Gov. Steve Sisolak announced on Thursday a new state-run incentive program that will award some $5 million in prizes — including a $1 million grand prize — to Nevada residents who get the COVID-19 vaccine.
The announcement of the program, called “Vax Nevada Days,” comes as the state lags behind President Joe Biden’s goal of having 70 percent of adults at least partially vaccinated by July 4 — as of June 16, the state has at least partially vaccinated 59.4 percent of the adult population, a mark that ranks 33rd among the 50 states.
“We want to avoid ever going through what we went through COVID last year,” Sisolak said. “That's why today I want to provide Nevadans with an exciting update on one more way we're planning to encourage all Nevadans to get their vaccine, in addition to thanking those who've already gotten their shots.”
Sisolak unveiled the program at a kickoff press conference at Allegiant Stadium, where a vaccine clinic and stadium tours were simultaneously being held. Though winners will be announced each Thursday from July 8-Aug. 26, those who have already been vaccinated will be automatically entered in the drawings once their vaccinator has submitted that information to the state.
Every Nevadan who is at least 12 years old and receives at least a first dose will be automatically entered to win one of nearly 2,000 prizes.
Other incentives up for grabs for people 18 and older include 149 cash prizes ranging from $1,000 to $250,000 each. Specifically, 100 people will win $1,000 each, 32 will win $25,000, 11 will win $50,000, two will win $100,000, three will win $250,000 and one person will win the $1 million grand prize. Teens between the ages of 12 and 17 are eligible for 135 different college savings plan awards valued from $5,000 to $50,000.
People of all ages are eligible to win one of 500 Nevada state park annual passes or one of 1,250 state fishing licenses.
All $5 million worth of prizes will come from federal COVID-19 relief funds, and they will be distributed through Immunize Nevada. Sisolak said he expects winners to first be called as prizes are drawn, though the administration of the program will be fully carried out by Immunize Nevada.
Sisolak was also joined at the event by Scott Gunn, a senior vice president at the gaming company IGT Global Solutions Corporation. Gunn explained that other states are able to administer COVID-19 incentives through their state lotteries. Because Nevada does not have a state lottery, IGT will be helping pick winners through a certified random number generator, which is the process used by lotteries in other states. Gunn also noted that IGT will not have access to anyone’s personally identifiable information throughout the process.
Sisolak explained that the drawings are legal in the state because Nevadans are being entered into a raffle system rather than a lottery that someone would have to pay to enter.
“We got an opinion from my counsel, from the attorney general’s counsel, from the Gaming Control Board's counsel that this is something that we're allowed to do,” he said.
Over the past few weeks, a variety of other states have announced incentives meant to boost vaccination rates, after the number of doses being administered daily across the country significantly declined in late April and May. Some states have announced cash prizes, such as Ohio, which started the “Vax-a-Million” campaign to boost vaccination numbers by giving out five $1 million prizes to vaccinated adults.
This week on IndyMatters, Reporter Howard Stutz and Host Joey Lovato present, Flashback, part one of three on the history of the gaming industry in Nevada. Then Editor Jon Ralston continues his breakdown on the 2021 legislative session from last week, talking about the freshman class, one legislative leader who will be retiring and more. At the end of the show, Reporter Megan Messerly talks about vaccines as the state reopens, the 70 percent vaccinated goal set by the Biden administration and vaccination rates in the rurals.
Nevada became the second state in the nation to enact a state-managed public health insurance option on Wednesday, with Gov. Steve Sisolak’s signature transforming a bill that hadn’t even been made public until six weeks ago into law.
Though Sisolak voiced his intent to sign the bill last week, his signature formally ends a more than four-year-long quest to establish a public option in Nevada, though, in many ways, work on the public option is just beginning. Under the new law, Nevada’s public option plan won’t be available for purchase until 2026, giving state officials time to conduct an actuarial study of the proposal to determine whether it will accomplish proponents’ goals of increasing health care access and affordability and at what cost. It also provides time for state officials to transform the still relatively broad-strokes concept into a workable policy and return to the Legislature in 2023 with any changes that may need to be made to the law.
“I'm always looking for ways to expand health care opportunities in Nevada for Nevadans, and that's what this legislation does,” Sisolak said during a bill-signing ceremony in Las Vegas. “By leveraging the state's existing health care infrastructure and reducing costs, it is my hope that Nevadans will have improved access to comprehensive insurance.”
Senate Majority Leader Nicole Cannizzaro, who’s expecting her first child this summer and sponsored SB420, nodded to the effect it could have on the state’s youngest residents.
"This bill will help to open up some more doors in critical investments in prenatal and maternal care and Medicaid for Nevada moms and babies right here in our Silver State,” she said Wednesday.
Heather Korbulic, who as head of the state’s health insurance exchange will have a key role in the development of the public option, said in a statement that she plans to “bring all stakeholders together to outline the actuarial study and conduct a meaningful analysis of the public option as it relates to every aspect of health care throughout the state.”
“In the meantime I'm going to continue to focus on getting Nevadans connected to Nevada Health Link where we have an open enrollment period that runs through August 15th and — thanks to the Biden administration — almost everyone eligible is getting financial assistance,” she said, in a nod to the American Rescue Plan’s expansion of exchange subsidies.
Richard Whitley, director of the Department of Health and Human Services, in an interview last week said the public option isn’t “a single solution” but “does definitely enhance the opportunity for individuals to gain access to health care.”
“I think that as an option for coverage, it definitely enhances that overall framework,” Whitley said.
Under the new law, insurers that bid to provide coverage to the state’s Medicaid population will also be required to bid to offer a public option plan, with ultimate decision-making authority left to the state to decide how many plans to approve. The plans would resemble existing qualified health plans certified by the state’s health insurance exchange, though the legislation would require the public option plan or plans to be offered at a 5 percent markdown, with the goal of reducing average premium costs of the plans by 15 percent over four years.
The public option concept first surfaced during the 2017 legislative session, when former Assemblyman Mike Sprinkle (D-Sparks), introduced a bill to allow Nevadans to buy into the state’s Medicaid program, nicknamed Medicaid-for-all. While an amended version of that proposal, instead establishing a Medicaid-like plan, cleared the Legislature, former Gov. Brian Sandoval ultimately vetoed it.
Sandoval, a health care advocate who earned plaudits from Democrats for being the first Republican governor in the nation to opt into Medicaid expansion under the Affordable Care Act and fought to protect the federal health care law in 2017, said at the time of his veto that the public option proposal was “moving too soon, without factual foundation or adequate understanding of the possible consequences.”
Sprinkle proposed a narrower version of his vetoed bill during the 2019 legislative session, nicknamed Medicaid-for-some, that failed to advance after he resigned from the Legislature facing allegations of sexual harassment. Cannizzaro revived the proposal in the waning days of that session in the form of an interim study of yet another public option proposal — this time to allow Nevadans to buy into the state Public Employees’ Benefits Program rather than Medicaid.
That study, which was carried out by the health policy firm Manatt Health, was released with little fanfare in January as lawmakers geared up for the legislative session during some of the pandemic’s darkest days.
The study — which looked at both a PEBP buy-in proposal and a state-sponsored qualified health plan proposal — found that a 10 percent reduction in insurance plan premiums would translate to between zero and 1,500 uninsured individuals gaining coverage in the first year of the plan’s existence, while a 20 percent reduction would reduce the state’s uninsured population between 300 and 4,800 people. There are about 350,000 uninsured Nevadans.
“These enrollment figures highlight that a 10 percent or 20 percent reduction in premiums may not be enough to substantially encourage the currently uninsured to enroll in coverage for the first time,” the study concluded.
For the next couple of months, the public option remained in the background as lawmakers tackled other health care policies. But the public option resurfaced in mid-April when Cannizzaro confirmed she was working on legislation behind the scenes and started meeting with health care industry representatives to present the concept.
In late April, the proposal was introduced as SB420, this time with the goal of leveraging the state’s purchasing power with Medicaid managed care contracts with insurers to compel insurance companies to provide affordable public option plans, too. Unlike some previous iterations of the proposal, the plan would not be offered by a public insurer — such as Medicaid or PEBP — but by private insurers.
Proponents, including progressive groups like Battle Born Progress, the Progressive Leadership Alliance of Nevada and Planned Parenthood Votes Nevada, threw their weight behind the bill, arguing that the proposal would make health care more affordable and accessible. Opponents, including the Nevada Hospital Association, the Nevada State Medical Association and the Nevada Association of Health Plans, countered that it would do just the opposite, going so far as to destabilize Nevada’s already-fragile health care system.
Specifically, health care providers argued that a provision in the bill setting the floor for rates for the public option plans at Medicare rates — which providers say are better than Medicaid rates but not as good as those paid by private insurance plans — would act as an effective cap. They also pushed back on a section of the bill requiring doctors who contract with Medicaid, the Public Employees Benefits Program and workers’ compensation to participate in at least one public option plan.
Instead, opponents of the bill argued that the state should focus on targeting people who are uninsured but either eligible for Medicaid or for subsidies through the state’s health insurance exchange. Together, those two groups represent more than half of uninsured Nevadans. To that end, they proposed an amendment in the final days of the session to scale back the bill to just an actuarial study of the public concept proposal and to look further into how to get Nevadans already eligible for Medicaid or exchange plans insured. But that amendment that was never seriously entertained by Cannizzaro.
While many of the groups that testified in support of and against SB420 were Nevada-based organizations, the bill also attracted significant national attention, including support from the Committee to Protect Health Care, the Center for Health & Democracy and United States of Care and opposition from the Partnership for America’s Health Care Future, a coalition of some of the health care industry’s biggest names — including the American Hospital Association, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America — as well as the Koch-backed Americans for Prosperity and LIBRE Initiative. Many of those organizations devoted dollars toward their efforts, sending mailers and runningads in support of or against the proposal.
Sisolak’s signature on the public option bill comes as interest in establishing a national public option, as President Joe Biden promised on the campaign trail, appears to be dwindling. Individual states, however, have continued to pursue their own public option proposals. Washington, the first state in the nation to enact public option legislation, has started to offer plans for sale this year and a bill creating the “Colorado Option” passed out of the Colorado legislature on Monday.
There wasn’t much debate about whether to receive the COVID-19 vaccine in the Lenihan household.
Brian Lenihan, his wife and their 20-year-old son rolled up their sleeves for the shots earlier this year. So when it came time for the family’s 14-year-old twins to receive their doses, it didn’t take much, if any, cajoling. The teens grew up receiving inoculations, including the seasonal flu and HPV vaccines. This jab in the arm, however, came with the promise of more freedom: get-togethers with friends, a summer trip to national parks, in-person school and a long-awaited sushi meal.
“Takeout sushi just isn’t the same,” Lenihan explained.
His twins — a son and daughter who will be attending Desert Oasis High School later this year — are due for their second COVID-19 vaccine doses Tuesday. They’re among the thousands of adolescents statewide who have initiated the process after the Centers for Disease Control and Prevention greenlighted the Pfizer vaccine for use in 12- to 15-year-olds in mid-May.
As of Wednesday, more than 18,000 adolescents between the ages of 12 and 15 in Nevada had been given at least one dose of the vaccine, representing about 10.7 percent of kids who fall into that age group, according to data from the state Department of Health and Human Services. While that number is significantly less than the 48.9 percent of eligible Nevadans who have initiated vaccination, it is increasing rapidly, jumping up two percentage points in six days.
Karissa Loper, health chief in the state’s Bureau of Child, Family and Community Wellness, described those day-over-day gains as “promising,” particularly given the fact that 12- to 15-year-olds have only been eligible for the vaccine for about three weeks.
“We're seeing that number [of new vaccinations] be steady every day, meaning I think parents are feeling comfortable, are getting their questions answered, are listening to their trusted sources or getting to talk to their medical professional, and then with maybe with their teen making that choice to get that teen vaccinated,” Loper said.
That’s the case with Dawn Billings Blake and her 14-year-old son. As a teacher, Billings Blake got her vaccine fairly early in the rollout, but she worried that her son, who has Asperger’s, would balk at the idea. He previously hated shots, and she didn’t want to pressure him. She prefers arming him with information and letting him feel the self-sufficiency that comes with making his own decisions.
Her concerns ended up being for naught. He quickly agreed, which she thinks stemmed from watching his parents, grandparents and older brother receive the vaccine and experience little to no side effects. As a rising sophomore at East Career and Technical Academy, her son also yearned for a more normal school year.
“He took it like a champ,” she said.
Elisa Martinez, 15, also made the decision for herself. Her mother has received the vaccine, but her father is hesitant. They let her choose. Martinez said she put her trust in the scientists who developed the vaccine. Plus, it provided some mental relief after watching relatives, including her grandmother who was placed on a ventilator, battle COVID-19.
“You are protecting your elders. You are protecting your family. You are protecting yourself from COVID,” said Martinez, who will be a junior at Palo Verde High School in Las Vegas.
Despite some students’ enthusiasm for the vaccine, Clark County is hardly the frontrunner. With 9.4 percent of its adolescents between the ages of 12 and 15 vaccinated with at least one shot, it ranks fourth among counties, according to state data. Washoe County, at the top, has vaccinated 16.3 percent of that age group, while Nye County, at the bottom, has only vaccinated 1.3 percent. Douglas and Carson City — which with Washoe County, are leading the pack in the overall immunization effort — come in at second and third, respectively.
Surprisingly, Elko County, which is ranked 15th out 17 counties for percentage of first doses administered to its residents at 24.8 percent vaccinated, is ranked fifth in vaccinating 12- to 15-year-olds, having already vaccinated just under 9 percent of them. Loper attributes the relatively high adolescent immunization rate to the work of Bobbi Shanks, the chief nurse for the Elko County School District.
“She does a really great job of making sure any vaccine is accessible to her Elko teens and that she's giving the information to the parents early. She answers all their questions. That staff is amazing,” Loper said. “I think that lends a lot of local trust and comfort in that person, that nurse who's recommending that vaccine to you.”
In an email, a spokeswoman for the Department of Health and Human Services said that while the school nurse's office no longer stocks childhood vaccines — and never stocked the COVID-19 vaccine — "they do collaborate within the Elko community to refer individuals to their excellent community partners."
In Washoe County, the primary question is always, “How do we reach this age group?” said Lisa Lottritz, division director for Community and Clinical Health Services at the Washoe County Health District.
To that end, the health district dispatched staff to Bishop Manogue Catholic High School in May for an on-site vaccination event. Lottritz said about 140 students received an initial dose of the vaccine at the time. The health district returned on Friday for a followup event, providing second doses as well as first doses to anyone who attended and wanted to start the vaccination process.
Similarly, the health district intends to host pop-up vaccination events in Washoe County School District parking lots during summer school later this month, Lottritz said. Health officials are also eyeing opportunities to provide vaccinations at parks, food banks, churches and Boys & Girls Clubs — all in the name of reaching people at places where they normally go.
“Not missing opportunities is a big thing for us,” she said.
The Southern Nevada Health District kicked off school-based vaccination events last week, too. Shortly before the doors opened on Tuesday, a small line had formed outside the Desert Pines High School gymnasium. It largely consisted of parent-teen duos, like Mike Meyer and his son, Nichols. The almost-14-year-old — who will begin his freshman year at the school in a couple months — said he didn’t want to wait any longer. Older family members have already gotten theirs.
“What’s the big deal?” Mike Meyer said, describing the decision as a no-brainer. “Just do it.”
But that certainly isn’t the case for all families. Health officials acknowledge they’re still combatting vaccine hesitancy among families.
Heidi Parker, executive director of the nonprofit Immunize Nevada, said the focus has been not only on communicating to parents that their kids still face a risk if they contract COVID-19, particularly if it develops into a rare but serious condition known as multi-system inflammatory syndrome, but that the vaccine will make it safer for them to return to the activities they enjoy, whether that’s being able to hang out with friends, go to school dances or play sports.
“We've been talking about the things that we all miss as adults, but they're in a similar situation and have missed a lot of things themselves,” Parker said.
Immunization officials have also been pointing to the vaccine’s success — and safety — among 16- to 17-year-olds, who have been eligible for the vaccine for months, in encouraging parents to get their 12- to 15-year-olds the shot. But they also understand some parents may be waiting for the Pfizer vaccine to get full approval, a process that usually takes months but could happen as soon as early as the second half of the year.
Irene Cepeda, a Clark County School Board of Trustees member, shared that her 15-year-old son had received his first dose several weeks ago and was due for his second last Wednesday. She encouraged others to follow suit to protect themselves and others as well as help the community move forward after a trying year.
“I think everyone’s just kind of really looking forward to being normal — walking around without a mask, not having to be physically distant,” she said.
More school-based vaccination events are planned this week in Clark County. Second doses will be provided at the same schools at the end of the month and beginning of July.
“We've seen some great success in Nevada with school-based flu immunization sites. It’s open to that surrounding community. It's a familiar access point. Families can walk there based on if it's in their neighborhood,” Parker said. “I think it does reduce some of those barriers [to accessing the vaccine] that we hear about.”
Though the COVID-19 vaccine isn’t expected to be required for K-12 students, those involved with the immunization effort are gearing up for anticipated back-to-school demand for the vaccine.
“We'll just continue to reiterate to parents the importance of trying to get in now and get those appointments taken care of sooner than later,” Parker said.
And, where vaccinators were concerned about a recommendation against administering the COVID-19 vaccine in close proximity with other shots, a policy change from the federal government allowing concurrent vaccination has now provided them with a golden opportunity. Incoming seventh-graders required to get the meningococcal conjugate vaccine, which covers four types of meningococcal disease, as well as the Tdap vaccine, which protects against tetanus, diphtheria and pertussis, or whooping cough, will now be able to get the COVID-19 shot at the same time.
Vaccination officials say it’s plausible they could see even higher rates of COVID-19 vaccination among seventh-graders than they do for other age groups, if they’re able to capture them when they’re receiving their other back-to-school shots. Loper echoed what other health officials have said about the importance of not squandering any opportunities.
“That was a huge win for vaccinators in general,” Loper said. “Any time I have you at a place where you can get vaccinated and I can't give you every vaccine that you could possibly get that day, for whatever reason, that's a missed opportunity for us. This allows us to miss no opportunities to vaccinate an eligible adolescent.”
As for whether schools will require the COVID-19 vaccine for older students, that seems unlikely but hasn’t been decided. Fermin Leguen, Clark County’s chief health officer, said he’s not aware of any discussions at this point about making the vaccine mandatory for children.
Loper said that interest in requiring the COVID-19 vaccine is “different at different levels,” noting that doing so would involve a multi-step process. Any decision to mandate kids to receive the shot before returning to school would have to be put forward as a regulation by the Division of Public and Behavioral Health and go through a public input process before it would be voted on by the state Board of Health. Even having that conversation, she said, doesn’t make sense unless a large number of parents and schools are on board with the idea.
“You want everybody to be in support of it before you really create a mandate, or it won't be effective. It will cause more animosity than anything else,” Loper said. “Starting at the stakeholder information process, that's really where we're at, and I'm sure all the school districts and things are thinking about that. I know we're here, ready to engage, but the State Immunization Program isn't necessarily leading that conversation right now.”
Health officials say priority at the moment is simply inoculating as many people as possible, children included, and the quicker, the better.
While the Biden administration has set a target of getting 70 percent of adult Americans vaccinated by the Fourth of July, neither the federal nor state government has set a similar goal for vaccinating kids. It’s also unclear how soon more children will become eligible, though Dr. Anthony Fauci, the president’s chief medical adviser, has expressed optimism about the age range widening to those as young as 4 years old by the end of the year.
“There is a sense of urgency to it and we do want to make sure that as many kids are protected as possible, especially as they do return to activities like summer camp and all of those things,” Parker said. “It is just making it as accessible as possible, all of the places and all of the days and times and making it easy for parents to get their kids in somewhere.”
The big question over the coming weeks and months is whether those efforts will translate to a dramatic increase in the state’s vaccination rate.
Nationally, Nevada ranks toward the bottom of states in terms of percentage of adolescents vaccinated with at least one shot of the COVID-19 vaccine. According to the Centers for Disease Control and Prevention, Nevada has vaccinated nearly 18 percent of 12- to 17-year-olds as of Friday, ranking 37th in the nation. Vermont, by comparison, is in first place at 55 percent while Idaho is in last at 0.4 percent.
Nevada ranks 32nd nationally for percentage of residents 18 and older who have received at least one shot of the vaccine, at 57.7 percent.
Those adolescent and adult rankings, while seemingly less than impressive on their face, actually represent good news for Nevada, which ranked last in the country for percentage of residents vaccinated against the flu in the 2019 to 2020 season, at 44.4 percent, according to the Kaiser Family Foundation. Rhode Island was first at 60.9 percent.
“Our vaccination rate right now is significantly higher than we ever get during flu season. For Nevada, that’s a cause for celebration,” Parker said. “Hopefully that same trend applies for our younger Nevadans as we start getting them more into clinics and hopefully we see similar increases as well.”
Correction: This article was updated on June 7, 2021 at 4:08 p.m. to correct incorrect information provided by the state Department of Health and Human Services. The Elko County School District no longer stocks childhood vaccines on site and never stocked the COVID-19 vaccine, a spokeswoman for the department said.
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.”
Nevada came one step closer to becoming the second state in the nation to pass a public health insurance option on Saturday after an Assembly committee voted to advance the legislation and two key leaders voiced support for the bill after being relatively mum on the measure.
While the public option bill faced a relatively clear path in the Senate, where bill sponsor Nicole Cannizzaro (D-Las Vegas) is the majority leader, it faced a less certain future in the Assembly, with leaders in that chamber remaining relatively quiet publicly on their feelings on the bill. That changed Saturday when Assembly Speaker Jason Frierson (D-Las Vegas) and Assemblywoman Maggie Carlton (D-Las Vegas), who chairs the Assembly’s money committee, not only voiced support for the legislation but defended it from attacks.
The Assembly Ways and Means Committee voted on party lines on Saturday to forward the measure on to a full vote of their chamber.
Carlton, ahead of the committee vote, acknowledged for the first time publicly her own doubts about the bill. But she said her concerns were assuaged by the fact that the bill, SB420, includes a significant runway before the public option would be available for purchase in 2026, allowing the Legislature to come back in 2023 and make any tweaks to the policy as necessary.
“It's not a secret I have been skeptical of this bill from the very beginning, but I've seen the amendments, and I have talked to a number of the different proponents of the bill and opponents of the bill on it,” Carlton said. “I feel much more comfortable knowing that in the future the people that are in this building now that do come back are well aware of what's going on, and I trust them to make the best decisions they can to protect the constituents of this state.”
Assembly Minority Leader Robin Titus (R-Wellington), however, didn’t mince words on the legislation, which has been uniformly opposed by Republican lawmakers who agree with the health care industry’s concerns about the bill.
“I think this piece of legislation is probably the single most damaging thing we’re going to do to health care access in our state in the entire time I’ve been in this building. I have incredible concerns about this bill,” Titus said. “We all say we want more access to care and, again, I've said it all along: Giving somebody a bus ticket without the buses and ensuring that the buses will be available, we might as well be throwing them under the bus, and I feel this bill throws health care under the bus.”
Frierson, however, pointed to the legislation’s “guardrails” and warned against the public being “misled about the nature of what we're doing.”
“There are concerns that are valid concerns, but we also have a thing called time,” Frierson said. “If this is not going to kick in until several years, then a subsequent Legislature can make adjustments. I beg to differ that this is the worst thing unless folks who plan on being here don't plan on doing their jobs, which is our job to look at future legislation and make adjustments.”
The comments from Carlton and Frierson marked the first time either has taken a publicly supportive position on the legislation, though Frierson is listed as primary sponsor of the bill.
On Friday, Carlton temporarily pumped the brakes on the legislation, saying the Assembly needed to take the time to get all interested parties “in the corral together” on the legislation before advancing it, while Frierson earlier this week deferred questions about the status of the public option bill — and whether it was getting tied up in legislative endgame conversations — to Cannizzaro, as majority leader.
The bill, as written, would require insurers that bid to provide coverage to the state’s Medicaid population to also offer a public option plan. While the plans would resemble existing qualified health plans certified by the state’s health insurance exchange, the legislation would require 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 would be available for purchase for coverage starting in 2026.
Health care industry representatives, however, have argued that not only will the bill not achieve its goal of increasing health care access and affordability but that it will destabilize Nevada’s already fragile health care system. To that end, they have proposed limiting the bill to an actuarial study of the public option concept as outlined in SB420 and letting the 2023 Legislature decide whether to move forward with putting a public option into law, depending on what the study finds.
Approving a public option just as an actuarial study would, however, be a gamble for Democrats, who control both chambers of the Legislature and the Governor’s Mansion. If they only approve a study, lose any one of the three parts of their Democratic trifecta to Republicans in 2022, and the actuarial analysis comes back and says the public option will achieve their goals and is financially feasible, it would likely be difficult, if not impossible, to pass a public option during the 2023 legislative session.
On the other hand, if lawmakers approve SB420 as drafted — including both the actuarial study and a timeline to establish the public option by 2026 — and the actuarial analysis comes back and says the proposal isn’t workable and either needs changes or to be scrapped entirely, Democrats could make the necessary changes to the bill if they remain in control in 2023, while Republicans would likely remain eager to change or undo the policy if they gain at least some control in 2023.
The Assembly Ways and Means Committee also approved a hodgepodge amendment to the bill on Saturday that would make several minor, mostly technical changes to the bill, require that a niche benefit be covered by the state Public Employees’ Benefits Program and add a $600,000 appropriation to the Silver State Health Insurance Exchange to cover the costs of implementing a public option.
The bill now heads to the Assembly for a final stamp of approval. If the Assembly passes the bill, the Senate will be required to concur with the changes made on the Assembly side before it heads to Gov. Steve Sisolak’s desk. Sisolak has not yet taken a position on the bill, though it would likely be politically fraught for a Democratic governor to veto a public option bill.
If Nevada passes its public option bill quickly, it will be the second state in the nation to approve such a proposal, though Colorado is also advancing a public option bill this spring. Washington was the first state to approve a public option plan in 2019, with its plan available for purchase starting this year.
Riley Snyder and Michelle Rindels contributed to this report.
With just three days left in the session, a Senate bill to establish a state-managed public health insurance option finally received its first hearing in the Assembly on Friday.
Because the bill does not require two-thirds support, the Democratic-controlled Assembly could quickly process the proposal, which was sponsored by Senate Majority Leader Nicole Cannizzaro (D-Las Vegas), and send it to Gov. Steve Sisolak, also a Democrat, for his signature. But Assemblywoman Maggie Carlton (D-Las Vegas), who chairs the Assembly Ways and Means Committee where the bill sits, has indicated her chamber isn’t in any rush to get the bill out and said there would be no action on the bill, SB420, on Friday.
Sisolak has not yet taken a position on the public option bill.
Carlton, in an interview, said her committee needed time to vet a new amendment to the bill — which would make a minor change in coverage requirements for the state Public Employee Benefit’s Program unrelated to the legislation’s public option or Medicaid service expansion sections — and consider how to cover $600,000 in fiscal impact from the legislation on the Silver State Health Insurance Exchange that cannot be taken from the exchange’s reserves.
She added that she wanted to take the time to get interested parties “all in the corral together,” saying they “may not all agree with each other” but “you don’t pass something this big without making sure you’ve got everybody” together.
“We’re not moving it today because it’s significant, and we want to make sure that everybody’s comfortable, that everybody’s got all their comments on the record and members have time to address their concerns,” Carlton said.
Health care industry representatives have voiced concerns since the first hearing on the bill about being left out of the bill drafting process and this week proposed their own amendment to the legislation, which would remove the portion of the bill actually establishing a public option and leave the legislation at just an actuarial study of the latest concept. That amendment would, essentially, leave it up to the 2023 Legislature to decide whether to move forward with the proposal, based on the outcome of the actuarial study.
Cannizzaro, however, has said she isn’t open to considering the industry’s proposed amendment.
“I’m not interested in gutting the bill and replacing it with a study when that is exactly the reason why we’re here is having done a lot of studies, and I think the actuarial analysis that goes with the bill is what’s needed to get this implemented, but now is the time to start implementing it, not just studying it,” Cannizzaro said in an interview on Thursday. “People are fine to propose their own ideas but I’m not interested in accepting that one.”
The bill, at its core, would require insurers that bid to provide coverage to the state’s Medicaid population to also offer a public option plan. While the plans would resemble existing qualified health plans certified by the state’s health insurance exchange, the legislation would require 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 bill passed the Senate on party lines earlier this week.
Welcome to the 49th installment of “Coronavirus Contextualized.”
For more than a year, we have brought you the latest COVID-19 numbers in Nevada, including COVID-19 cases, hospitalizations and deaths, and provided context to them on a near-weekly basis through this series. You can view the prior editions of “Coronavirus Contextualized” here.
As noted in the last few editions, we plan to continue providing you with the data you need to know about COVID-19 in Nevada for as long as necessary. However, “Coronavirus Contextualized” now publishes on a semi-regular basis, which means we may occasionally skip a Friday or two if there are no new trends to report.
Don’t fear though: You’ll still be able to continue to find the latest data daily on our COVID-19 data page and on Twitter. As always, you can reach out to email@example.com with any questions.
Below, we explore how COVID-19 cases and hospitalization numbers have remained low as the vaccination effort continues and the state continues to open up — with every county expected to be fully open as of Tuesday.
Cases and test positivity
The number of new COVID-19 cases reported each day has been steadily declining over the last two weeks.
As of Thursday, an average of 209 cases were reported each day over the last seven days, down from 267 the week before and 381 the week before that. The last time the seven-day average was lower than it is now was June 12, 2020, right around when COVID-19 cases first started to climb after Nevada started to reopen following the spring shut down.
Since the beginning of the pandemic in March 2020, there have been 323,481 COVID-19 cases reported statewide. A little less than 3 percent of those cases, 9,396 have been diagnosed in the last month, and 0.5 percent, or 1,463 cases, have been reported in the last week.
For comparison, the number of COVID-19 cases reported in the last week is about half of the cases Nevada was seeing on average reported each day during the worst of the pandemic this fall. On Dec. 10, the peak, the seven-day average hit 2,736.
Since the beginning of the pandemic, about 1 in 10 Nevadans has tested positive for the virus.
At the same time, the test positivity rate, which looks at the percentage of tests coming back positive out of the total tested, has been steadily decreasing for about a month.
It is not possible to independently calculate the test positivity rate based on test encounters because the state only reports the number of positive cases, not the number of positive test encounters. However, the state does provide this number, calculated as an average over a 14-day period with a seven-day lag. As of Wednesday, that number was 4.21 percent, down from 4.8 percent the week before and 5.34percent the week before that. The test positivity rate is now, once again, below the World Health Organization’s recommended5 percent threshold.
Since the beginning of the pandemic, more than 1.6 million people — roughly 1 in 2 Nevadans —have been tested for COVID-19, and there have been more than 3.3 million individual testing encounters.
As of Thursday, nearly 45 percent of Nevadans have been either partially or fully vaccinated against COVID-19, and 42 percent of Nevadans eligible for the vaccine have yet to receive it.
Since vaccinations started in December, nearly 2.5 million doses of the COVID-19 vaccine have been administered in Nevada, up from nearly 2.4 million last week. In total, nearly 1.4 million people have received at least one dose of the COVID-19 vaccine and more than 1.1 million Nevadans have been fully vaccinated. Nevada has received more than 2.8 million doses of the vaccine for distribution.
The pace of vaccine distribution has continued to generally slow. As of Thursday, about 13,000 vaccines were being reported administered each day over the last seven days, down from about 16,000 last week and a high of nearly 30,000 on April 15.
Among the counties, Carson City has the highest percentage of residents partially or fully vaccinated against COVID-19 at 48.5 percent, followed by Washoe County at 47.5 percent, Douglas County at 44.6 percent, and Clark County at 39.9 percent. Tiny Storey County has vaccinated the least, with only 14.2 percent of its residents partially or fully vaccinated.
As the federal government continues to forge ahead with its goal of vaccinating 70 percent of American adults with at least one dose of the COVID-19 vaccine by July 4, Nevada continues to lag. As of Thursday, Nevada has given 56.4 percent of the adult population, or about 1.3 million adults, at least one dose of the vaccine.
Nationally, Nevada ranks 32nd among the 50 states for percentage of adults given first doses of the COVID-19 vaccine, trailing almost all of its neighboring states except Idaho, which comes in at 44th with 49.6 percent vaccinated. California ranks 12th, at 69.1 percent; Oregon ranks 20th at 64.9 percent; Utah ranks 25th at 60.3 percent; and Arizona ranks 31st at 57.1 percent.
To reach 70 percent, Nevada will need to vaccinate about 325,000 more adults. With an average of 7,000 first doses a day being administered, if all of those shots were given to adults, the state would hit the 70 percent vaccination goal in 46 days — on July 12.
For more on the vaccination process in the state, read our vaccine Q&A here.
The number of new COVID-19 deaths reported on average each day has continued to generally decline, with some day-to-day fluctuations.
As of Thursday, four deaths were being reported on average each day over the prior seven days, roughly unchanged from last week and slightly down from five deaths two weeks ago.
Over the last seven days, 28 COVID-19 deaths have been reported across the state, including:
24 in Clark County
3 in Washoe County
1 in Nye County
Since the beginning of the pandemic, there have been 5,578 deaths from COVID-19. In the last month, 134 deaths from COVID-19 have been reported statewide, about 2 percent of the deaths reported statewide since the beginning of the pandemic.
Pershing County has had the highest number of deaths per capita in Nevada, with 30 deaths per 10,000 residents, followed by Nye County at 23 and Carson City at 22.
COVID-19 hospitalizations continue to decline, again setting a new record low of 243 on Wednesday, the last day for which data is available. The previous record low, 259, was set on March 28, before hospitalizations started to fluctuate for a few weeks.
Nevada hit peak hospitalizations during the fall surge at 2,025 on Dec. 13.
“Nevada continues to see hospitalizations and all critical metrics near the bottom of the scale,” the Nevada Hospital Association wrote in its weekly report. “Nevada has not witnessed any significant hospitalization increases since the counties lightened social distancing protocols on 1 May 2021.”
County by county
Fourof the state’s 17 counties — Douglas, Elko, Eureka and Lincoln —are considered at elevated risk for the spread of COVID-19 according to state criteria as of Thursday.
Counties are considered at risk for elevated spread of COVID-19 if they meet two of the following three metrics:
The average number of tests per day per 100,000, calculated over a 14-day period. If this number is less than 100, a county could be considered at risk.
The case rate per 100,000, calculated by taking the number of cases diagnosed and reported over a 30-day period. If this number is greater than 200, a county could be considered at risk.
The case rate per 100,000 and the test positivity rate, calculated over a 14-day period with a seven-day lag. If the case rate is greater than 50 and the test positivity rate is greater than 8.0 percent, a county could be considered at risk.
While Eureka and Lincoln are flagged for a too low test rate combined with a too high test positivity rate — metrics that are now less concerning as counties may be testing less as more residents get vaccinated — Douglas and Elko are flagged for all three metrics, including a too high case rate.
Elko has a case rate of 296 per 100,000 over the last 30 days, while Douglas has a case rate of 217. A third county, Lander, has the highest case rate, 300, but isn’t flagged because it doesn't meet either of the other two other criteria.
No other counties have an elevated case rate and, in fact, nine counties, including both Clark and Washoe counties, aren’t flagged for any criteria at all.
Insurance companies, hospitals and doctors have proposed an amendment to Nevada’s public option bill that would gut much of the existing legislation and replace it with a study, effectively delaying a formal decision on whether to move forward with the proposal for two years.
While the most recent draft of the public option bill, SB420, already requires state health officials to conduct an actuarial study of the proposal as part of a four-and-a-half-year ramp up, it also sets the wheels in motion to establish that public option for purchase for plan year 2026. The new industry-backed amendment would instead turn the bill into just an actuarial study — with no timeline or plan for actually implementing a public option — leaving it up to lawmakers in the 2023 session to decide whether to proceed with the proposal.
“I think that it would be prudent from a policy perspective to have a process whereby you move forward with legislation that creates an option that is consistent with the actuarial study instead of putting the public option into statute, have the actuarial study come back, and then have to claw, potentially, items back or add to it,” said Tom Clark, lobbyist for the Nevada Association of Health Plans.
The amendment is being put forward by the Nevada Association of Health Plans, the Nevada Hospital Association and the Nevada State Medical Association. Industry representatives said they delivered the amendment to the office of Senate Majority Leader Nicole Cannizzaro, the bill’s sponsor, early Tuesday evening, though they haven’t yet had a conversation with her about it.
In bill hearings, however, Cannizzaro has made clear that she isn’t interested in simply another study of the concept. Notably, conversations around a different version of the public option proposal turned into a study at the end of the 2019 legislative session.
“I am just at a little bit of a loss of words with some of those comments where, ‘We should study this. We should figure out why people are uninsured. We should figure out why people aren’t accessing health care,’ because that’s a question that's been raised for as long as I've been in this building,” Cannizzaro said during a hearing on the bill earlier this month. “While that's not as long as some, it's a long enough period of time for me to know that it's time to take action.”
Under the public option legislation, as currently drafted, insurers that bid to provide Medicaid coverage would also be required to bid to offer a public option plan. The public option plans would resemble existing qualified health plans on the state’s health insurance exchange, though they would be required to be offered at a 5 percent markdown, with the goal of reducing the plans’ average premium costs by 15 percent over four years.
The new amendment, at its core, is the sum of the many arguments the health care industry has made against the bill during hearings and through a direct campaign to everyday Nevadans, including that a public option would destabilize the health care landscape in Nevada and that there are better ways of reducing the state’s uninsured rate.
Specifically, the amendment would require the proposed actuarial analysis to hone in on individuals who have been uninsured for at least six months and who are not eligible for Medicaid or subsidies on the state’s health insurance exchange — two groups that collectively make up more than half of uninsured individuals in the state. Opponents of the bill, including representatives of the health care industry and chambers of commerce, have argued the Legislature ought to focus on getting those two groups covered first.
To that end, the amendment would also require the Interim Legislative Committee on Health Care to come up with ideas for how to get people who are currently eligible for Medicaid or exchange subsidies but aren’t enrolled signed up for coverage.
“If we’re looking at capturing those who are uninsured currently, what can we do to encourage them to enroll in the programs that they’re already eligible for? That’s a really important part of the equation,” Clark said.
The amendment lists several areas health care industry representatives would like to see the actuarial analysis dive deeper into, including the effect of the public option on the stability of the health insurance market, accessibility of physicians and network adequacy.
It also asks that the study look at the effect of mandating “below market or below cost rates” for providers — a reference to the fact that the bill sets Medicare rates as a floor for provider payments under the public option plan, which providers view as an effective cap. Additionally, the study would analyze what insurance coverage benefits may need to be reduced in the plans to achieve the rate reductions mandated by the bill.
The amendment also directs the actuarial study to look into what federal opportunities might exist to support the public option — which bill proponents already plan to do in the form of federal waivers, though the amendment also leaves room for unnamed “other opportunities” — as well as consider the impact of the federal American Rescue Plan, which opens up health insurance exchange subsidies to people who make more than 400 percent of the federal poverty level.
The amendment only proposes to change the public option portion of the bill, not the secondary portion that expands Medicaid services.
Clark said the additional requirements would provide more of a framework for the actuarial study.
“That actuarial study needs some guardrails,” Clark said. “You can't just say, ‘Do an actuarial study.’”
Under the industry’s proposed amendment, the actuarial analysis would be required to be completed by July 1, 2022, and the director of the Department of Health and Human Services, the insurance commissioner and the executive director of the Silver State Health Insurance Exchange would be required to review the actuarial analysis and submit a comprehensive report on “their collective recommendations for effective implementation of the Public Option in Nevada; improving access to and affordability in Nevada’s health care market; and addressing the challenges of enrolling individuals in Medicaid and the Exchange who are eligible but remain uninsured” by Oct. 1, 2022.
Clark pushed back on any framing of the amendment as an attempt to kill the public option bill — as is often the case with many legislative bills that get turned into studies.
“We feel that this isn’t just a blanket, ‘Kill the bill.’ This is saying, ‘Let's take this major step forward first before we put the policy in the statute’,” Clark said.
The bill passed the Senate on a party-line vote Monday and was referred to the Assembly Ways and Means Committee on Tuesday. It has yet to be officially scheduled for a hearing but will likely be heard in the next day or two.
A bill to establish a state-managed public health insurance option cleared its first major legislative hurdle on Monday, passing the Senate on a party-line vote.
Though the bill, SB420, has attracted significant attention from high-profile national groups, including progressive health care organizations backing it and big health care industry names opposing it, there was little pomp and circumstance around the Senate’s vote. Senate Majority Leader Nicole Cannizzaro (D-Las Vegas), the bill’s sponsor, and Sen. Fabian Doñate (D-Las Vegas), who works in public health, briefly spoke in favor of the legislation, with no Republicans speaking in opposition — a rarity for a high-profile bill that splits on party lines.
“In the state of Nevada we have a persistently higher uninsured rate … of 11 percent that remains unchanged despite being one of the states that did opt into expanded Medicaid coverage and that has actually implemented provisions of the [Affordable Care Act] through the Silver State Health Insurance Exchange. While we’ve seen great progress in that regard, there’s still a large chunk of Nevadans who remain uninsured and who are unable to afford insurance,” Cannizzaro said, presenting the bill on the Senate floor “The public option is a way in which for us to … have individuals get more affordable options to get coverage for their health insurance.”
Before voting against the bill in the Senate Health and Human Services Committee earlier this month, state Sen. Ben Kieckhefer (R-Reno) voiced concerns about the disruptive effect the legislation might have on the state’s health insurance market and said the state should be using the tools at its disposal to get Nevadans who are already eligible for either Medicaid or subsidies on the state’s health insurance exchange — which together represent more than half of the state’s uninsured population — signed up for coverage.
“I still believe that we have incredible tools at our disposal to try to tackle the uninsured population in Nevada through continued outreach through Medicaid, as well as the eligible but unenrolled population through the exchange,” Kieckhefer said. “Without really understanding how we're going to capture some of the other populations of uninsured, I can't support it this time based on the disruption that I think it will have on the insurance market.”
Under the proposal, insurers that bid to provide Medicaid coverage would also be required to bid to offer a public option plan, with the state ultimately responsible for selecting how many plans it approves. The public option plans would resemble existing qualified health plans on the state’s health insurance exchange, though they would be required to be offered at a 5 percent markdown, with the goal of reducing the plans’ average premium costs by 15 percent over four years. The first year the public option plans would be offered is 2026.
Supporters of the bill, including Battle Born Progress, the Progressive Leadership Alliance of Nevada, the Culinary Union and Planned Parenthood Votes Nevada, argue that the legislation will boost health care affordability and accessibility. Opponents, including the Nevada Hospital Association, the Nevada State Medical Association and several chambers of commerce across the state, argue that it would do just the opposite.
Nationally, the Center for Health and Democracy, the Committee to Protect Health Care and United States of Care are backing the legislation. It is being opposed by Nevada’s Health Care Future, a project of the national organization Partnership for America’s Health Care Future Action, which is a partnership of some of the health care industry’s heaviest hitters including the American Hospital Association, America’s Health Insurance Plans and Pharmaceutical Research and Manufacturers of America.
One health insurance reform expert at the Center on Health Insurance Reforms at Georgetown University not involved with the legislation told The Nevada Independentthe reality probably lies somewhere in between. A recent amendment to the bill makes more explicit that the state will be required to conduct an actuarial study before moving forward with implementing the public option — a study that will likely provide more concrete answers as to how the proposal will affect the overall health care landscape in Nevada and whether it really will reduce premiums and boost accessibility.
A secondary portion of the legislation proposes expanding some Medicaid services in the state, including increasing eligibility up to 200 percent of the federal poverty level for coverage for pregnant women, adding coverage for doulas and community health workers and requiring payment parity between advanced nurse practitioners and physicians. A recent amendment to the bill, however, makes those coverage expansions optional in an effort to reduce the bill’s fiscal impact.
As a result, Medicaid is likely only to implement the doula and community health worker provisions in the bill, resulting in a net savings to the state. Instead of costing the state $23.9 million in general funds in the upcoming biennium and $39.8 million in the following two-year period, the Medicaid portion of the bill will actually save the state $384,000 in the upcoming biennium and $533,000 in the next one, according to projections shared before a Senate Finance Committee vote on the bill on Friday.
There is, however, still a fiscal cost associated with the public option portion of the bill. An amendment to the bill adopted by the Senate on Monday provides funding to cover those costs in the upcoming biennium, sending $1.6 million to a new Public Option Trust Fund to cover preparations over the next two years. It also allocates nearly $168,000 to the Division of Welfare and Supportive Services to cover expenses related to the Medicaid portion of the bill.
Because the legislation provides a more than four year runway before the public option would actually be offered to Nevadans, many of the costs associated with the legislation would likely hit in the 2023-2025 biennium and beyond — not the upcoming biennium that lawmakers are currently budgeting for. Medicaid estimates it will need $2.4 million in the 2023-2025 biennium to implement the public option portion of the bill, while the Silver State Health Insurance Exchange anticipates it will need nearly $8.8 million in the next two biennia to implement the legislation.
The bill will now head to the Assembly for consideration.