Gov.-elect Steve Sisolak assembled a team of health-care policy experts Friday for what one of the moderators jokingly referred to as a speed dating session centered around behavioral health care, Medicaid, the ongoing shortage of medical providers and health-care costs.
Under the umbrella of those topics, the more than three dozen attendees in rapid-fire succession listed a host of issues plaguing the state, including a lack of reciprocity in health-care licensure with other states, the ongoing need to support graduate medical education and how to provide health care to Nevadans at a price point they can actually afford. Sisolak, who presided over the event with Culinary Health Fund policy director Bobbette Bond and University Medical Center CEO Mason VanHouweling, asked a handful of questions during the session but largely took the opportunity to listen to the attendees.
In a brief interview after the event, Sisolak said it was like “drinking out of a firehose.”
“This is what our transition has been, but the good thing is there are so many ideas out there,” Sisolak said. “Now we’ve got to be able to capture them, dilute them down, and come up with some plans.”
He said that at a new governor’s training session he attended there was consensus that if the country doesn’t do something, health care is going to bankrupt the country in the next 20 years.
“Our population continues to age, the health care costs continue to rise,” said Sisolak. “There’s too much fingerpointing, but when you can get folks that can bring others together, like I said it’s an incredible asset to our state.”
Of the dozens of suggestions that arose during the event, Sisolak said he was hopeful that the state might be able to tackle the issue of medical licensing reciprocity fairly quickly. Attendees spoke about the months that it can sometimes take providers to get licensed in Nevada even if they have completed all of the necessary requirements and have been practicing for years in another state.
“Speaking on the behavioral health side and living in a frontier, rural community, recruitment is always an issue,” said Lana Robards, executive director of the New Frontier behavioral health clinic in Fallon, adding that the additional burden of waiting six months to a year for social workers or marriage and family therapists from out of state to get licensed in Nevada only increases difficulties with recruitment.
Sisolak also expressed concern about an issue raised at the meeting by the firefighters union that paramedics frequently transport individuals to the hospital not because they are experiencing a significant health crisis but because they ran out of their medication.
“That’s something we’ve known that happens. People get transported because they’re out of their insulin, they’re out of their high blood pressure medication,” Sisolak said. “We’ve got to come up with a better system for that.”
He also voiced support for getting children interested early in entering the health-care field. Laura Culley, the UNLV School of Medicine’s associate dean of community engagement, talked during the event about a group of medical students who run teddy bear clinics with first and second graders to get children comfortable with the concept of going to the doctor.
“We also have people that are interested in going to the schools at every level to talk about the different health related professions that people can get into,” Culley said. “These medical students are so excited, particularly in the first two years where they’re not doing clinicals yet … The children respond amazingly to having these medical students come in.”
Sisolak said he believes that many of the different proposals highlighted at the meeting, such as better coordination between various existing agencies, can be accomplished without significant monetary expenditures. But he did acknowledge that raising Medicaid reimbursement rates — an ongoing topic of conversation among providers and hospitals, though not a central focus of Friday’s conversation — is under consideration, specifically hospitals’ neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) rates.
“There are some areas I do think we need to raise some of the rates. I mean the NICU and PICU units, from what I’m being told, are really underfunded,” Sisolak said. “They’re taking care of the really sick babies. I think if you talk to some of the docs, they say they really need to raise some of those rates. I don’t know where the compromise position is.”
Other areas of concern discussed by attendees included the ongoing shortage of providers both for physical and behavioral health, a lack of primary care physicians screening for suicide risk in seniors, a lack of autism treatment options for children, the increasing uninsured rate for children, the expansion of Medicaid managed care organizations, victims of crime refusing medical treatment, not enough low-cost health-care options for people who don’t have insurance and drug pricing transparency.
Earlier in the day, Sisolak held a health-care-focused news conference urging Nevadans to sign up for plans through the state’s health insurance exchange. Sisolak appealed specifically to millennials — who are one of the groups most likely to forego insurance coverage because they don’t need it — to sign up for plans on the exchange.
“It’s especially important for young people, millennials, to be covered,” Sisolak said.“I’ve got two of them as daughters. You think you’re invincible, but you’re not. No one is invincible when it comes to health care and illness and or injuries.”
The exchange has been making a strong final push to encourage Nevadans to enroll in plans on the exchange as enrollment this year has lagged behind last year’s record-breaking totals. The gap between this year’s and last year’s enrollment numbers has slowly shrunk over the enrollment period, though there were still 5,574, or 12 percent, fewer Nevadans enrolled as of Dec. 8.
Heather Korbulic, the exchange’s executive director, has pointed to the expansion of health plans with skimpier coverage, telemarketing scams, misinformation about a new federal rule change and the repeal of a health insurance mandate penalty as possible reasons for the lag.
The enrollment deadline is midnight on Dec. 15, though Korbulic said those who have called into healthcare.gov’s call center and placed themselves in the enrollment queue may receive a call back after the midnight deadline but still will be able to sign up for plans.
Sisolak is planning on tasking a Patient Protection Commission with developing specific policy proposals to bolster the state’s health insurance exchange. In a brief interview after the news conference, Sisolak said he wasn’t prepared to talk about taking Nevada down the road of creating a state-level individual mandate to purchase health insurance, support a ban on short-term limited duration health insurance plans or commit to a timeframe for passing state-level protections for patients with pre-existing conditions.
“I’m working with the legislative leadership,” Sisolak said. “We will get to it as quick as we possibly can.”