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Democratic Assemblywoman Maggie Carlton in the Legislature in Carson City on Feb. 1, 2021. (David Calvert/The Nevada Independent)

When Gov. Steve Sisolak proposed establishing a Patient Protection Commission to conduct a top-to-bottom review of Nevada’s health care system, he told industry representatives that his goal was compromise — and that those not working toward that goal could lose their seats at the table.

Under a bill Sisolak put forward and the Legislature approved in 2019, the commission was established as an industry-heavy body, with a few patient and general public representatives added in, that would come together to address pressing health care issues in the state — in the vein of an industry working group that had successfully compromised on surprise emergency room billing legislation earlier that year.

Today, the commission’s representatives include two doctors, two hospital CEOs, one union health trust representative, one private insurance representative, one drug company executive, a regional behavioral health coordinator and two patient advocates.

But, if Assemblywoman Maggie Carlton (D-Las Vegas) has her way this session, the commission may soon see a shakeup of that membership.

A bill sponsored by Carlton, AB348, would overhaul the commission’s membership to instead center primarily around patient advocates and those who work in the nonprofit health care space. 

Carlton, in presenting the bill to the Senate Health and Human Services Committee on Tuesday, lamented what she described as the commission’s “industry flavor,” suggesting it was at odds with the commission’s work, including with the Peterson-Milbank Program, which helps states set and implement health care cost growth targets.

“If we’re going to have real, honest, objective conversations, I believe the industry needs to step back and let other folks come forward and have those real conversations,” Carlton said. “This doesn’t say that the industry can’t participate, they just will not be voting members.”

In an email on Wednesday, Sisolak spokeswoman Meghin Delaney didn’t comment directly on the specifics of the legislation but said the governor supports “bringing more patient voices to the Commission and wants to ensure that all representatives of Nevada's health care community can participate in critical discussions about the future of care in our State.” 

“Governor Sisolak is grateful to the members of the Patient Protection Commission who have spent the past year-and-a-half engaged in transparent and comprehensive dialogue about how to bring affordable and quality health care to Nevada’s residents,” she said.

Delaney also said the governor is “proud” of the commission’s acceptance into the Peterson-Milbank program and that he “looks forward to working closely with the Commission as they implement health care cost growth targets.”

AB348 would specifically require that the commission be made up of:

  • two patient advocates
  • one for-profit health care provider
  • one registered nurse who practices as a nonprofit hospital
  • one physician or registered nurse who practices at a federally qualified health center 
  • one pharmacist not affiliated with any retail chain pharmacy, or a patient advocate
  • one public nonprofit hospital representative
  • one private nonprofit health insurer representative
  • one member with expertise advocating for the uninsured
  • one member with expertise advocating for people with special health care needs
  • one member who has expertise in health information technology and works with the Department of Health and Human Services
  • one representative of the general public

The bill also would transfer the Patient Protection Commission from the governor’s office to the director’s office in the Department of Health and Human Services. It also would require the commission to adopt bylaws and commission members to disclose conflicts of interest and abstain from votes when conflicts arise.

The Health Services Coalition, the Nevada State AFL-CIO and the Culinary Health Fund testified in support of the legislation on Tuesday.

While several industry representatives testified in favor of adding extra voices to the commission, they rebuffed the complete overhaul of the commission's membership as proposed by the bill, which would limit — or in the case of the pharmaceutical industry, entirely eliminate — their representation on the commission.

“We have no concern about the expansion of the commission but would request that the committee consider reinstating at least one more hospital to provide some of the diversity of that perspective and the cost drivers that go with that,” Jim Wadhams, a lobbyist for the Nevada Hospital Association, said during the Tuesday hearing.

But state Sen. Julia Ratti (D-Sparks), who chairs the Senate Health and Human Services Committee, was blunt in her assessment of the commission in its current form. During the hearing, Ratti said she has spent “significant” time working on the two bills that came out of the commission this session — a telehealth bill, SB5, and an all-payer claims database bill, SB40 — and that, in her view, the commission isn’t working.

Ratti praised the commission’s executive director, Sara Cholhagian, and said she believed there have been “good and sincere” efforts by the commission. But she also said she was “okay with trying something a little new.”

“I feel like I’ve been relatively engaged in this process, and I’ve tried to be a good, neutral player to continue to move things along,” Ratti said. “But I hope that, whether you have a seat on the board or not, that everybody stays engaged and we continue to try to figure out how to work together as people who care about advancing health care.”

Several members of the Patient Protection Commission, however, took issue with Ratti’s assessment of the commission during their Wednesday meeting, saying that it glossed over the hours of effort they put into building relationships with one another and trying to come to consensus.

“I am really disappointed, to say the least, about the opinion in the legislators’ minds that the commission is not working,” said Dr. Ikram Khan, the commission’s chair. “It may not be doing what the legislators, in their mind, thought should be happening, and there is always room for modifying the subjects to be addressed and brought to the commission.”

Members of the Senate Health and Human Services Committee voted on Tuesday evening on party lines to forward the bill to the Senate for a final vote. The committee’s two Republican members, Ben Kieckhefer (R-Reno) and Joe Hardy (R-Boulder City), voiced support for more industry representation on the commission and voted against the legislation.

The proposal passed out of the Assembly last week, also on party lines.

Disclosure: This story and all others about the Patient Protection Commission are edited by Managing Editor Elizabeth Thompson and/or Assistant Editor Michelle Rindels. Sara Cholhagian, the commission’s executive director, is in a relationship with Editor Jon Ralston.

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