Thursday, April 18, 2013

Nevada's Shocking Health Care... Success Story?!

When we were in Carson City last month, we took a glimpse at Nevada's plan to implement a major facet of the Affordable Care Act (ACA). Despite ongoing federal budget woes and treacherous politics, the ACA (aka Obamacare) has somehow managed to survive... And its health insurance exchanges are still scheduled to start this October.

Against this backdrop and continuing state budget challenges, the Silver State Health Insurance Exchange is set to begin this October. Yet in chugging along to meet this goal, Nevada has done something unprecedented. In this regard, Nevada has actually become a leader in health care policy!

“Nevada is one of the cases we looked to,” said Mike Nunez, executive director of the New Mexico Health Insurance Alliance, a working group that did early-stage fact finding about state health care exchanges before the legislature approved an exchange for New Mexico in late March.

Nunez couldn’t elaborate how Nevada’s example might ultimately resonate in New Mexico, because the board that will make those decisions is now being appointed.

But he hinted at geographic and demographic similarities that made Nevada a more attractive example for New Mexico’s designs than many other states with independent exchanges. Like Nevada, New Mexico has a high proportion of uninsured residents (in both states, approximately 23 percent of the population is uninsured), and a large complement of native American tribes that must be seamlessly integrated into the exchange’s IT system.

“We have limited time and a new law and a new board that’s about to convene,” Nunez said. “We looked at what Nevada had done because as they described things to me, they were available for other states, to save cost and time.”

In Idaho, Nevada’s influence has been far more regular: The state has hosted Idaho representatives eager to see Nevada’s exchange construction in action, and late last year, Silver State Exchange officials made trips to Idaho to brief the state’s exploratory Health Care Exchange Working Group. According to national health care experts, Idaho appears all but poised to copy the Silver State’s example whole, once the membership of their board is finalized this month.

“We contacted them over a year ago…we knew they were ahead of us, so we wanted to ask: ‘What mistakes did you make so that we do not,’” said Tom Shores, state president of the Idaho Association of Health Underwriters and a member of the Idaho Health Exchange Working Group.

So what's been the secret to Nevada's surprising success? The state subcontracted design of the exchange to Xerox. No, I'm not even kidding. The state decided it was easier to use Xerox's existing exchange model than to create one entirely from scratch.

However, it doesn't end there. Nevada has made its own mark on the exchange program. The program is set to be very consumer friendly, as it's integrated with Medicaid and taking a "no wrong door" approach to connecting consumers to the most compatible insurance, whether it's private or public. Nevada is also the first state to fully aggregate premiums instead of just leaving cost calculation to the insurance companies. This should make it even easier for consumers to figure out which insurance policy works best for them.

Amidst all the continuing challenges in fully implementing the ACA, Nevada's health insurance exchange program is already becoming an unlikely success story. And it's not even online yet.

It's amazing what happens when Nevada complies with federal law and actually makes an effort to provide affordable health care to its people. Great things can happen. Perhaps our state should try doing this more often.

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