For foes of health care exchanges, effort has no traction in Nevada

A letter from 12 U.S. senators and 61 members of the House to the nation's governors, asking them to oppose the creation of health care exchanges under the Affordable Care Act, comes too late to have any effect in Nevada.

No members of Nevada's congressional delegation signed the letter, which says in part: "These expensive, complex, and intrusive exchanges impose a threat to the financial stability of our already-fragile state economies with no certainty of a limit to total enrollment numbers. By refusing to create an exchange, you will assist us in Congress to repeal this violation which will help lower the costs of doing business in your state, relative to other states that keep these financially draining exchanges in place."

Sen. Jim DeMint of South Carolina and Rep. Michele Bachmann of Minnesota are the first names on the letter, signed only by Republicans and dated June 29.

The GOP-controlled House is set to vote this week on whether to repeal the law, but the Democrat-controlled Senate is not expected to consider such a measure.

GOP Gov. Brian Sandoval moved forward in the first days he took office in January 2011 to implement the Silver State Health Insurance Exchange, despite his concerns about the constitutionality of the law. The U.S. Supreme Court last month ruled most of the law constitutional. Nevada was one of 26 states to challenge the constitutionality of the law.

Sandoval announced his intentions in his 2011 State of the State address: "I firmly believe that many aspects of the law are unconstitutional, and I will continue to fight to have them overturned. In the meantime, however, the law imposes many deadlines, and we cannot wait until litigation is resolved. We must also plan for a Health Insurance Exchange so that we - and not the federal government - control the program."

A health care exchange is basically a one-stop shop for purchasing health insurance.

Several governors have said they won't create their own health exchanges, among them Texas Gov. Rick Perry.

The states that have not moved forward to create an exchange include Louisiana, Florida, Nebraska, Alabama, Oklahoma, Georgia, Indiana, Kansas, Missouri, Michigan, South Dakota, Texas, Virginia and Wisconsin.

Nevada's program is well along, and officials say it will have a state-based exchange operational by Oct. 1, 2013. To date, the exchange has been awarded approximately $24.7 million in federal grants to pay for its establishment and implementation.

"Nevada was prudent to begin implementation over a year and a half ago rather than wait and risk federal intervention," said Jon Hager, executive director of the exchange, in a recent news release. "Thanks to advanced planning and foresight, Nevada is positioned to implement a state-based health insurance exchange that is built with the needs of Nevadans in mind."

The U.S. Census Bureau estimates that 21.3 percent of Nevadans, or 563,000 people, are uninsured. The exchange's mission is to increase the number of insured Nevadans by simplifying the purchase and sale of health insurance a transparent, simplified marketplace of qualified health plans.

Nevada's exchange was created by Senate Bill 440 of the 2011 Legislature.