Nevada’s bid to establish a state-managed public health insurance option appeared all but certain to become a reality late Sunday evening after the Assembly voted on party lines to approve legislation setting the process for establishing such a plan in motion.

The bill, SB420, cleared the Senate on party lines last week and now will return to that body on Monday to concur on an amendment that makes several minor, mostly technical changes to the bill and adds an additional appropriation to cover the costs of implementing the public option. Because the amendment was made with the blessing of Senate Majority Leader Nicole Cannizzaro (D-Las Vegas), the bill’s sponsor, it is likely to clear the Senate without issue.

Once the Senate approves the amendment, the bill will head to the desk of Gov. Steve Sisolak for his signature. If he signs it quickly, Nevada will become the second state in the nation, after Washington, to approve a public option. (Colorado is also in the final stages of approving a public option bill.)

Sisolak has not taken a public position on the legislation, though it would be unlikely for the Democratic governor to veto the bill. Gov. Brian Sandoval, a Republican, vetoed a different public option proposal in 2017 that would have allowed anyone in the state to buy into a Medicaid-like system of health insurance. At the time, Sandoval said the proposal was “moving too soon, without factual foundation or adequate understanding of the possible consequences.”

Since then, the Legislature has continued to consider establishing a public option, including approving an interim study in the waning days of the 2019 legislative session to look into the possibility of allowing Nevadans to buy into the state Public Employees’ Benefits Program.

SB420, now the third iteration of the public option proposal in Nevada, will require insurers that bid to provide coverage to the state’s Medicaid population to also offer a public option plan. The plans will resemble existing qualified health plans certified by the state’s health insurance exchange, though the legislation requires them to be offered at a 5 percent markdown, with the goal of reducing average premium costs in the state by 15 percent over four years. The public option will be available for purchase starting in plan year 2026.

Because the concept differs from the prior two public option proposals lawmakers have considered, no one yet knows for certain what kind of an impact the bill might have on reducing costs and expanding accessibility to health care, two goals that proponents have honed in on in advocating for the legislation. To that end, the bill requires an actuarial study to be conducted as part of the four-and-a-half year ramp up before the bill takes effect.

The bill also expands coverage for certain Medicaid services to the extent money is available, including community health workers and doulas.

The Assembly’s swift approval of the bill on Sunday came as no surprise after Assembly Speaker Jason Frierson (D-Las Vegas) and Assembly Ways and Means Chair Maggie Carlton (D-Las Vegas) threw their support behind the bill on Saturday after previously remaining mum on the topic. While health care industry representatives had angled to turn the bill into an actuarial study only — removing the portions of the bill actually setting the public option in motion — both Frierson and Carlton voiced comfort in the fact that the bill offers significant time before the public option is actually offered for purchase.

“This is a good first step. We're trying to get someplace. We know there's an issue. We're trying to address it. This is a long term process to get there,” Carlton said on the Assembly floor. “The part of the bill that I support the most is being able to get that actuarial study done, know where the state stands and for future legislators sitting in these seats to be able to make a decision. I'm not sure if this is the right way to go, but we're not going to know until we get the data, and that's the part of the bill that I truly support.”

Republican lawmakers have staunchly and uniformly opposed the bill, siding with industry concerns that the legislation will not only not achieve its goal of increasing health care access and affordability but that it will destabilize Nevada’s already fragile health care system. 

“If passed, the bill would mandate insurers to offer a public option and mandate physicians and hospitals to accept rates below cost,” Assembly Minority Leader Robin Titus (R-Wellington), a family practice doctor by trade, said on the floor. “Doctors will leave the state and hospitals will raise rates or cut critical elective services that are widely used by all. The net effect is less access to care and higher costs for the remaining Nevadans, just the opposite of what we should want.”