Senate Bill 420: Improving health care requires a more thoughtful approach

Lawmakers in Carson City have a lot on their plates, and it is perfectly understandable for  health care to be at the top of their priority list when it comes to the issues that impact all  Nevadans. However, efforts to force through a misguided piece of legislation that would  fundamentally reshape the health care landscape in our state do not serve the best interests of  Nevada patients or local physicians’ efforts to provide high-quality care for our communities. 

The legislation that has health care and economic leaders so worried is Senate Bill 420, which  would create a state government-controlled health insurance system, also known as the “state  government option.” There is a growing concern that this bill is being rushed through the  legislative process without lawmakers fully understanding how it could increase costs and  reduce access for patients while undermining efforts to provide quality care. 

If passed, SB420 would force providers who currently accept Medicaid to also accept this  government-run option. This would drastically reduce payments to physicians and hospitals  when we should be focusing on ways to strengthen the health care community, especially given  the economic impact that the ongoing pandemic has had on hospitals here in Nevada and  nationwide. The likely unintended consequence of this proposal would be for many Nevada  physicians to drop out of the Medicaid program, or to possibly leave the state altogether,  leaving more Nevadans with less access to health care 

Health care is a serious and complicated issue. It is not something that should be taken lightly  or rushed through the legislative process in the eleventh hour without proper consideration.  Yet, the stakeholders that should be involved in this discussion—from patients and families to  physicians and nurses to local hospitals, ERs, and other health care providers—have been  largely shut out. 

Now, with lawmakers having amended the bill so that its proposed state government option  would not even begin operating until 2026, there is truly no reason for the Legislature  to rush passing this overly complex, costly proposal with just a few weeks left on the legislative  calendar. Instead, lawmakers should pause their work and invite a larger debate and discussion  about the ways in which we could improve health care access and lower costs without  threatening the foundation of our entire health care landscape. 

The need to slow down and get this right is further underscored by recent developments at the  state and federal levels that are helping drastically expand access to care for Nevadans. The  coronavirus relief legislation passed in March, the American Rescue Plan Act (ARPA), represents  the “biggest expansion of federal help for health Insurance” since the Affordable Care Act became law more than a decade ago.  

In states across the country, including right here in Nevada, ARPA is being used to increase  health care subsidies in order to make coverage more accessible and affordable for Nevada 

patients and families. For that reason, the Brookings Institution is cautioning state legislatures against making “lasting changes” to their states’ health care policy until the full impact of ARPA  is clear. Legislators in Carson City should take note. 

Imposing a state government option could worsen an already notable shortage of physicians  and other health care workers in our state, countering any claims that this legislation is about  expanding access to care. By slashing payments to doctors and hospitals, the state government  option could threaten at-risk facilities, particularly in our rural, hard to reach communities. If  these facilities and providers are forced out of business or out of state as a result of the state  government option, then that will leave entire communities more vulnerable with fewer  resources to manage their health care needs. 

There is simply too much at stake for our elected officials to be rushing through such a  potentially harmful piece of legislation without fully understanding its impact on access,  affordability, and quality. Rather than scrambling to pass SB420 in the last few weeks of this  legislative session, lawmakers should focus on strengthening programs that are currently  working well and helping deliver high-quality care for Nevadans. 

Ultimately, it is only by working together that we can best ensure all Nevadans have access to  the comprehensive care and services they need to live fuller, happier, and healthier lives. 

We believe this would be the best option for Nevada at this time.  

Keith Brill, MD, Jocelyn Quebral Ivie, MD, Samantha Schoenhaus, DO, Marisa Shiode, MD, and Amit Garg, MD, are Board Certified Obstetrician-Gynecologist physicians, working at Women's Health Associates of Southern Nevada. All are members of Nevada State Medical Association and Dr. Brill serves as President.