Nevada and The Future of Obamacare

No matter what subject someone was supposed to be presenting at the recent Nevada Health Care Forum in Green Valley, the conversation kept meandering back to the Patient Protection and Affordable Care Act—a.k.a. Obamacare.

Even as the act is the season’s hottest political potato, many health care industry insiders see it as a fait accompli, particularly given the Supreme Court’s June ruling that the individual mandate is constitutional. Even forum speakers such as U.S. Rep. Joe Heck, R-Las Vegas, and Republican state Assemblyman Joe Hardy, both physicians, agreed that Obamacare can’t be repealed per se.

“It’s a lot harder to take something away once it’s been given, than to never give it in the first place,” Hardy said. Heck added that the market has already started to adapt to the plan: Coverages have been extended, policies updated, computer programs written.

That’s not to say Heck, Hardy and their political peers wouldn’t make some changes, given the chance.

Heck pointed out three specific touch-points on the horizon. First is the state-by-state implementation of online insurance exchanges—the Silver State Health Insurance Exchange, in our case. Herb K. Schultz, regional director for the U.S. Department of Health and Human Services, described these as being the health-insurance equivalent of Expedia for travel. When the mandate for individual coverage kicks in Jan. 1, 2014, these exchanges will become critical.

Second thing to watch out for: Medicaid expansion. To help the indigent and working poor afford the required coverage, Obamacare expands eligibility for Medicaid. States decide, however, if they want to participate in the expansion, making them eligible for matching federal funds. Expect this to be a major topic of discussion in the 2013 Nevada Legislature.

Last is the independent payment advisory board, charged with achieving specified savings in Medicare without affecting coverage or quality. The board can’t reduce benefits or raise premiums, which leaves health care providers such as Heck concerned—the only area left to tinker with is reimbursements for providers.

“You want us to give more people higher quality care for less money,” Hardy says. “The indirect impact will be fewer doctors accepting Medicare.”

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