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'Health Care Crisis' Looming For Rural Nevadans

If Nevada can't secure health coverage for rural counties, thousands will be losing health insurance by next year.

Reno Public Radio’s Anh Gray sat down with the head of The Silver State Health Insurance Exchange program to find out what happened.

The Silver State Health Insurance Exchange is the state’s health insurance marketplace. Last week, the group announced two insurance companies are exiting the program by next year. Residents in more populated counties like Clark, Washoe, and Nye will still continue to have coverage on the exchange, but about 8,000 residents living in the 14 other counties, mainly rural ones, will lose insurance.

The Affordable Care Act, also known as Obamacare, became law in 2010. About four years ago, The Silver State Health Insurance Exchange was set up so low-to-middle-income Nevadans could buy health insurance.

Through this marketplace, individuals and small businesses have been able to get coverage at federally-subsidized rates. Heather Korbulic is the Executive Director of the state exchange and joins us to talk about the recent changes to the program.

Insurance company Prominence Health Plan recently announced that beginning in 2018, it's withdrawing from Nevada all together. And Anthem Inc. is pulling coverage out of rural Nevada. What happened? Why did the companies pull out?

What’s been going on over the last seven or eight months has been really at a national and state level, where our carriers have been really concerned about stability. That stability is really around two issues: primarily cost-sharing reductions and whether or not those are going to be paid to the insurance companies, and the enforcement of the individual mandate, which is the tax penalty that is imposed on consumers if they do not have insurance. Those two combined things, along with the continued dialogue and debate around what will health care reform look like--will the Affordable Care Act be here or not--has created a situation of volatility in an already unstable marketplace.

The individual mandate issue is quite complex. Some people say that it’s burdensome and they don’t need the health insurance. But supporters of the mandate say it's necessary, otherwise it leaves insurance companies covering only sick people, and that increases health care costs. What’s your perspective?

The individual mandate is one of the most politically contentious parts of the Affordable Care Act. It’s seen as forcing of people into the marketplace, and penalizing people, and as government control. But regardless of the debate about the enforcement, or the individual mandate, it is a critical component to keeping healthy, younger people in the risk mix, or in the pool of people who are insured. If you don’t create incentives or you don’t have a mechanism to keep those people, then what happens is only typically sick people are signing up. When you have a very sick risk mix, then premiums go up for everybody involved, and carriers have a very hard time making any profit.

Photo of The Silver State Health Insurance Exchange Executive Director Heather Korbulic. Photo from Las Vegas Business Press.

Some are fearing that this loss of insurance coverage in rural areas will mean more sick people and possibly even death for some. Heather, in recent statements you described this situation as a “health care crisis for Nevada.” Explain how dire this situation is.

I will repeat that this is a health care crisis for Nevada. We have about 8,000 consumers living in these 14 counties. The bulk of them, 5,000-plus, live in Carson City, Douglas County, Lyon County and Storey County. Of those we know, the majority of them are between the ages of 55 and 64 years old. We know that a lot of these individuals are purchasing Gold Level plans. Gold Level plans indicate that these are people who use their insurance regularly and are probably accessing continued and ongoing care.

It’s extremely concerning for me as a fellow Nevadan to know that my neighbors will not have any access to health insurance. We’ve had calls at the exchange from individuals who are living in these areas that are going to be impacted, who are pregnant right now and are scheduled to give birth in January, and asking questions [like] ‘What does that mean for me?’

The exchange and the [Nevada] Division of Insurance and the [Nevada] Department of Health and Human Services, along with the Governor’s Office are working very closely with our carriers right now, trying to develop something on the exchange for those individuals in these impacted counties. Our carriers have until September 20th to make changes to their plans. We’re also exploring options like federal waivers to identify potential opportunities to incentivize carriers to come back into the marketplace. The exchange has been working closely with Access to Healthcare Network which has what’s called a “Medical Discount Program.” It’s not insurance, but it does offer some people an opportunity in these rural communities to have discounted medical services. We’re working on trying to find a solution. It’s a fluid situation and hopefully we’ll have something put together by September. 

Anh Gray is a former contributing editor at KUNR Public Radio.
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