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November 28, 2015

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Health Care:

Nevada waits to hear the verdict on health insurance

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Two-year-old Miles Russell II takes a tour of the Martin Luther King Health Center with his dad, Miles Russell, during its opening Monday, June 11, 2012, in Las Vegas. The Affordable Care Act included $728 million in grants for community health centers like the Martin Luther King Health Center, which expects to treat 11,000 patients annually.

To those who support the law, it’s called the Affordable Care Act, the hard-fought legislation that reforms a broken system of health care costs that grow too fast and private insurance that covers too little.

Or, in the words of Vice President Joe Biden: “A big (expletive) deal.”

To opponents, it’s Obamacare, and also a big deal. It’s an unconstitutional, anti-business law that inserts too much government into health care, with an over-reaching mandate that forces people to buy a private product.

Perhaps as soon as Monday, the entire debate over health care, its costs and government’s reach in everyday lives may be reignited.

By the end of the month, the U.S. Supreme Court will decide its case on the landmark federal health care law. The court may uphold it. It may uphold part of it. Or it may do away with the thing entirely.

But now, unlike when the bill passed in 2010, the debate is much more than philosophical. Millions of dollars have been spent implementing the legislation. Thousands of Nevadans already are relying on benefits they didn’t have before it was passed. And millions more are anticipating coverage to kick in two years from now.

For Nevada, health care issues are particularly acute. Almost a quarter of non-elderly Nevadans — 545,000 people — don’t have health insurance. That’s the fourth highest rate in the country, according to the Kaiser Family Foundation. Nevada’s children — 16 percent of whom are uninsured — rank worse. The Silver State has the second highest rate of uninsured children in the country.

But getting those people health insurance would come at a cost.

So far, here’s how the Affordable Care Act has — and will — affect Nevada:

MLK Health Center

The Martin Luther King Health Center, a 31,000-square-foot facility offering general medicine and OB/GYN clinical services, celebrates its opening Monday, June 11, 2012, in Las Vegas. The Affordable Care Act included $728 million in grants for community health centers like the Martin Luther King Health Center, which expects to treat 11,000 patients annually. Launch slideshow »

• The Affordable Care Act included $728 million in grants nationally for community health centers, like the Martin Luther King Health Center in Las Vegas, which opened Monday. Officials expect to treat 11,000 patients a year there.

• The state Department of Health and Human Services projects that the law will cost Nevada $574 million between 2014 and 2019. That cost is mostly attributable to tens of thousands of people who are now eligible for Medicaid but who aren’t enrolled. The law’s individual insurance mandate will force them to enroll at an expense that will be borne by the state, not the federal government.

• Almost 750 Nevadans who had been rejected by private insurance companies for having pre-existing health conditions, like diabetes or cancer, are on a federal health insurance plan that was created by the new law. That subsidized health insurance plan is projected to cost $5 billion until 2014, when private insurance won’t be able to discriminate against pre-existing conditions. Nevada’s portion of that is $61 million, and has cost the federal government $13.7 million so far.

• More than 22,000 young adults in Nevada now have health insurance because of the bill, according to the federal Department of Health and Human Services. The federal law allows parents to keep their children on their insurance until they are 26.

• Under the contested law, insurance companies can’t cap lifetime or yearly benefits for the uninsured.

• The federal government has invested millions in community health centers and programs to promote health, in accordance with the new law.

The legal challenge to the law focuses on the mandate that all Americans have health insurance.

Some insurance companies, like UnitedHealthcare, the largest private insurer in Nevada, announced that even if the legislation is thrown out, they will keep some of the new policies in place. UnitedHealthcare, for instance, will still provide preventive health care without co-pays, offer coverage for dependents up to age 26 and eliminate lifetime benefit caps.

If the law is struck down, however, UnitedHealthcare said it likely would not continue providing coverage for children with pre-existing conditions.

With the Supreme Court decision pending, Nevada officials were reluctant to talk about the legislation.

“As the governor has noted before, he believes the federal health care legislation has serious constitutional questions,” said Mary-Sarah Kinner, Gov. Brian Sandoval’s spokeswoman. “He looks forward to the court’s decision.”

Nevada, like other states, challenged the constitutionality of the law after it was passed. Gov. Jim Gibbons initiated the court challenge and Sandoval, a former federal judge, supports the challenge and has said he believes the law is unconstitutional.

The central, most controversial piece of the legislation is the mandate that all Americans have health insurance or face a penalty from the IRS. That provision, if upheld by the U.S. Supreme Court, won’t go into effect until Jan. 1, 2014.

Nevada, despite suing to halt the law, has already made significant progress — and spent a considerable amount of federal dollars — preparing for it.

The Silver State Health Insurance Exchange, created by a bill passed by the Nevada Legislature in 2011, is meant to be a health insurance marketplace, where individuals and businesses can find affordable coverage options. It’s a massive undertaking, requiring an appointed board and staff to navigate the law and federal regulations, some of which are still being passed.

To help with the cost, Nevada has received $21 million in federal grants to establish the exchange.

But it’s not just the state government spending resources to implement a law that may not exist after next week.

A central argument against the health care legislation — one advanced by Republican presidential hopeful Mitt Romney — is that it has hurt the economy, scared businesses into laying off workers and prevented them from hiring.

Tim Wulf, the owner of two Jimmy John’s Gourmet Sandwich Shops in Reno, said “Obamacare was the straw that broke the camel’s back.”

He sold off a third franchise he owned, cut employment at his stores and scuttled plans to expand in the market, he said, in part because of the potential costs and uncertainty in the health care bill.

The best estimate he could come up with was that providing health care to his 94 part-time employees, at its peak, would cost about $80,000 a year.

“Entrepreneurs are planners. They want to pencil out costs. This seems like a moving target,” said Wulf, a former economics professor who spoke with media on a conference call organized by the Romney campaign. “We don’t know what the rules are.”

He now has 68 employees. Almost all are part-time and don’t have health insurance through his company. The stores, he said, are doing well.

But he said there’s still too much uncertainty for him to want to expand.

Other business owners said health care costs had become an increasing burden long before Obama’s health care legislation.

“For the last six or seven years, we’ve been getting less coverage for our employees and having to pay more,” said Ron Nelsen, owner of Pioneer Overhead Door in Las Vegas.

Nelsen, an Obama supporter, has five employees, all of whom he provides with health insurance. One year, his health insurance costs spiked 28 percent.

This year, for the first time, costs leveled off and he received a small business tax credit to help purchase health insurance.

“We bought a little bit better policy for the same price as last year,” he said.

Nelsen dismissed concerns about federal overreach, blaming the insurance companies for increasing costs.

“I need the sheriff to protect me from a bully,” Nelsen said. “For the last 10 years, the bully has been the insurance companies. ... Yeah, I need a sheriff every once in a while. Government is helping regulate a private enterprise that may have gotten out of hand.”

So, what happens to the coverage, the planning and the money already spent after the U.S. Supreme Court releases its opinion?

Not many are willing to even speculate.

“All of those questions have to be answered,” said Marilyn Wills, the governor’s consumer health advocate.

“We can’t comment until the Supreme Court releases its decision,” said CJ Bawden, spokesman for Silver State Health Insurance Exchange.

Instead, business owners, government administrators and patients already relying on coverage are collectively holding their breath, waiting for the decision.

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