Rural Nevada to lose all Obamacare plans next year

RENO, Nev. — Blaming the uncertainty over health care reform in the Senate, insurance carriers will stop offering plans under the Affordable Care Act in nearly all of Nevada’s rural counties.

In total, about 8,000 Nevadans will lose their insurance next year with no options to buy a different subsidized plan on the federal health exchange. More than 5,000 of the people affected live in three counties and Carson City, considered an independent city that is the equivalent of a county, near Reno.

“My administration is working diligently to identify solutions to ensure there is, at the very least, a safety net available to rural Nevada residents who will be left without any options for coverage in the wake of these devastating and unfortunate decisions,” Gov. Brian Sandoval said in a written statement. “The reduced footprint of carriers on the exchange ... is unacceptable.”

Sandoval said he also has communicated the news to Health and Human Services Secretary Tom Price. 

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The news shocked members of the Silver State Health Exchange board, who decried the Senate's efforts to repeal the Affordable Care Act. Heather Korbulic, director of the state-run insurance marketplace, described the situation as a “health care crisis for rural Nevada.”

“It is not too late for our carriers to still work with us,” Korbulic said. “We are continuing to work collectively to identify other potential solutions for the customers impacted in the event we cannot provide an on-exchange solution.”

The deadline for insurance carriers to apply to provide plans on the federal health exchange passed two weeks ago with no applications to cover Nevada's 13 rural counties and Carson City, said Glenn Shippey, an analyst with the state insurance commission. Anthem is the only company that now sells plans on the exchange in those areas.

That means residents in Clark, Nye and Washoe counties will be the only Nevadans able to buy individual and family plans later this year that are eligible for federal subsidies on the exchange next year. Clark County contains Las Vegas; Nye County, where the federal government owns almost 98% of the land, is adjacent to Clark County; and Washoe County contains Reno;

Across the USA, about two dozen counties in Missouri, a dozen and a half in Ohio and four in Indiana also are at risk of having no insurance companies available on the federal exchange for 2018. That is more than 60 counties in four states where almost 42,000 people are now enrolled, according to the Kaiser Family Foundation.

Prominence, one of Nevada's three carriers in the exchange, decided to pull out of the exchange entirely. Prominence sold plans in Clark and Washoe counties and Carson City.

The changes will affect about 13,000 Nevadans who now have plans on the exchange.

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A new state law gives insurance carriers some flexibility with their applications, meaning some companies potentially could change their minds about selling in rural Nevada, Shippey said. Participation for 2018 won't be finalized until this fall.

Sandoval said he is working with the insurance commissioner in an attempt to persuade the carriers not to leave the market.

Florence Jameson, chairwoman of the exchange board, pleaded with the carriers to reverse their decisions to abandon rural Nevada.

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“They would truly be such heroes,” Jameson said. “If they could perhaps break even or take this as a loss, they would be a hero for our Nevadans.”

At issue is the current Senate bill, which eliminates the mandate that individuals purchase health insurance and reduces the subsidies paid directly to insurance carriers for low income families who enroll through the exchange. It has become nearly impossible for companies to even write rates with the uncertainty of the cost-sharing provisions in the Affordable Care Act, Korbulic said.

“Enforcement of the individual mandate is critical to the ongoing enrollment on the exchange,” Korbulic said. “If the federal government does not enforce the federal mandate, consumers who are healthy are more unlikely to purchase health insurance. ... and that drives up the costs for everybody.” 

Changes that Senate Republicans have proposed would make plans offered in rural Nevada so expensive that few could afford them, Nevada Insurance Commissioner Barbara Richardson said.

“How much is too much cost for our consumers? And is that better or worse than not having any insurance at all?” she asked.

Centene and Aetna have applied to sell plans in Clark, Nye and Washoe counties. Residents in those counties now will have four carriers to choose from. 

State exchange board members were irate over attempts to repeal the Affordable Care Act.

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“This is an attempt to continue to be able to say the ACA is failing, and, of course, to pressure people to then vote for what I perceive to be a diabolical bill that would provide health care to very few and provide an awful lot of money to the very rich,” board member Lavonne Lewis said.

Rep. Mark Amodei, R-Nev., who voted in favor of the House bill to replace the Affordable Care Act, blamed the collapse of the exchange in rural Nevada on the “status quo.”

“Sadly, this news isn’t shocking,” Amodei said in a written statement. “It represents another symptom of the sickness that is killing America’s health care system. While there are plenty of arguments on how to fix this, regardless of your political views, it’s clear the status quo isn’t working and is in need of serious repair."

Follow Anjeanette Damon on Twitter: @AnjeanetteDamon

Source: Kaiser Family Foundation