As Nevada prepares to launch a state-managed public health insurance option next year, Republican Senate Minority Leader Robin Titus (R-Wellington) has brought back a lawsuit challenging the constitutionality of the 2021 law establishing the program.

The lawsuit, filed jointly with the National Taxpayers Union, is nearly identical to a challenge they filed in January 2024, saying that the law (SB420) violates the Nevada Constitution in three ways, including that it generates public revenue but was not passed by the required two-thirds majority vote of legislators. 

A Carson City District Court judge dismissed the lawsuit later that year, saying the injury claims within the legislation were “purely speculative” as the law had not yet gone into effect. 

The 2021 law creating the public health insurance option requires insurers who want to offer plans through the government-funded Medicaid program to offer a public option too. 

Those plans will resemble existing qualified health plans on the state’s health insurance exchange, though they will be required to be offered at a 4 percent markdown with the goal of reducing the plans’ premium costs by 15 percent over four years.

The lawsuit was filed as the state has been moving forward with launching the public option by Jan. 1, 2026. 

In the new challenge filed last week, attorneys representing Titus and the advocacy group address the earlier opinion on timeliness by noting that the public option’s launch is “just months away” and Nevadans will begin to enroll in health insurance plans, including public option plans, on the state’s insurance marketplace beginning in November.

“If the Court does not hear this challenge on the merits now, then the judiciary will not have the opportunity to adjudicate these claims before the Public Option goes live, risking the uncertainty and potential harm that would result from the launch and then immediate, court-ordered rollback of a governmental program,” attorneys wrote.

The complaint reiterates claims that the 2021 law directly violates the Nevada Constitution and the Nevada Administrative Procedure Act.

Attorneys claimed that the then-Department of Health and Human Services "exercised lawmaking authority” when setting up the public option, a role that is usually reserved for the Legislature. 

The complaint points to two guidance letters, which were not included in the court filing obtained by The Nevada Independent, issued in 2022 and 2023 that attorneys said were evidence of the department adopting regulations without prior approval of the Legislative Commission — the interim body of lawmakers who review and approve state agency regulations.

These letters, attorneys said, struck out portions of SB420 related to how the discounted public option plan should be measurably lower than a baseline premium.

Titus, a medical doctor who voted against the bill during the 2021 session while she was serving in the Assembly, didn’t return a text message from The Nevada Independent on Monday seeking comment. A spokesperson for Titus also did not immediately respond to a request for comment.

Gov. Joe Lombardo’s administration added a twist to the public option proposal by funding a reinsurance program — which works as insurance for insurance companies, paying a portion of high-cost claims and thus allowing insurers to lower the premiums for individual health insurance plans — as part of the implementation. 

“My plan to use these new federal funds to support our state’s healthcare infrastructure and workforce will help offset the instability created by the public option,” Lombardo previously said in a statement about the program to The Nevada Independent. 

Lombardo’s office did not respond to an emailed request for comment on Monday.
The lawsuit could have implications for the state’s efforts to address the fallout from federal cuts to health care, as state officials have said that the new state reinsurance program and public option could be used to help offset some of the costs and changes.