Healthy legislature

In all likelihood, the 2017 Nevada Legislature will be remembered for its attention to health care issues, even if all its health work product does not survive. With the nation’s capital in tumult, some measures were adopted in part to protect Nevadans from possible actions by Congress and Donald Trump.

“We won in just about every category,” said the Nevada Women’s Lobby’s Marlene Lockard.

Probably the biggest accomplishment of all was enactment of a “Medicaid for all” health care plan, which was largely overlooked by journalists inside the state while creating a fuss from coast to coast. “Nevada Is Considering a Revolutionary Health Care Experiment” is the way New York Magazine headlined its report, and the Los Angeles Times called the Nevada plan “a landmark Medicaid-for-all healthcare model.”

The measure—called the Nevada Care Plan (NCP)—would create a state health care program in case Congress repeals the Affordable Care Act. And other measures specified benefits from the ACA that would be guaranteed by the Nevada health plan.

At this writing, Gov. Brian Sandoval has not yet announced whether he will sign the measure creating NCP, sponsored by Washoe Assemblymember Michael Sprinkle, but even if he vetoes it, the lawmakers have sent a message that states have options that do not depend on Congress. At a time when other states have been considering Medicare-for-all plans, the novelty of going the Medicaid way has captured wide attention. It would mean lower costs because Medicaid pays physicians less while providing what Alternet news service called “more robust” benefits. The four-page bill would allow Nevadans to use their Affordable Care Act credits toward Medicaid.

Trade sites that cover the health care industry were analyzing the Nevada measure, with Health Payer Intelligence reporting, “The bill would allow applicants who are currently eligible for advance payments of premium tax-credits or cost sharing reductions to use those funds to purchase their Nevada Care Plan. Those without coverage whose income currently disqualifies them from subsidies, could buy into the plan with their own money. … Proponents of the Nevada Medicaid-for-all bill believe the lower cost of Medicaid versus Medicare makes it a more attractive program to roll out as an open public option.”

“Single-payer activists have promoted the idea of Medicare for all, but Nevada could be the first state to implement Medicaid for all,” said Health Care Dive. “The state/federal system usually pays doctors and hospitals less than Medicare and much less than private payers. … However, left-leaning states are watching Nevada to see what the more centralist state does and could potentially follow suit if Nevada tests the waters.”

While sweating out the weekend wondering if the governor would veto or sign, sponsor Sprinkle said, “I recognized this is all part of the process but am certainly anxious for a decision to be made.”

While Nevada was taking this action, the state’s senior U.S. senator, Dean Heller, was working in D.C. to phase out Medicaid in seven years, a stance that brought concern from his fellow Republican, Gov. Sandoval.

Another measure that brought Nevada wide attention is a program under which the state will track insulin pricing. This bill drew the alarmed attention of the pharmaceutical industry. “Big pharma had in there 12 lobbyists,” said Lockard. The measure, which had died at the hands of a Sandoval veto when it was sponsored by Sen. Yvanna Cancela, was brought back to life, its language dumped into a similar but weaker measure sponsored by Sen. Michael Roberson, and approved, requiring insulin manufacturers to disclose their profits so the state can track them.

The bill was enacted in spite of the indifference of powerful diabetes patient lobby groups.

Kaiser Health News reported, “Prominent patient advocacy groups, like the American Diabetes Association, have maintained stony silence while diabetes patients championed the bill and lobbied the legislature during this debate—a silence that patients and experts say stems from financial ties. … Many of the dozens of U.S. diabetes advocacy organizations, large and small, garner significant portions of their funding from insulin manufacturers. The Nevada bill also requires such organizations operating in-state to disclose all contributions they receive from the pharmaceutical industry to discourage that sort of conflict. … Generally speaking, their advocacy focuses on pressuring insurers to pay the price of insulin, not protesting price rises.”

In April, former American Diabetes Association CEO Larry Hausner wrote in the capitol newspaper Nevada Appeal opposing the measure: “Caring for people with diabetes involves more than what they pay for insulin or another medication.”

Kaiser quoted Beyond Type 1 CEO Thom Scher: “Normally all of the patient advocacy groups rally around causes and piggyback on each other in a productive way. That’s what advocacy groups are good at, but that hasn’t been the case here.”

Beyond Type 1 does not take big pharma money and did not take a stance on the Nevada measure. An estimated 1.25 million people in the United States live with Type 1 diabetes.

In another health field, while other states were using attacks on Planned Parenthood as a fig leaf to reduce reproductive health options, Nevada went the other way, firming up legal protections for women both in family planning and in wider women’s health issues.

Planned Parenthood lobbyist Elisa Cafferata said Sen. Julia Ratti’s Senate Bill 233 is “phenomenal. That helps women of every age.” The measure requires that the same women’s preventive health benefits provided by the ACA be incorporated into state law against the possibility the ACA is repealed. It mandates that Medicaid, private insurance, local and state government plans—though not ERISA—cover 21 services without copays, including 12-month supplies of contraception of various types; blood pressure, diabetes, HIV, prenatal and depression screening; vaccinations; hormone replacement; mammograms; breastfeeding support; cervical cancer testing; counseling for various problems, and others. Additional measures sponsored by Sen. Cancela, Assm. Teresa Benitez-Thompson and Speaker Jason Frierson supplemented the Ratti bill.

A report in the New York Times that a Nevada measure would have made RU486 legal was inaccurate. A search of every bill in the legislature found that the “morning-after” pill was not mentioned by either its popular or generic name, mifepristone.