Posts Tagged ‘Affordable Care Act’

Sandoval Announces Intent To Expand Medicaid

By Nevada News Bureau Staff | 6:19 pm December 11th, 2012

CARSON CITY – Gov. Brian Sandoval today announced he will include 78,000 additional people in Nevada’s Medicaid program as provided for under the federal Affordable Care Act.

“Though I have never liked the Affordable Care Act because of the individual mandate it places on citizens, the increased burden on businesses and concerns about access to health care, the law has been upheld by the Supreme Court,” he said in a statement. “As such, I am forced to accept it as today’s reality and I have decided to expand Nevada’s Medicaid coverage.

Gov. Brian Sandoval.

“My fiscal year 2014-2015 budget will provide 78,000 additional Nevadans with health insurance coverage through Medicaid, which is estimated to save the state general fund approximately $17 million dollars in mental health savings,” Sandoval said. “My executive budget will also help Nevada businesses cope with the burden placed on them by decreasing the modified business tax. My decision to opt-in assists the neediest Nevadans and helps some avoid paying a health-care tax penalty. As part of my proposal, I will also call upon the Legislature to pass Medicaid patient responsibility cost-sharing measures.

“I will commit to working with the Legislature if anything changes at the federal level,” he said. “At any point during the Legislative session, if there is any sign of change at the state or federal level, it may alter my support for expansion.”

U.S. Sen. Harry Reid today praised Sandoval for his decision.

“This is wonderful for the people of Nevada and for the thousands of Nevadans who now will have health care,” he said. “I commend Gov. Sandoval for taking this bipartisan step. This is a win-win, it will save the state money, is good for the economy, good for employers and most importantly will help people. I worked hard to pass this legislation and I couldn’t be happier that the governor has made this decision.”

Nevada Agencies Request $6.46 Billion In New Budget, Up $279 Million From Current Spending Plan

By Sean Whaley | 1:02 pm October 15th, 2012

CARSON CITY – Nevada’s next two-year general fund budget would grow by $279 million to $6.46 billion based on the initial spending requests submitted by state agencies, information released today by the Budget Division shows.

State Budget Director Jeff Mohlenkamp, who will continue to piece together Gov. Brian Sandoval’s final recommended 2013-15 budget through at least December, said the increase in spending is due primarily to the growing public education and Medicaid populations. The public education piece is estimated at $18 million. The Medicaid population increase is expected to cost $104 million.

State Budget Director Jeff Mohlenkamp. / Nevada News Bureau file photo.

The budget is still subject to a variety of revisions by Sandoval between now and January when it is released to the public and lawmakers. The final budget will depend greatly on available tax revenue, which will be set by the state Economic Forum in early December.

“We’re wrestling quite a few different variables that all have to be factored in before ultimately those decisions are made,” Mohlenkamp said.

The agency request budget also includes the cost of expanding Medicaid to already eligible Nevada residents expected to enroll in the program because of the federal Affordable Care Act. This piece is expected to cost $86.6 million.

The budget does not include an expansion of Medicaid to a newly eligible group of Nevadans provided for under the health care law, Mohlenkamp said. Sandoval has yet to make a decision on that issue, he said.

“We have decision units prepared, that should the governor make the decision to opt in, then we can very quickly make that happen within the budget,” Mohlenkamp said.

The budget does anticipate the continuation of several tax increases that are now set to sunset on June 30, 2013. It also, for now, continues salary reductions and furloughs for state workers that would save approximately $160 million.

Sandoval has said he will consider restoring some of the reductions if general fund revenues are sufficient to do so.

Geoffrey Lawrence, deputy policy director for the Nevada Policy Research Institute, praised Sandoval and his budget staff for helping state agencies limit their spending increases.

“While not perfect, these agency budget requests are a concrete step toward limiting the growth of government from already inflated levels,” he said. “Besides limiting spending increases, this budget shows the power of performance-based budgeting, which focuses on providing the highest level of outcomes for every dollar spent.”

Lawrence also warned lawmakers against using any higher revenue projections from the Economic Forum to boost spending.

“Higher-than-expected revenue projections from the Economic Forum should be used to lower taxes on struggling Nevada families, instead of as an excuse to increase government spending,” he said.

Mohlenkamp said the spending numbers released today are expected to be within the general fund tax estimates set by the Economic Forum.

“We do believe that we are in the range, but we don’t know how close we are to actually what the Economic Forum will come in at,” he said. “But that’s pretty much of an unknown right now.”

The final budget will be the first to comprehensively include performance-based budgeting, Mohlenkamp said. The process is expected to make the budget more transparent so the public can easily understand where the money is being spent. It will also provide better accountability on whether the state is achieving its goals, he said.

Several major initiatives being proposed in the budget include a restructuring of the Division of Mental Health and Developmental Services, with the mental health side going to the Health Division, and the developmental services piece going to Aging and Disability Services.

“It’s a fairly major restructuring that is going on within Health and Human Services,” Mohlenkamp said.


Audio clips:

Budget Director Jeff Mohlenkamp says Gov. Brian Sandoval has not yet made a decision on expanding Medicaid:

101512Mohlenkamp1 :25 decision on that.”

Mohlenkamp says the state’s tax revenues remain an unknown until the Economic Forum meets:

101512Mohlenkamp2 :19 unknown right now.”



Nevada Division of Insurance Seeking Public Input on Essential Health Benefits

By Sean Whaley | 1:33 pm September 24th, 2012

CARSON CITY – The Nevada Division of Insurance (NVDOI) is seeking public input on what should be included in Nevada’s essential health benefits plan under the Affordable Care Act (ACA).

Gov. Brian Sandoval will ultimately decide which of 10 existing health insurance plans now offered in Nevada will be used to determine the essential benefits that will be required in all individual and small group health insurance plans starting on Jan. 1, 2014.

The ACA requires health insurance policies offered in the individual and small group markets, both inside and outside of the Silver State Health Insurance Exchange, to offer a comprehensive package of items and services, known as essential health benefits.

Ten categories of items and services are required for the state’s essential benefits plan: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

With some variations, the 10 plans available in Nevada now are fairly comparable in what they offer in these required categories, said Adam Plain, insurance regulation liaison for Division of Insurance.

But the plans differ in what additional services and benefits they offer, he said. A plan might cover chiropractic treatments or hearing aids as well, Plain said. Another may not.

So it is important for the public to weigh in on what coverages they think should be part of an essential health benefits plan for Nevada, keeping in mind that the more benefits covered, the higher the cost will be, he said.

“What we’re looking at is: is physical therapy covered,” Plain said. “If it is, what benefits specifically are covered. And are there any limitations like 20 visits per year, or 60 visits per year, or is the benefit unlimited in the number of visits. And so that is what we’re looking at.”

The state must also pick benefits and services as they are offered now in one of the 10 existing plans, he said. So depending on which plan is selected, advocates for some coverages may not get what they want in the essential benefits plan, Plain said.

“Because none of the plans are perfect, and no single plan is the best in terms of coverage, we can’t say, you know, we want everything to be covered, because no plan does that,” he said. “If someone wants coverage for hearing aids, and someone else wants coverage for gastric bypass surgery, and those two benefits aren’t offered under the same plan, someone is not going to walk away happy.”

Cost-sharing issues, including co-pays and deductibles, are not at issue in this provision of the ACA, Plain said.

The 10 existing health plans that can be used to set the benchmark for the items and services included in the essential health benefits package are:

  1. Health Plan of Nevada Point-of-Service
  2. Aetna PPO
  3. Anthem PPO
  4. Nevada PEBP High-Deductible Health Plan
  5. Nevada PEBP Health Plan of Nevada HMO
  6. Nevada PEBP Hometown Health Plan HMO
  7. Government Employees Health Association
  8. FEHBP/ Blue Cross-Blue Shield Standard
  9. FEHBP/ Blue Cross-Blue Shield Basic
  10. Clark County School District/Health Plan of Nevada HMO

The Nevada Division of Insurance is seeking public comment at meetings being held across the state this week. The meetings will be held in:

- Henderson on Wednesday at 2 p.m. at the Henderson City Council Chambers, 240 Water St.;

- Las Vegas on Wednesday at 6 p.m. at the Charleston Campus of the College of Southern Nevada, 6375 W. Charleston Blvd., Room K-101;

-  Reno on Thursday at 6 p.m. at Truckee Meadows Community College, 7000 Dandini Blvd., Room 205 of the Vista Building.

A hearing was also held in Elko last week.

Public comment can also be submitted in writing to the Commissioner of Insurance at 1818 E. College Pkwy., Suite 103, Carson City, NV 89706 or by fax at (775) 687-0788 or by email to Adam Plain at All written public comment must be received by Thursday at 5 p.m.

After the public comment period has closed the NVDOI will make a recommendation to Sandoval regarding which essential health benefits should be required for Nevada based on the range of services offered in the 10 separate plans. Sandoval is required to decide by Sept. 30 which plan will be used to set the essential benefits for the state.


Audio clips:

Adam Plain, insurance regulation liaison for the Division of Insurance, says the purpose of the hearings is to determine which benefits should be covered:

092412Plain1 :20 we’re looking at.”

Plain says not all benefits will be able to be included in an essential plan:

092412Plain2 :30 walk away happy.”

State Medical Association Supports Expansion Of Medicaid Eligibility Under Affordable Care Act

By Sean Whaley | 1:35 pm September 13th, 2012

CARSON CITY – The Nevada State Medical Association has announced it supports expanding Nevada’s Medicaid caseload as permitted under the federal Patient Protection and Affordable Care Act (PPACA).

The association’s board of directors met on Sept. 8 and adopted the policy statement, which was based on the information currently available about the expansion of the Medicaid program.

Photo by Debora Cartagena/CDC.

“We believe that this is necessary to assure that there is not a new class of uninsured Nevadans created by a gap in the PPACA coverage plan,” said the statement by the association, released Wednesday.

“Nevada physicians are concerned that this does not improve the current Medicaid program, which is significantly underfunded,” the statement said. “Current payment levels have made it increasingly difficult for physicians and hospitals to maintain their availability for Medicaid patients. This has become particularly true for children with disabling conditions or chronic illnesses and for women facing high-risk births.”

As a result, the association said it is urging Gov. Brian Sandoval and the Legislature to “address the access to care needs of the patients who are, and will continue to be, covered by the current Medicaid program.”

The Nevada State Medical Association is Nevada’s oldest and largest physician advocacy organization.

The authorized Medicaid expansion is still under review by the Sandoval Administration. If recommended by Sandoval and approved by the Legislature in 2013, it would take effect on Jan. 1, 2014 for Nevadans up to 138 percent of the federal poverty level. The potential caseload expected under such an expansion is still being analyzed.

Federal funding would pay for 100 percent of any Medicaid expansion for the first three calendar years beginning in 2014, with the state required to pick up a percentage of the cost beginning in 2017. The first year state cost is 5 percent, in 2018 the state cost is 6 percent, in 2019 the state cost is 7 percent, and in 2020, the state cost is 10 percent.

The expansion in Nevada would mostly cover childless adults who are not covered by the state program now.

Nevada is already moving forward with its Silver State Health Insurance Exchange, which will offer eligible residents the opportunity to purchase health insurance beginning on Oct. 1, 2013.

Meanwhile, data from the U.S. Census Bureau shows that Nevada’s uninsured population continues to increase. While the rate nationally declined by 0.5 percent to 16 percent between 2008-09 and 2010-11, Nevada’s rate increased 2.7 percent in that same time period, to 22 percent.

State Board Rejects Proposal To Seek State Funding To Subsidize Nevada’s Health Insurance Exchange

By Sean Whaley | 1:22 pm August 16th, 2012

CARSON CITY – A board overseeing the creation of the state’s health insurance exchange opted today not to seek general fund support to subsidize the fees charged to participants in the program.

The Finance and Sustainability Advisory Subcommittee of the Silver State Health Insurance Exchange Board had proposed subsidizing the monthly fee paid by enrollees with a general fund appropriation from the state Insurance Premium Tax.

The proposal was to take 25 percent of the estimated increase in the insurance premium tax revenue resulting from uninsured Nevadans entering the health insurance market to help fund the program.

Relying on general fund support would have dropped the monthly user fee from $4.40 in 2014 to about $2.78 for each participant. The rate under the proposed funding plan will rise to $6.20 in 2015. This rate too would be lower with general fund support.

The fees are estimated to generate $7.7 million in calendar year 2014 and $13.6 million in 2015.

But the recommendation to seek general fund support was rejected by a 6-1 vote of the board. The budget for the exchange, and its funding sources, will become part of Gov. Brian Sandoval’s 2013-15 budget now being drafted for the 2013 legislative session.

Sandoval made it clear on Tuesday that he would oppose supporting the exchange with general funds, even though he has decided that having Nevada move forward with its own exchange is the better option than letting the federal government operate it.

The exchange should have to “stand on its own merits through user fees,” he said.

The federal government is paying for more than 99 percent of the cost of implementing and operating the exchange through Dec. 31, 2014. But beginning Jan. 1, 2015, the state will have to pick up the costs of running the exchange. The plan as approved by the board would cover those costs with the user fees exclusively.

Board member Dr. Ronald Kline said an argument could be made to justify seeking general fund support.

“While I agree philosophically with the recommendations of the committee, that by having more insured people in Nevada we’re going to increase revenue and so it is not unreasonable to ask for a portion of that,” he said. “I agree with that philosophically.”

But from a political perspective such a proposal is unlikely to get support from the governor and could engender bad will for no positive reason, Kline said.

“The second point is, that for subsidized individuals, the higher per-member, per-month fee is completely absorbed by the federal government,” he said. “So by taking 25 percent from the general fund and lowering the per-member, per-month fee, what we’re practically doing is we’re taking more money from our general revenue and accepting less money from the federal government.”

The exchange is basically a one-stop shop for Nevadans to search for and purchase health insurance coverage. The exchanges were authorized by the Affordable Care Act, most of which was upheld by the U.S. Supreme Court in late June. It will begin operation on Oct. 1, 2013.


Audio clips:

Dr. Ronald Kline says an argument can be made to seek general fund support to help operate the exchange:

081612Kline1 :24 per-member, per-month fee.”

But Kline says using general funds would in effect reduce the amount of federal money received to run the exchange:

081612Kline2 :23 the federal government.”


Gov. Sandoval Says Many Questions Must Be Answered Before Medicaid Expansion Decision Can Be Made

By Sean Whaley | 2:28 pm July 13th, 2012

CARSON CITY – Gov. Brian Sandoval said today he needs a lot of questions answered before he can decide whether to expand Medicaid eligibility in Nevada, and that it could take several months to resolve all the uncertainties.

“There’s no specific time schedule,” he said. “I mean I understand right now we’ve had the Supreme Court decision. Everyone has been waiting for that. I think there are still people that are trying to interpret it.

Gov. Brian Sandoval. / Nevada News Bureau file photo.

“There’s still a question within the law regarding the penalty provision,” Sandoval said. “That if a state, whether it ops in or opts out, whether it is still subject to some type of a penalty. Although the federal government can’t withhold all of your Medicaid money there is still an outstanding question about whether it can withhold some of it.”

The U.S. Department of Health and Human Services has to interpret the U.S. Supreme Court ruling upholding most of the Affordable Care Act and answer the many questions before a decision can be made in Nevada, he said.

“The answers to those questions will have a lot to do with how we’re going to estimate the expenses in this state,” Sandoval said. “So it’s premature right now. We’re doing the best that we can with the information that we have. And once I have that information then I can make an informed decision.”

State officials are busy preparing information on what expanding Medicaid to 138 percent of the federal poverty level, as proposed in the health care law, would cost Nevada. The information should be in Sandoval’s hands within two weeks. But having that information does not mean that Sandoval will be ready at that time to make a decision.

The federal government will pick up most of the cost of an expansion for the first several years, but there will be costs to the state as well.

Sandoval also said Nevada decided in the 2011 legislative session to establish its own health care exchange under the law, and that the process of doing so is moving forward. This despite the fact that a $72 million contract sought by the Silver State Health Insurance Exchange to create the information technology needed to operate the exchange beginning Oct. 1, 2013, was delayed today.

The contract with Xerox State Healthcare was scheduled for a vote by the Board of Examiners, including Sandoval, but was pulled because the board overseeing the Exchange was unable to approve it on Thursday.

Six dozen Republican members of Congress have called on the nation’s governors not to implement the exchanges, arguing they add to the cost of doing business. Several governors, including Rick Perry of Texas, who is in Nevada today campaigning for Mitt Romney, have said they won’t move forward with establishing an exchange.

“My biggest concern as I’ve said all along is that I don’t want the federal government coming to the state of Nevada running our exchange,” Sandoval said. “This is a state issue that we should be handling. We have a great board. We have a great director. And we’re going to move in accordance with the law.”


Audio clips:

Gov. Brian Sandoval says there is no timetable to make a decision on expanding Medicaid:

071312Sandoval1 :12 to interpret it.”

Sandoval says questions remain, including the penalty provision for opting out of a Medicaid expansion:

071312Sandoval2 :17 some of it.”

Sandoval says that when he has all the information he can make an informed decision:

071312Sandoval3 :24 an informed decision.”

Sandoval says Nevada needs to run its own health exchange:

071312Sandoval4 :13 with the law.”




State Officials Crunching Numbers For Gov. Sandoval To Make Decision On Medicaid Expansion

By Sean Whaley | 3:22 pm July 12th, 2012

CARSON CITY – Nevada officials are busy preparing cost and enrollment estimates so Gov. Brian Sandoval will have reliable information before deciding whether to expand Medicaid following the U.S. Supreme Court ruling last month upholding much of the Affordable Care Act.

But even if Sandoval does not expand Medicaid to 138 percent of the federal poverty level as provided for in the law, the program is expected to grow significantly as Nevadans who are now eligible but not enrolled decide to sign up when the health insurance mandate takes effect on Jan 1, 2014.

The effective date is in the middle of the first year of the upcoming two-year budget now being prepared by the Sandoval administration. The Legislature will take up the budget, and the Medicaid issue, when the 2013 session starts in February.

State officials are readying data for Sandoval to make a Medicaid decision

Mike Willden, director of the Department of Health and Human Services, and state Budget Director Jeff Mohlenkamp, are gathering the data to show the anticipated effects on the state budget of these two distinct Medicaid groups.

“Our goal is to have the numbers over to the governor by the end of next week,” Willden said. “We’re just not ready to give out numbers yet and I don’t want to give out bad numbers. There are 10 moving parts.”

Mohlenkamp said the court threw everybody “a bit of a curve,” when it decided states do not have to opt into an expanded Medicaid program.

State Budget Director Jeff Mohlenkamp. / Nevada News Bureau file photo.

“So we’re now in the process of analyzing what that looks like, the pros and cons of that, the financial impact on the state of the options, and, is it absolutely straightforward; you either opt in or opt out,” he said. “Or are there other options within the Supreme Court ruling that we can consider.”

Sandoval’s initial response was to reject an expansion

When the Supreme Court said the federal government could not penalize states if they do not choose to opt into the Medicaid expansion, Sandoval’s initial comment was that the state could not afford to do so. But he is awaiting the information before deciding how to proceed.

“This is going to be a governor’s office decision,” Mohlenkamp said. “The governor will make the decision as to the policy of the state going forward. He has not yet made that decision. He’s looking for a very critical analysis of what the options are and the pros and cons for the state.”

The bigger cost to the state general fund will likely come from those eligible but not enrolled in Medicaid, because the state share of adding those individuals is projected to be 38 percent in 2014, compared to a 62 percent share from the federal government.

This cost to the strapped state budget will occur whether or not an expansion is approved by the Nevada Legislature.

All of the analysis is dependent on the implementation of the federal health care law. Republican members of Congress and GOP presumptive presidential nominee Mitt Romney want to repeal the law.

Federal funding will cover most, but not all, of a Medicaid expansion

Federal funding will pay for 100 percent of any Medicaid expansion for the first three calendar years beginning in 2014, with the state required to pick up a percentage of the cost beginning in 2017. The first year state cost is 5 percent, in 2018 the state cost is 6 percent, in 2019 the state cost is 7 percent, and in 2020, the state cost is 10 percent.

But Willden said there are also administrative costs to the state that are not fully covered by the expansion but instead are shared between the federal government and the state at a 50-50 match. They include information technology costs and the cost to hire new eligibility workers, for example, he said.

State Health and Human Services Director Mike Willden / Nevada News Bureau file photo.

“And so we’re trying to again cost out for the governor, clear through 2020, because there are state costs involved in those out years even though everybody says it’s 100 percent federal the first three,” Willden said. “There are state costs in the out years, there are also state costs associated with the administrative costs for the new eligibles.”

There will be some savings because mentally ill people now being treated by the state at full cost to the state general fund will be Medicaid eligible, and there will be some savings to the counties because they now use county general fund money to pay for medical care for individuals who would become Medicaid eligible, he said.

The counties are analyzing that potential impact, Willden said.

Another question that is being researched with federal officials is whether the opt-in option would require a full commitment to the 138 percent of poverty level, of if some lesser level could be pursued, he said.

“The goal is to try to get all of this to come together in the next couple of weeks,” Willden said. “That way the governor would have enough information to at least review on the opt in, opt out opportunity.”

Medicaid expansion would cover new groups, including childless adults

If Medicaid is expanded in Nevada, new participants will be childless adults, who are not covered by the state program now, Willden said. The other expansion will come from parent caretakers of children who are covered at 75 percent of poverty now.

Medicaid now covers primarily low-income children, the disabled, pregnant women and seniors. These groups are now covered at different poverty rates ranging from 100 percent to 138 percent.

State lawmaker concerned about long-term financial implications of an expansion

State Sen. Ben Kieckhefer, R-Reno, who will be involved in the Medicaid issues in 2013 as a member of the Senate Finance Committee, said Sandoval is taking a prudent course because there are so many unanswered questions given the Supreme Court’s surprise decision allowing states to opt out of the expansion.

A critical question is what happens with the generous federal funding after 2020 and as Congress and the President grapple with unsustainable spending on federal programs, he said.

“It is a very good deal in the first couple of years,” Kieckhefer said. “I mean the feds pay 100 percent of the medical costs for the first three years. That’s a great deal. It then goes down to 90 percent after the fifth year. And there is nothing that mandates that that goes on forever.

“So I think the stronger concern is, how does the federal government continue to justify paying 90 percent of those costs as it’s trying to deal with the massive federal deficit and reducing that deficit,” he said. “And I think that there is a strong likelihood that eventually the feds start shifting that cost burden back to the states and that’s a risk that the state needs to weigh.”

Assembly Ways and Means Chairwoman Debbie Smith, D-Sparks, said her plan is to have an overview of the court ruling from staff at the Legislature’s Interim Finance Committee on Aug. 23.

“I want to just make sure that we have a really good understanding of what all the possibilities and ramifications are,” she said. “I want that to be the first informational piece and then we can go from there.”

Nevada’s health insurance exchange is another factor in the complex review

Another variable in the assessment is the Silver State Health Insurance Exchange now being readied in Nevada where residents will be able to shop for health insurance beginning Oct. 1, 2013. Nevadans between 100 percent and 400 percent of the federal poverty level will be eligible for subsidies when they purchase insurance.

The ACA rules appear to indicate that if Medicaid is not expanded, Nevadans who would have been covered in an expansion could go to the Exchange and receive a tax credit as long as all other requirements are met.

The Exchange is gearing up now with federal funds, but the state will have to pick up the cost of its operation when federal grants run out in 2015, Willden said.

Another issue is whether there are enough doctors and other medical providers to offer services to an expanded population, he said.

Willden said in May that as many as 150,000 additional Nevadans would be eligible for Medicaid if the law was upheld by the court, but that estimate was two years old and was made before the court said states could opt out of the expansion.

He estimated that bringing new residents onto the rolls would cost the state general fund an estimated $574 million between now and 2020.

But Kieckhefer said only $63 million of that cost estimate was due to the Medicaid expansion. The rest was due to those already eligible who were expected to enroll as a result of the mandate to obtain insurance.


Audio clips:

Mike Willden of Nevada Health and Human Services says his agency is trying to estimate the cost of a Medicaid expansion program through 2020:

071212Willden1 :22 the new eligibles.”

Willden says the goal is to get the data to the governor in the next couple of weeks.

071212Willden2 :13 opt out opportunity.”

State Budget Director Jeff Mohlenkamp says the pros and cons of a Medicaid expansion are being analyzed:

071212Mohlenkamp1 :19 we can consider.”

Mohlenkamp says Gov. Brian Sandoval will make the call on a Medicaid expansion but that he has not done so yet:

071212Mohlenkamp2 :16 for the state.”

State Sen. Ben Kieckhefer says he is concerned about the potential long-term financial obligation to the state:

071212Kieckhefer :26 reducing that deficit.”


GOP Members Of Congress Ask Governors To Reject Health Exchanges, Nevada Program Already Well Under Way

By Sean Whaley | 12:30 pm July 10th, 2012

CARSON CITY – 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 Democratic-controlled Senate is not expected to consider such a measure.

Gov. Brian Sandoval.

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.

Among 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.

But Nevada’s program is well along and 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 approximately 21.3 percent of Nevadans, or 563,000 people, are uninsured. The Exchange’s mission is to increase the number of insured Nevadans by facilitating the purchase and sale of health insurance that provides quality health care through the creation of a transparent, simplified marketplace of qualified health plans.

Nevada’s exchange was created by Senate Bill 440 of the 2011 Legislature. It was passed unanimously of those voting in both the Senate and Assembly at the end of the session. Four members of the Assembly were excused and did not vote.

Nevada Groups React To U.S. Supreme Court Decision On Health Care Law

By Sean Whaley | 1:52 pm June 28th, 2012

CARSON CITY – Nevada groups and organizations weighed in on the controversial U.S. Supreme Court ruling on the health care law today, with comments across the spectrum.

The Nevada Policy Research Institute, a libertarian think tank, called it a, “practical and significant blow to individual liberty.”

Photo by Franz Jantzen courtesy of the U.S. Supreme Court.

“Our nation’s founders intended the constitution to greatly restrict the power of the federal government, but unfortunately, this ruling further expands federal authority,” said Joseph Becker, chief legal officer and director of NPRI’s Center for Justice and Constitutional Litigation. “Not even King George believed he had the authority to compel colonists to buy the tea tossed overboard in Boston Harbor, yet we now have an expansion of federal authority which, through the force of taxation, mandates as a practical matter that citizens must buy private-sector goods.”

Geoffrey Lawrence, deputy policy director at NPRI, said: “Just because the Supreme Court has ruled that the Affordable Care Act is constitutional doesn’t change the damage this flawed policy will do to individuals in America’s health care system.

“The primary shortcoming of the health care industry is that government policies have induced too much cost-shifting and neutered the effectiveness of the price system,” he said. “The ACA just doubles down on this shortcoming by increasing the degree of cost-shifting to ludicrous proportions. Small businesses will pay more, families and individuals will pay more, and states could pay more.”

Nevada State Medical Association (NSMA) President Florence N. Jameson, M.D., a Las Vegas obstetrician-gynecologist and founder of Volunteers in Medicine of Southern Nevada, said in part: “Unfortunately, major health care problems are not resolved by this law. The Congress and the president must continue to work to find an acceptable way to sustain Medicare for seniors and persons with disabilities and the Medicaid program for indigent and chronically ill children and seniors.

“Governor Brian Sandoval and the Nevada Legislature will have to determine the impact on Nevada Medicaid of the Supreme Court’s decision, but it doesn’t make the funding of the Medicaid program easier,” she said. “It means that they must address again the often unfair way that health insurance coverage fails patients when they have the greatest need for medical care.”

Randi Thompson, Nevada state director for the National Federation of Independent Business, which was the named plaintiff in today’s landmark decision, said: “The Supreme Court may have ruled that the act may be constitutional, but it’s not good policy.

“I agree with the dissenting statement that the Affordable Care Act exceeds federal power in mandating the purchase of health insurance,” she said. “The court confirmed the mandate is a tax on every American. Add the mandate tax to a host of other new taxes in the new heath care law and you have the most costly bill every thrust on the American taxpayer.”

Michael Ginsburg, Southern Nevada director of the Progressive Leadership Alliance of Nevada, said: “This law expands coverage to more than 30 million people and eliminates the worst insurance company abuses such as premium price-gouging, discrimination and denial of care for the sick in order to increase corporate profits. This decision makes clear that implementation of the law must move forward at the state and federal level without further delays from partisan political interference – including governors and elected officials.”

Scotty Watts, president of the Nevada Alliance for Retired Americans, said: “Today is an historic day for Americans of all ages, an affirmation of a law that helps children, workers, and retirees obtain affordable health care. Americans can now live more secure, knowing that their health and well-being are no longer tied to the whims and greed of the big insurance companies.”

“Today is a tremendous victory for Nevada  seniors, their children, and their grandchildren,” he said. “But we cannot rest on our laurels.  In the 2012 elections we cannot let politicians roll back the progress we have made.”

Nevada was one of 26 states that challenged the constitutionality of the law that resulted in today’s ruling. Nevada was represented by Las Vegas attorney Mark Hutchison, who worked on the case for free after Nevada Attorney General Catherine Cortez Masto declined to challenge the law at former Gov. Jim Gibbons’ request.

Nevada State Democratic Party Chairwoman Roberta Lange said the decision, “offers relief to Nevadans with preexisting conditions, young people who can stay on their parents’ healthcare plans until they are 26 and seniors who rely on lower prescription drug costs.

“However, despite the Supreme Court settling this issue, Mitt Romney is still promising to fight old political battles of the past that would roll back protections from some of the worst abuses by the private insurance industry,” she said. “It’s time to move forward, end the partisan games and get back to work creating good paying middle-class jobs that stay here in Nevada.”

Romney, the presumptive GOP presidential nominee, said today: “What the court did not do on its last day in session, I will do on my first day if elected president of the United States. And that is I will act to repeal Obamacare.

“Let’s make clear that we understand what the Court did and did not do,” he said. “What the court did today was say that Obamacare does not violate the Constitution. What they did not do was say that Obamacare is good law or that it’s good policy.”

President Obama said in remarks at the White House: “The highest court in the land has now spoken. We will continue to implement this law. And we’ll work together to improve on it where we can.  But what we won’t do – what the country can’t afford to do – is refight the political battles of two years ago, or go back to the way things were.

“With today’s announcement, it’s time for us to move forward – to implement and, where necessary, improve on this law,” he said. “And now is the time to keep our focus on the most urgent challenge of our time: putting people back to work, paying down our debt, and building an economy where people can have confidence that if they work hard, they can get ahead.”


Gov. Sandoval Says Effect Unclear On Nevada Medicaid, Delegation, Candidates Weigh In On Affordable Care Ruling

By Sean Whaley | 11:04 am June 28th, 2012

CARSON CITY – Gov. Brian Sandoval said today the effects of the U.S. Supreme Court decision upholding much of the Affordable Care Act on the state’s Medicaid program remain unclear.

“The implications for Medicaid costs are still unclear, but Nevada will prepare to meet the serious financial implications of this decision,” he said in a statement shortly after the court ruled.

The court said in the ruling today that states could not be penalized if they did not go along with the Medicaid provisions in the law.

In an interview today on the Nevada NewsMakers program as the decision was announced, Sandoval said his intention would be not to opt in to the Medicaid expansion because of the costs to the state.

“And as I have said all along, that if that component had been found constitutional, it would cost us $60 million in this budget and $100 million in future budgets,” he said in the interview. “We can’t afford that. And to make that decision and to opt into that program, would mean that I would have to look at cutting education, at other what I think are untenable outcomes. So as I sit here today, it wouldn’t be my intention for this state to opt in.”

A statement from Sandoval’s office issued later in the day said the decision indicates states will have an option to expand Medicaid, but, “additional guidance is needed in order to understand the penalties for not expanding the Medicaid program and we must determine if there are savings to the general fund by shifting existing costs to the federal government. We will continue to examine today’s opinion to fully understand its implications.

“Therefore, given what we know today, the governor does not intend to automatically accept the Medicaid expansion,” the statement said. “These serious budgetary implications, including the impact on education spending, require further analysis – not just of the next biennial budget but of the long-term costs. Further information will be provided as the budgeting process unfolds over the next few months.”

In his initial statement on the ruling, Sandoval also said: “I believe the Congress should act to reform this law and ease the serious burdens it places on the states and the nation’s businesses. The American people remain deeply divided on the wisdom of this law and they are still entitled to see it changed.”

U.S. Sen. Dean Heller, R-Nev., said he too wants to see the law changed.

U.S. Supreme Court.

“This law has now been affirmed as a colossal tax increase on the middle class, and its excessive regulations are stripping businesses of the certainty they need to hire at a time when Nevadans and the rest of the country are desperate for jobs,” he said. “The president should work with Congress to find real solutions to healthcare reform so the excessive mandates and taxes in this law do not further add to our national debt or continue to stifle economic growth.

“This onerous law needs to be repealed and replaced with market-based reforms that will provide greater access, affordability, and economic certainty to our nation,” Heller said.

U.S. Senate Majority Leader Harry Reid, D-Nev., said the matter is now settled.

“It’s time for Republicans to stop refighting yesterday’s battles,” he said.

“I’m pleased to see the Supreme Court put the rule of law ahead of partisanship, and ruled the Affordable Care Act constitutional,” Reid said. “Passing the Affordable Care Act was the greatest single step in generations toward ensuring access to affordable, quality healthcare for every American – regardless of where they live or how much money they make.

“No one thinks this law is perfect,” Reid said. “But Democrats have proven we’re willing to work with Republicans to improve the Affordable Care Act.”

Rep. Joe Heck, R-Nev., said the ruling doesn’t make the health care act a good law.

“This is still the same flawed bill that was forced through Congress on a party line vote in the dead of night with special interest provisions like the ‘Cornhusker Kickback’ and the ‘Louisiana Purchase’,” he said. “And today we have learned that the law amounts to a huge tax increase on the American people in a struggling economy. We know that a majority of Americans think the law should be repealed and that it will increase health care costs, reduce access to care and add to our deficit.

“Instead of injecting more government into our health care system, our focus should be on patients, especially our seniors who rely on access to quality health care,” Heck said. “Our system is working for most Americans and it can work for all Americans through common sense reforms like moving insurance coverage towards an individual-based model, increasing competition by allowing the purchase of insurance across state lines, incentivizing the purchase of insurance through tax credits, and letting people, not the government, decide what services they need and want.

“The Supreme Court had their word on June 28, but the American people will have the final word on November 6,” Heck said.

Assembly Speaker John Oceguera said it is time to refocus on jobs.

Oceguera, D-Las Vegas, who is challenging Heck in the 3rd Congressional District, said: “Now that the Supreme Court has ruled, it’s time that those in Washington moved on from trying to score political points instead of finding solutions. This decision doesn’t change the reality that too many Nevada families and small businesses are struggling to pay for the rising costs of health care.

“One thing we know for sure, if Washington politicians don’t stop the bickering and finger pointing and focus on what matters – creating jobs and getting our economy back on track – nothing will get done,” he said. “This shouldn’t be about politics – it should be about getting something done.”

Rep. Mark Amodei, R-Nev., said it is time to repeal the law.

“Advocates for Washington-based management of health care and unprecedented tax increases on the middle class won today,” he said. “However, I will continue to work for patient-centered solutions, reductions in health care costs, and improving health care access for all Nevadans.

“I look forward to the opportunity to vote the week of July 9 for full repeal of this harmful government intrusion into health care,” Amodei said. “Congress created this mess and it’s our responsibility to clean it up. We owe it to the middle class to give them specific, well-thought out options focusing on portability of insurance across state lines and affordability, while not interfering with the patient-doctor relationship.

“This 2,700-page monster offends seniors, veterans, middle class families and employers,” he said. “I will continue to take every opportunity to repeal and address this mess for Nevadans in a practical way without picking political winners and losers.”

State Sen. Steven Horsford, D-Las Vegas, said he was pleased with the ruling.

In a campaign email, the 4th Congressional Democratic candidate said: “Today’s decision is a victory for those with pre-existing conditions, for women who now don’t have to pay more than men for care, and for Nevada seniors who will save on prescription drugs.

“Now Republicans in the House are scheduling a vote to repeal the health care law, instead of working on a jobs bill,” Horsford said. “The Republican Congress needs to stop playing political games and start working on getting our economy moving and creating jobs for Nevadans.”

GOP Congressional candidate Danny Tarkanian said the law needs to be repealed.

The candidate for the 4th Congressional seat said: “I have consistently stood against Obamacare and remain committed to its full repeal. Rather, we need to press forward with legislation that will extend the same tax incentives that businesses receive for providing health insurance to individuals who purchase their own plans. We need to get serious about tort reform and stabilize Medicare reimbursement rates. We need to make insurance portable and purchasable across state lines.

“When they should be focusing on promoting economic growth and creating jobs, Democrats insist instead on ramming through job-killing policies that increase taxes on Americans, like Obamacare,” Tarkanian said.

There was no immediate response from Rep. Shelley Berkley, D-Nev.

A big issue for Nevada is what the ruling means to the state’s Medicaid program.

The head of Nevada’s Department of Health and Human Services said in May that as many as 150,000 more residents will be eligible for Medicaid coverage if the state has to comply with the Medicaid provisions. Bringing new residents onto the rolls was estimated to cost the state an estimated $574 million between now and 2020, said HHS Director Mike Willden.


Audio clip:

Gov. Brian Sandoval says it would not be his decision to opt into the Medicaid expansion allowed under the Affordable Care Act:

062812Sandoval :24 to opt in.”



Consumers Can Review Health Insurance Rates at New State Website

By Anne Knowles | 4:04 pm September 2nd, 2011

Nevada consumers and small businesses can now review and comment on rate hikes in their health insurance policies online.

The Division of Insurance has launched Nevada Health Rate Review in compliance with a provision of the Affordable Care Act (ACA) that went into effect on Sept. 1.

The federal law requires the state to provide a way for individuals and small businesses to comment on proposed rate hikes. All rate changes for individual, small business and HMO policies must be submitted to the division for approval.

Rates are the base price for a policy; an individual policy may cost more due to medical conditions or other factors specific to each policy holder.

When an insurance provider applies for a rate change, the division will post the application and all the supporting documents with a summary of the proposed change. Visitors will have 60 days to review the material and post a comment, either privately or publicly.  Comments will be reviewed daily by a division actuary, according to Jake Sunderland, the division’s public information officer, and included in the final application.

The law does not require the state to analyze the comments, but the division plans to review and factor them into its decisions. This is one way the state plans to go “above and beyond the law,” said Sunderland. Another way is that the state will review any change in rate, even drops, although the law only requires reviews of rate hikes of 10 percent or greater.

The site already has about one year of previously-decided or pending applications posted online and will post three new applications next week on which consumers can review and comment before the state rules.

So far this year, the division has received 87 applications for rate hikes. It has denied 23, modified four to a lower rate, has 25 pending and has approved 35.

Previously, consumers had to make public records requests to gain access to the applications.

“Bringing greater transparency to families and businesses and giving them easy access to information will help them make better decisions about their health insurance options,” said Annette Raveneau, a spokeswoman with Know Your Care, a nonprofit established to educate citizens about the ACA. “Because of the Affordable Care Act, insurance companies will no longer be able to raise rates without explaining their actions. Rate hikes will be posted on public websites and will have to be justified.”

Part of the goal, says Sunderland, is to give individuals and small businesses more power when dealing with insurance providers. Large corporations are not included because they have the clout and expertise to negotiate more favorable rates.

Sunderland said there are 12,508 policies sold to small businesses in the state, insuring 102,728 people. There are currently 57,681 policies sold to individuals covering 87,309 people.

To comply with the federal law, the Nevada Legislature passed a bill during the 2011 legislative session giving the state the authority to collect rate information on health insurance policies held by businesses with between two and 50 employees.

The insurance division plans to soon start running public service announcements to make the public aware of the new website, said Sunderland.

As part of the ACA, the rate review and website has its detractors.

“The reason a website like this has become necessary is that policymakers’ decision to turn the health care industry into a regulated utility will ultimately deprive consumers of alternatives,” says Geoffrey Lawrence, deputy director of policy at Nevada Policy Research Institute in Las Vegas. “On the exchange, prices and products will homogenize, meaning that consumers will have less opportunity to switch providers in the event of a rate increase.”
Lawrence says stricter regulations will also increase the barriers for potential new providers to enter the market.
“With nowhere to turn, consumers can only complain to regulators, as is the case with other regulated utilities,” said Lawrence.
The rate review process is just one provision of the ACA the state is working on to comply. The Nevada Department of Health and Human Services this week requested $2.8 million in a federal grant money from the legislature’s Interim Finance Committee to create the agency and fill four staff positions to run the Silver State Health Exchange, the state exchange for health insurance mandated by the law. The exchange must be up and running in 2014.

Gov. Brian Sandoval’s office said the appointments to a board to oversee the exchange will made by the end of this month.


Gov. Sandoval Praises Appeals Court Ruling on Federal Health Care Package

By Elizabeth Crum | 2:56 pm August 12th, 2011

CARSON CITY — Gov. Brian Sandoval today praised a federal appeals court ruling that struck down the so-called “individual mandate” in federal health care legislation.

“The ruling by the 11th Circuit Court of Appeals confirms what we have known all along: the federal health care law’s individual mandate was over-reaching and unconstitutional,” said Sandoval in a statement. “Nevada continues to be well-represented in this case and I expect there will be ultimate victory before the United States Supreme Court.”

A panel of the Atlanta-based 11th Circuit Court of Appeals found fault with the requirement in the Obama administration’s Patient Protection and Affordable Care Act that says Americans must carry personal health insurance or face financial penalties.

The 11th Circuit decision is a pivotal judicial event because it reviewed a sweeping ruling by a U.S. District Court in Florida.

A divided three-judge panel did not agree with the lower court on all counts but did strike down the so-called “individual mandate,” ruling in favor of 26 states that had sued to block the law on the basis that it was unconstitutional and violates individual rights.

White House adviser Stephanie Cutter said on a White House blog that the administration strongly disagreed with the ruling.

“Individuals who choose to go without health insurance are making an economic decision that affects all of us — when people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab,” wrote Cutter.

But today’s decision, written by Chief Judge Joel Dubina and Circuit Judge Frank Hull, found that “the individual mandate contained in the Act exceeds Congress’s enumerated commerce power.”

“What Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die,” the opinion said.

Circuit Judge Stanley Marcus said in his dissent that the panel majority ignored the “undeniable fact that Congress’ commerce power has grown exponentially over the past two centuries, and is now generally accepted as having afforded Congress the authority to create rules regulating large areas of our national economy.”

Marcus’ opinion agreed with that of the 6th Circuit Court of Appeals in Cincinnati, which in June upheld the government’s requirement that most Americans buy health insurance.

Government officials are expected to either ask for a review of today’s decision by the full court or appeal to the U.S. Supreme Court.


Pre-Existing Condition Insurance Rates Drop By 37.5 Percent In Nevada

By Sean Whaley | 1:04 pm June 2nd, 2011

CARSON CITY – Insurance Commissioner Brett Barratt said today that rates for the high risk pool in the federal Pre-Existing Condition Insurance Plan (PCIP) for Nevada have been reduced by 37.5 percent by the U.S. Department of Health and Human Services starting July 1.

“This is great news for the thousands of uninsured Nevadans eligible for the PCIP,” Barratt said. “These rate decreases make PCIP more affordable and comparable to the commercial market for individuals.”

The federal Affordable Care Act of 2010 included a provision to create the PCIP as a “bridging” healthcare program to provide pre-existing condition coverage between now and 2014, when insurers will no longer be permitted to decline health coverage to individuals with pre-existing conditions. Coverage through this program will be available until January 2014 when more health insurance coverage options will become available through a Health Insurance Exchange.

PCIP delivers health coverage to consumers who have a pre-existing medical condition, have not had insurance for six months, who are legal residents of Nevada and are U.S. citizens. Starting July 1, people applying for coverage can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness. Applicants will no longer have to wait on an insurance company to send them a denial letter.

PCIP covers doctor visits, hospitalizations, prescription drugs and preventative care services for consumers who have been denied health insurance coverage. There are no income requirements, and the plan does not charge a higher premium because of a pre-existing condition. Coverage for a pre-existing condition takes effect immediately; there is no waiting period.

To increase the effectiveness of the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program. This step will help reach those who are eligible but unenrolled.

People Denied Health Insurance For Pre-Existing Conditions Have New Option

By Andrew Doughman | 1:48 pm February 10th, 2011

CARSON CITY – Nevadans denied health insurance for pre-existing conditions are now guaranteed coverage via a federally funded health insurance program.

In the past, it’s been either costly or impossible to find coverage if someone has a health condition requiring frequent or expensive treatment.

The Pre-Existing Condition Insurance Plan ensures coverage for someone who has been denied coverage within the past six months.

As many as 19,000 Nevadans may be eligible to receive this coverage, said Marilyn Wells, director of the Governor’s Office of Consumer Health Assistance, an office whose staff help people navigate the health care system.

She said only 57 people have received coverage through the federal government plan since it began during September, 2010.

To qualify, a person must be a citizen or legal resident, have a pre-existing medical condition and can not have had health insurance during the past six months.

The plan also disqualifies people who currently receive Medicaid or Medicare benefits. Since the plan does come with some expense for its benefits, Wells said it’s aimed at middle-income individuals whose health insurance would be prohibitively expensive because of a pre-existing condition.

“Most people who have applied for regular insurance may be able to afford regular insurance, but when they are ‘upgraded’ because of their pre-exsiting condition, that makes their policy way out of line for them,” Wells said. “This brings it to more of a standard cost so it’s more affordable for them.”

The federal government has allocated $61 million to fund the program nationwide.

The Patient Protection and Affordable Care Act, President Barack Obama’s health care law, mandates that insurers will not deny anyone for pre-existing conditions from 2014 on.

For now, though, this insurance plan is available as a “bridge” until that element of the law takes effect.

In the meantime, litigation surrounding the law continues in the federal court system.

Nevada Could Pay $625,000 To Implement Obama Health Care Reform Law

By Andrew Doughman | 2:05 pm February 8th, 2011

CARSON CITY – Nevadans could pay up to $625,684 to consultants who are helping the state implement the controversial federal health care reform law under a state contract.

The contract with Massachusetts-based Public Consulting Group allows up to that level of spending through June 30, 2012.

Officials at the state’s Department of Health and Human Services hired the consultants for their expertise in health care reform. The state has already paid $132,121 to the consultants, according to Lynn Carrigan, the chief fiscal officer with the department’s Division of Health Care Financing and Policy.

The contract and subsequent expansions of it were approved during meetings last year, when Jim Gibbons, who had also called the law unconstitutional, was still governor.

Nobody can yet say whether that’s money well spent or wasted. Several challenges to the Patient Protection and Affordable Care Act are winding their way through the court system, and many predict the case will end up before the U.S. Supreme Court.

Gov. Brian Sandoval has called the law “unconstitutional,” but he’s also acknowledged that the state will continue to implement the law that’s on the books.

The law mandates that the states have health insurance exchanges up and running by 2014. The exchanges are marketplaces like Travelocity and Expedia through which people could purchase the best insurance plan for them.

To be on target for implementation, the state Legislature should pass a bill this session that sets up the skeleton structure of the exchange. Should they not, the federal government might intervene and create that structure for Nevada.

States legislatures across America are also taking up the issue.

Republican governors unhappy with law’s mandates

Sandoval has also signed a letter submitted yesterday by several Republican governors to  Kathleen Sebelius, director of the U.S. Department of Health and Human Services. The letter asks Sebelius to make changes to the law’s mandate to establish state health insurance exchanges. Otherwise, the governors write, they may opt out of running their own exchanges and let the federal government intercede.

“While we hope for your endorsement, if you do not agree, we will move forward with our own efforts regardless and HHS should begin making plans to run exchanges under its own auspices,” they wrote.

The statement seems to run counter to what Sandoval said in his State of the State address several weeks ago.

“We must also plan for a Health Insurance Exchange so that we – and not the federal government – control the program,” he said during the speech in which he also called the federal law “unconstitutional.”

Sandoval said today, however, that he signed on to the letter primarily to put pressure on the federal government to make a decision regarding the validity of the law.

“It encourages the expedited review of the court case because in the meantime our state is having to expend funds to meet the requirements of the federal law,” he said of the letter.

The state is a party to the lawsuit challenging the constitutional standing of the health care law,  but governor said Nevada will continue crafting its health insurance exchange.