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January 20, 2018

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Last-minute bill introduced to cap emergency room charges

Assembly Speaker Marilyn Kirkpatrick, D-North Las Vegas, wants to amend the constitution to cap costs for anybody receiving treatment in a hospital emergency room.

To get around a the possibility of gubernatorial veto, she plans to introduce the constitutional amendment this week, which tethers hospital bills to no more than double federal public insurance reimbursement rates.

“This is something for our constituents that is important,” she said. “I have constituents in my district, you know, do you pay off the health bill, or do you maintain the mortgage on your home? Medical debt is the No. 1 reason for bankruptcy.”

The proposal would also enshrine in the state constitution a federal law that already allows patients to seek emergency medical care regardless of insurance status or ability to pay.

Under the proposal, the Legislature would reserve the right to provide by law a different rate cap if necessary to preserve a “reasonable cost” of emergency care. The Legislature would also be able to impose penalties on hospitals that don’t comply with the constitution.

Kirkpatrick said she has constituents who have been hit with high medical bills because they went to an emergency room that doesn’t have a contract with their insurance provider.

The constitutional amendment would obviate or at least reduce the distinction between in-network and more expensive out-of-network emergency care. Regardless of a hospital’s contractual relationship with an insurer, the costs hospitals can charge would be capped at 200 percent of the federal reimbursement rate.

Kirkpatrick’s Assembly Joint Resolution echoes the intent of a bill from the 2011 legislative session that Gov. Brian Sandoval vetoed.

She said she hasn’t talked to the governor about this proposal to amend the constitution. The amendment would need to pass the Legislature twice -- once this year and again in 2015 -- before the voters would have an opportunity to decide the matter on the 2016 ballot.

But because it’s a constitutional amendment, the governor would have no veto power, as he did with Senate Bill 115 in 2011.

“It’s just an extension of having that same conversation again and figuring out how we can do this for our constituents,” Kirkpatrick said. “We can’t ever seem to get somewhere with it, so why not let the voters have a say with what’s fair with the health care rates they pay?”

The debate from two years ago featured proponents including self-insured groups like the Culinary Health Fund -- a partnership among labor unions and gaming companies -- and opponents including the Nevada Hospital Association.

Hospitals worried that a price cap would force them to operate at a loss. Federal reimbursement rates are lower than private insurer rates, so hospitals are again concerned that their hands will be tied when they try to recoup costs from the privately insured.

Kirkpatrick said her amendment only puts Nevada in line with other states that also have such caps.

“It’s just to say that like many other states you can’t charge more than 200 percent of the cost of Medicare reimbursements,” she said. “Other states do 120 percent, 140 percent, across the nation people are trying to help control the health care costs.”

The amendment comes at a time when Nevada and other states are implementing President Barack Obama’s healthcare law. Provisions of Obamacare also address in-network and out-of-network emergency care.

The Speaker’s constitutional amendment proposal comes during the last few weeks of the legislative session.

The Legislature is scheduled to adjourn June 3.

But Kirkpatrick said there’s plenty of time to discuss and pass her proposal.

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