she says will save constituents from expensive hospital bills incurred when they’re taken to out-of-network hospital emergency rooms.

She said she’s trying to stop situations in which people have an accident, are involuntarily taken to an out-of-network hospital and end up with a massive bill that can put them in bankruptcy.

Assembly Joint Resolution 9 amends the constitution to establish these price caps at 200 percent of the federal Medicare reimbursement rate, but the resolution has no immediate practical consequence because it takes passage during two legislative sessions and majority approval at the ballot to amend the constitution.

But the resolution does have political consequences.

Legislators have unsuccessfully tried 10 times during the past dozen years to establish these health care price caps.

“We are having a hard time as a state dealing with this issue and our constituents are being hurt while we’re trying to figure out how to address it,” said Assemblywoman Maggie Carlton, D-Las Vegas.

During the last legislative session, Democrats passed a health care cost containment bill that Republicans opposed. Republican Gov. Brian Sandoval vetoed the bill. Democrats can now skirt the governor via a constitutional amendment.

Kirkpatrick’s resolution also would need approval in the 2015 legislative session and at the 2016 ballot, but legislators can use this populist measure as a 2014 election issue.

They can also pass the resolution this year and return in 2015 to wield it as a cudgel over the heads of hospitals and doctors groups that oppose the resolution. The threat of passing the resolution a second time could bring these groups to the table to compromise.

During a hearing Thursday, the bill received support from labor unions and large employers, which are seeking to have their insurance plans protected from some high costs when their members are taken to out-of-network providers.

Jeff Ellis of MGM Resorts said the constitutional amendment would protect MGM and its employees from high health care costs.

“Bill charges in this state really have no relation to what a contracted rate is or what a fair and equitable rate is,” he said.

Hospitals and doctors, however, argue that this is no time for the Legislature to meddle in a health care market already rife with uncertainty due to the implementation of Obamacare.

Federal law already says that nobody can be turned away from an emergency room.

But costs can vary widely depending on what hospital patients are brought to when they have an emergency.

Should a woman have a heart attack at a restaurant, she would be taken to the nearest hospital. She may or may not have insurance, and even if she does, that hospital might not have a contract with her insurance provider. So costs can quickly skyrocket.

Hospitals say this is really the fault of the insurance provider.

“The entity that has the power to contract in fact bears that risk of where that patient may be delivered,” said Jim Wadhams, lobbyist for the Nevada Hospital Association.

Bill Welch, also from the hospital association, said that Nevada has made the choice not to support many public hospitals, so the constitutional cap would have a chilling effect on the private sector’s ability to earn a profit.

“I think that that is a pretty clear message that would be communicated and would have significant impact on what hospital services would be provided going forward,” he said.

Legislators took no action on the proposal, but they have less than two weeks to pass the resolution.

The Legislature is scheduled to end June 3.

Democratic legislators said they’re hopeful that they’ll pass the health care cost cap on their 11th attempt.

“We keep having this conversation over and over and over,” said Sen. Debbie Smith, D-Reno. “There is no progress.”

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