State moving on health care exchanges

While Nevada remains at the bottom of states for the provision of health care to its uninsured and underinsured population, the state is proceeding with plans for the implementation of SB 440, which sets up the exchanges mandated under the 2010 health care reform law.  

During a recent presentation sponsored by the Northern Nevada League of Women Voters, Marilyn Wills, director of the Office for Consumer Health Assistance, said the state has been on track with implementing the many reforms that have already gone into effect, and preparing for those that will be phasing in over the next several years.

Wills's office assists Nevada residents seeking access to health care and with questions about benefits, insurance and billing. With the high unemployment rate in the state, her office has been handling a lot of phone calls from people seeking help accessing health care. According to a recent census report, 841,00 Nevadans - about 32 percent of the population - were uninsured during 2007-2008.

"This has been huge in the past couple of years," Wills said. People have lost jobs and homes, not being able to cover their medical bills. Her office does its best to help connect people with resources, but there just is not enough out there to address the need, she said.

Wills told the story of a 22-year-old her office is working with who needs vital surgery, but because she has some income from disability and has a pre-existing condition, she won't qualify for any programs until October. Wills said many others are in the same situation. Some of these people will receive help soon under the new health care law, and some will have to wait until 2014, when most of the regulations will be in effect.

Her office has already seen some of the reforms go into effect: children under 26 being able to remain on their parents' policy; recent eligibility for coverage for pre-existing conditions for some people who have been uninsured for over six months (Willis said that some 16,000 Nevadans were expected to qualify under this program, and encourages people to call her office for information); and new provisions governing coverage of preventative care. Also, Medicare recipients have recently seen some improvements in prescription drug coverage.

Wills outlined some of the reforms that will have the greatest impact on Nevada residents:

• People with pre-existing conditions can no longer be denied insurance; although most adults will have to wait until 2014, some are now covered or will be soon.

• Medicaid eligibility will increase to 133 percent of poverty level, which will help gain access for care for millions of Americans.

• There will be stricter rules governing premium increases, and the health insurance industry will be under stricter scrutiny.

• Health insurance policies will be required to cover certain things, and the most basic policies will be comprehensive.

One of the biggest tasks is setting up the exchanges - in Nevada's case, the Silver State Health Insurance Exchange, which will serve as a marketplace for people to buy insurance. The exchanges will provide transparency (they will have to provide consumer satisfaction information, complete rate and enrollment information) and give consumers a "one-stop shopping" approach to purchasing the mandatory health insurance.

"Rate review will be a big part of the reform," Wills said.

The exchanges will offer four levels of insurance coverage: bronze, silver, gold and platinum levels. The most basic plan will be required to cover certain essential benefits, including prescription drugs, emergency hospitalization, mental health, rehabilitation, lab work, chronic disease maintenance, oral health and vision. The complete list is still being developed, she said. Subsides for people earning under 400 percent of poverty level will be available, at a small percentage of the annual cost of the premium.

Nevada is one of 26 states that have joined in a lawsuit against the health care law. A recent ruling that the mandatory purchase of insurance is unconstitutional, as it constitutes an inappropriate exercise of congressional authority, means that the Supreme Court will be making the final ruling regarding this key piece of the legislation.

Wills said that despite the ruling, Nevada will continue with implementation procedures, and she wants Nevadans to be involved. Consumer focus groups are being formed, and her office wants to hear from people having difficulty gaining access to health care, as this will help document where people are falling through the cracks.

For more information, to participate in focus groups, and to register concerns about health care access, people can call the state Office for Consumer Health Insurance Assistance at 888-333-1597.

To calculate estimated payments for health insurance and eligibility for subsidies under the health care law, people can go to www.kff.org/healthreform/upload/7962.pdf.