Election Preview: State Senate races will determine Democrats’ chances at reaching a super-majority

All it takes is one.

After the 2018 election, Democrats controlled 13 of 21 seats in the state Senate — enough for a clear majority, but one short of a supermajority that could give the party the power to raise taxes and take other major procedural action without a Republican in support. The arrangement was brought into laser-sharp focus through Democrats’ multiple failed attempts to raise mining taxes during the summer special session because they failed to notch a Republican vote.

Now, with less than a month before Election Day, state Senate Democrats are aiming to flip two Republican-held districts while defending two suburban Las Vegas districts they won narrowly in the 2016 election.

It’s unlikely Republicans will gain a majority in the Senate without a major wave that gives them victory over essentially all seats in play and a fifth seat that’s considered generally out of reach. Democrats enjoy a 13-8 advantage in the Senate, and Republicans are aiming to both pick up seats and defend potentially vulnerable districts to ensure that Democrats don’t obtain a supermajority.

As members of the 21-seat state Senate serve four-year terms, only 11 districts are up for re-election in 2020 — and only four are considered to be up for grabs, given relative closeness in voter registration totals. 

Democrats are playing defense in two suburban Las Vegas Senate districts, with Senate Majority Leader Nicole Cannizzaro running against Republican attorney April Becker in District 6, and political newcomer Kristee Watson attempting to keep control of Senate District 5 in a race against Republican charter school leader Carrie Buck (Democratic former Sen. Joyce Woodhouse is termed out of office).

On the flip side, Republicans are fending off challenges to well-funded incumbents Heidi Gansert in Reno (running against Wendy Jauregui-Jackins) and Scott Hammond (running against Liz Becker) in northwest Las Vegas.

Other Senate candidates are facing a much easier walk to re-election — incumbent Democrats Chris Brooks and Pat Spearman didn’t attract a single challenger, while incumbent Republican Sen. Pete Goicoechea and Democratic candidate Dina Neal are both running in districts with overwhelmingly favorable voter registration advantages. Former Democratic state party head Roberta Lange overcame robust challenges from sitting lawmakers in the primary election for termed-out Sen. David Parks’ seat, but she does not have a general election opponent.

Some Republican consultants have identified Senate District 11 — where appointed Sen. Dallas Harris is running for the first time against Republican Joshua Dowden — as a potential pickup opportunity in a wave election. However, registered Democrats currently outnumber registered Republicans by a nearly 18-percentage-point margin in the district, making it unlikely that control of the district will flip.

But Republican candidates are for the most part entering the final period before the election with a cash advantage. All four Republicans in swing districts — Gansert, Hammond, Becker and Buck — outraised their opponents over the most recent fundraising quarter, which ran from July to the end of September.

“We've really been focused not only on protecting our incumbents, Sen. Gansert and Sen. Hammond, but really making sure that Carrie Buck and April Becker had a strong team behind them and the resources that needed to compete knowing how close these races have been historically,” said Greg Bailor, director of the Senate Republican Caucus.

The most recent numbers also mean that, save for Cannizzaro, Republicans have cumulatively outraised Democratic candidates since the start of 2019 in three of the four competitive districts. They’re also receiving a boost from several outside groups, including a PAC created by the Las Vegas Police Protective Association that’s raised half a million dollars, and former Lt. Gov. Mark Hutchison-led PAC (Stronger Nevada PAC) that has raised more than $1.8 million this year and placed substantial television and digital ads attacking Democratic candidates.

But fundraising totals and voter registration data are just some of the factors that determine electoral success, not infallible predictors.

Nevada State Senate Democrats Executive Director Cheryl Bruce said early returns from the first week of mail voting had been a positive indicator, but that candidates and the party would continue pushing hard through the state’s early vote period and Election Day. 

“In races like these that we're playing in, it is always going to be tight, it's always going to be close,” she said. “And so we cannot take anything for granted, and we're not going to. We have reasons to be optimistic, but we're not going to let our foot off the gas.”

While some campaigns got a slower start to door-knocking and canvassing because of concerns over the COVID-19 pandemic, Bruce said that the party recently started using a “hybrid” canvassing system, where volunteers who are comfortable drop campaign literature at doors or have conversations with voters at a six-foot, socially distanced space.

And while the presidential race has sucked up much of the political oxygen, the lack of a statewide race on the ballot (such as governor or U.S. Senate) means that legislative candidates in two races — Cannizzaro and Becker, and Gansert and Jauregui-Jackins — have purchased television advertisements.

No legislative candidates bought television ad time in 2018, and only one — former Sen. Joyce Woodhouse — did so in 2016. Though there are some drawbacks — television ads can’t be geolocated to an individual district and thus likely reach a large number of voters who can’t vote for the candidate — Bruce said that the lack of other major races or a big-money ballot question gave candidates “a little bit more of an opening, both in terms of maximizing our dollars and also cutting through some noise on TV.”

Republicans hope to pin their opponents to Democratic Gov. Steve Sisolak, whose approval ratings have dropped by double digits as economic troubles have carried on, unemployment remains sky high and critics have scrutinized his response to the pandemic. If they block Democrats from holding a two-thirds majority, Republicans can continue to be a relevant part of the policy conversation.

“We're also 200 days plus now into the COVID shutdown and the economic shutdown and seeing the governor continue to struggle to communicate,” Bailor said. “If there is a path to get the Senate back in Republican control, that puts at least a check back on the system of state government. And that is an opportunity to maybe have a more bipartisan conversation when we go to Carson City in 2021.”

Bruce said that even with the governor’s lower approval ratings, Democratic candidates were not shying away from Sisolak’s support or endorsement. She said if anything, voters were more apt to make decisions on down-ballot races based on their reaction to President Trump.

“People are really responding well to the steps and the actions that he's taken to help us weather the storm of the pandemic, both economically and health and safety-wise,” she said. “There is definitely a very strong sense of anger towards the Trump administration right now, and really DC politics in general, that I think is going to probably play a factor in these races.”

As for Republicans? 

“Nobody's shying away from the party ticket,” Bailor said. “But with our messaging, we're not talking about national issues. We're talking about local issues at the state level.” 

Below, The Nevada Independent explores those four Senate races this year. Click here to read more about the Assembly races and check out our election page for more information overall on the 2020 election.

Senate District 5 

Republican former charter school principal Carrie Buck is trying for the third time to win a seat in the swingy Henderson-area district held by termed-out Democrat Joyce Woodhouse. Buck lost to Woodhouse by less than one percentage point in 2016 and proffered herself as a potential replacement in an unsuccessful attempt to recall Woodhouse in 2017.

Currently the head of Pinecrest Foundation, which supports the now eight-school Pinecrest Academy charter school network, Buck raised $211,066 in the latest quarter and spent $60,562, leaving her with $246,023 heading into the final month of her campaign. Her fundraising eclipses that of Democrat Kristee Watson, who reported raising $115,055 and spending $161,266, leaving her with $123,686 to spend in the home stretch.

Buck said her priority bills would require students to read at grade level by fifth grade, and she wants to develop the workforce by identifying available jobs and working backwards to what can prepare middle and high schoolers for those openings. 

Watson is the program facilitator for literacy nonprofit Spread the Word Nevada. She ran for an Assembly seat in 2018, but lost to Republican Melissa Hardy by about nine percentage points.

Libertarian and retired electrical engineer Tim Hagan is also competing in the race and reported $6,000 in contributions last quarter, all from an in-kind donation for video production. All three candidates ran unopposed in their June primaries. 

Democrats hold a roughly 6 percent voter registration advantage in the district over Republicans as of the most recent registration data available, with 37.7 percent registered as Democrats, 31.8 percent registered Republicans and 24 percent nonpartisan. Senate District 5 includes portions of Henderson and southeastern Las Vegas. 

At the same time in 2016, Democrats represented about 38.9 percent of registered voters compared to roughly 34 percent of Republicans, or about a 5 point difference in voter registration advantage (with about 20.1 percent of voters registered as nonpartisan). 

Senate District 6 - Cannizzaro/Becker

Prosecutor and Democratic Senate Majority Leader Nicole Cannizzaro is in a fierce contest to keep her swingy Summerlin-area seat this cycle. She faces Republican real estate attorney April Becker in a race that is a referendum on one of the most powerful decision makers in the Legislature and therefore the direction of the body as a whole, including bills passed on narrow margins and late-night hearings on major policy.

“There's plenty to campaign on right now, just over the behavior of the Senate majority, the politics that were played,” Bailor said. “It's unnecessary, especially when we are dealing with such a large economic burden and such a health care crisis.”

Cannizzaro raised $193,131 in the latest quarter and spent $302,972, with a massive war chest of $581,936 cash on hand heading into the final month of the campaign. Becker topped her fundraising haul in the latest quarter, bringing in $248,668, but spent $217,527 and has less cash on hand — $181,011 — heading into the last month of the campaign.

Cannizzaro’s television campaign focuses largely on health care — touting votes for protecting people with pre-existing conditions and ending surprise hospital billing — while accusing Becker of being supported by politicians who support repealing the Affordable Care Act.

Bruce said that Cannizzaro’s campaign was focused largely on the twin points of health care and education, while also addressing the state’s pandemic response and recovery. She said many of the complaints about the rushed legislative process during the special sessions came from lobbyists or other legislative watchers and not from normal citizens.

“It's kind of a disconnect between what the general lobby corp and Carson City insiders would say, versus what every day voter and citizen in Nevada would say about that,” she said.

A centerpiece of Becker’s campaign has been riding around her district in a bright blue ice cream truck meeting voters. Her ads accuse Cannizzaro of voting to raise her own pay (through support of annual legislative sessions) and promises that she’ll donate her legislative salary to teachers.

Becker also criticized moves to scale back Opportunity Scholarships, which give businesses tax credits for donations to scholarships that families can use to attend private schools, and argues that “we need to stiffen penalties on dangerous felons.”

Democrats hold about an 8 point voter registration advantage in this district over Republicans, with the most recent data showing the district’s more than 84,000 voters to have 39.7 percent registered Democrats, 31.8 percent registered Republicans, and 22.4 percent registered nonpartisan.

That’s a slightly smaller percentage advantage than the 8.5 percent registration advantage Democrats enjoyed in 2016, which saw registration made up of 40.9 percent registered Democrats, 32.4 percent registered Republicans and 19.2 percent registered non-partisan. 

In 2016, Cannizzaro narrowly defeated former Republican Assemblywoman Victoria Seaman by slightly more than 1,000 votes out of more than 56,000 cast.

Democrats upped their total registered voter advantage by about 2,000 over the four-year period (4,691 advantage in 2016 and 6,684 in 2020), though the total number of registered voters in the district also jumped by more than 14,000 over the same four-year period.

Senate District 15 

Republican Sen. Heidi Gansert is seeking re-election to her Reno-area district. She raised $201,665 in the last quarter and spent $191,223, leaving her with $282,068 on the eve of the election.

Gansert is the executive director of external relations at the University of Nevada, Reno, and served as chief of staff to former Gov. Brian Sandoval. 

“She grew up in that community, she's served multiple sessions in assembly, and now the Senate,” Bailor said. “People know Heidi. And that's also something that's gonna help — she's (part of the) fabric of that community.”

Bruce said there was a “big difference” in the dynamics of Gansert’s 2020 race after two terms in the Legislature,  as opposed to her initial 2016 state Senate bid, where she defeated attorney Devon Reese by an 11-point margin.

“She can't necessarily paint herself as this moderate this time when she has a voting record to answer for,” she said.

Democrats have endorsed and rallied around Wendy Jauregui-Jackins, a county appraiser and the sister of Assemblywoman Sandra Jauregui. Jauregui-Jackins reported raising more than $126,000 over the last three months, spending just under $100,000 and keeping roughly $133,000 in cash on hand. 

Similar to Cannizzaro, Jauregui-Jackins’s television ad focuses largely on health care issues and claims Gansert took campaign dollars from drug and insurance companies and voted against a resolution urging Congress to not repeal the Affordable Care Act.

Gansert has responded directly to that ad, releasing a response touting her votes for drug transparency legislation, birth control access legislation and a vote in favor of the Equal Rights Amendment.

One possible sign of concern for Gansert comes in voter registration trends; Democrats now enjoy a narrow 841-person voter registration lead over Republicans in the district, a flip from the same point in 2016 when Republicans held a 1,641-person advantage in registered voters.

Senate District 18 

Republican incumbent Scott Hammond is seeking to maintain a seat he’s held since 2012 representing a Republican-leaning, northwestern portion of Las Vegas. He raised $131,762 and spent $65,050 last quarter, holding $90,095 heading into the final leg of the race.

A former teacher who now works as Director of Community Outreach for the Nevada Contractors Association, Hammond’s campaign has involved convening weekly telephone town halls on topics relating to the pandemic.

He will compete against Democratic challenger Liz Becker in November. She is a former teacher and environmental scientist who previously worked with Southern Nevada Water Authority who lists environmental issues and gun violence prevention among her top campaign priorities.  

Becker’s funding falls far short of Hammond’s, though — she raised $24,161, or less than a fifth of what Hammond did in the most recent quarter.

Becker spent $16,493 and had $41,650 cash on hand with a month left to go in the race.

Democrats account for 33.7 percent of active registered voters in the district, while Republicans have 37.5 percent.

Police union launches campaign attacking Cannizzaro over alleged lack of support for law enforcement

State Senate Majority Leader Nicole Cannizzaro on Friday, July 31, 2020, during the first day of the 32nd Special Session of the Legislature in Carson City.

The Las Vegas Police Protective Association is going on the offensive against Democratic state Senate Majority Leader Nicole Cannizzaro, kicking off an independent expenditure campaign against the Democrat’s re-election campaign after lawmakers rolled back a bill granting additional protections to officers accused of misconduct.

The LVPPA, which represents active and retired members of the Las Vegas Metropolitan Police Department, has created a political action committee and launched a website, social media ads and two videos attacking Cannizzaro for allegedly siding with “criminals over law enforcement”. Cannizzaro is locked in a re-election race against Republican April Becker, who has been endorsed by the LVPPA. 

It’s the latest development in an acrimonious political divorce between state Democrats and the LVPPA, which broke from the ranks of most organized labor organizations to endorse President Donald Trump and a mix of other Republicans on the 2020 ballot, including congressional and state Senate Republican hopefuls.

In a statement, Senate Democratic Caucus Executive Director Cheryl Bruce said the attack was disappointing given that Cannizzaro is employed as a prosecutor with the Clark County district attorney’s office, working in the office’s gang unit.

“At the same time LVPPA is sending out blatantly false information about her record on public safety, Senator Cannizzaro is prosecuting a double homicide case, among other violent criminal cases,” she said in an email. “Attacking a prosecutor who is risking her own safety to keep our streets and families safe is the worst kind of lie.”

Though the union endorsed Cannizzaro and all other state Senate Democratic candidates in the 2016 election cycle, it soured on the Democratic Senate leader after lawmakers in a late summer special session approved a bill rolling back parts of a 2019 bill that granted several powers and protections to officers accused of misconduct. 

Criminal justice advocates pushed hard for that legislation, SB2, amid a nationwide reckoning and renewed focus on police violence and misconduct stemming from the death of George Floyd in Minneapolis. But it was opposed by several police unions, including the LVPPA, as an unnecessary reaction removing protections for accused officers.

The LVPPA did not return an email request for comment.

The campaign so far includes a 15-second video stating Cannizzaro is “on the wrong side of the law” after passing a bill that “lowered sentences for drug traffickers and burglers (sic).” Similar language is used in a Facebook ad that began running on Wednesday, stating “our families aren’t safe with Nicole Cannizzaro.”

It’s an extremely simplified reference to a 157-page bill passed in the 2019 Legislature, AB236, a sweeping criminal justice reform measure that originated from a Department of Justice study and recommendations as to how to cut costs and reduce the state’s prison population. Among its many changes included lowering the state’s “strict” rules on drug possession and sales, and changes to state laws on burglary 

The bill was initially opposed by police departments and prosecutors, but was amended in the Senate by Cannizzaro to address some of those concerns raised by district attorneys and other law enforcement agencies. The final version of the bill passed on a 19-2 vote in the Senate.

Per legislative minutes, the LVPPA did not testify on the bill during any of the three public hearings held on the measure.

That social media ad redirects to a website — “Corrupt Cannizzaro” — that outlines a barrage of attacks against her, including supporting bills that her lobbyist husband’s clients supported, attempting to raise her salary (through supporting a change to annual legislative sessions), raising taxes and holding “closed-door” special sessions over the summer.

Democrats currently enjoy a 13-8 seat advantage in the 21-member state Senate, but are playing defense in two suburban Las Vegas districts (Cannizzaro and termed-out Democratic Sen. Joyce Woodhouse) while backing candidates against Republican Sens. Scott Hammond and Heidi Gansert.

Cannizzaro, who took over the Senate majority leader position in 2019 after the resignation of former Sen. Kelvin Atkinson, who pled guilty to federal charges of misappropriation of campaign funds for personal use. She won a narrow victory over former Assemblywoman Victoria Seaman in the 2016 general election, prevailing by slightly more than 1,000 votes out of more than 56,000 cast.

Cannizzaro has been endorsed by the Nevada Association of Public Safety Officers (NAPSO), a separate organization representing more than two dozen law enforcement organizations. That organization is separate from the “Public Safety Alliance of Nevada,” which includes the LVPPA.

“She has a strong record on public safety, and that’s why as Nevada’s largest law enforcement Coalition, we continue to proudly endorse her re-election campaign,” NAPSO Executive Director Rick McCann said in an email. “We know Nicole, and we trust her.”

Two state Senate Democratic candidates took additional donations from maxed-out Cannizzaro-led PAC

Senate Majority Leader Nicole Cannizzaro on the twelfth day of the 31st Special Session of the Legislature in Carson City on Sunday, July 19, 2020.

Two Democratic state Senate candidates who received maximum allowable contributions from a political action committee registered to state Senate Majority Leader Nicole Cannizzaro also received donations from another entity entirely funded by her PAC.

State law explicitly prohibits so-called “conduit contributions,” or donations made in the name of another person to get around contribution limits. 

The law also specifically prohibits making donations to PACs as a way to get around contribution limits, stating that it’s illegal to “make a contribution to a committee for political action with the knowledge and intent that the (PAC) will contribute that money to a specific candidate which, in combination with the total contributions already made by the person for the same election, would violate the limitations on contributions.”

According to campaign finance records, the Cannizzaro-led PAC — “Battle Born and Raised Leadership” — transferred campaign dollars to a secondary PAC (registered to another state senator), which in turn made contributions to state Senate candidates Roberta Lange and Kristee Watson that, in total, exceed the maximum $10,000 per cycle limit on contributions. 

In an email, state Senate Democratic Caucus Executive Director Cheryl Bruce said the contributions were “made in the usual conduct of a Nevada political action committee during an election cycle.”

“There was absolutely no violation of campaign finance laws, and any suggestion otherwise is inaccurate and irresponsible,” she wrote.

Although Nevada law caps campaign contributions to $10,000 per single person or entity, many businesses and entities are able to get around the limits either through making donations through different business entities, or creative use of PACs, which are allowed to accept unlimited contributions.

Cannizzaro’s “Battle Born and Raised Leadership” PAC initially made maximum, $10,000 contributions to Lange and Watson in December 2019, according to campaign finance records

The PAC later made a combined $7,500 ($5,000 on March 31, and $2,500 on May 31) in contributions to “Brunch in Nevada,” a PAC registered to Democratic Sen. Chris Brooks. The PAC was registered on Feb. 25, and has not reported receiving any other contributions other than the $7,500 it received from Cannizzaro’s PAC.

The “Brunch in Nevada” PAC then contributed $5,000 to Lange (a $3,000 contribution on April 24 and a $2,000 contribution on June 2) and $1,000 to Watson on June 30.

Another PAC registered to Cannizzaro — Majority 2020 — also received and made contributions from sources (Brooks and termed out Sen. Joyce Woodhouse) that had already made maximum contributions to two candidates — Lange and Cannizzaro herself.

Lange won a narrow victory in a primary election against two sitting state Assembly members, and will be automatically elected to the state Senate as no other candidates filed to run for the seat. Watson is set to face off against Republican candidate Carrie Buck, who narrowly lost a 2016 bid for the same seat.

Both candidates have been endorsed by the Senate Democratic Caucus, which is currently one seat short of a two-thirds majority in the upper house.

Updated on Tuesday, July 28 at 8:36 to correct that Kristee Watson is running against Carrie Buck.

Cannizzaro-led PAC gave Dem Senate leader donation from maxed-out contributors

State Senate Majority Leader Nicole Cannizzaro accepted contributions earlier this year from her political action committee that was entirely funded by two fellow Democratic state senators who had already maxed out on contributions to her campaign.

Nevada law explicitly prohibits so-called “conduit contributions,” or donations made in the name of another person to get around contribution limits.

The law is also specific on making donations to PACs as a way to get around contribution limits, stating that it’s an illegal practice to “make a contribution to a committee for political action with the knowledge and intent that the (PAC) will contribute that money to a specific candidate which, in combination with the total contributions already made by the person for the same election, would violate the limitations on contributions.”

According to her most recent campaign finance report, Cannizzaro reported raising more than $114,000 between April and the end of June, including a $5,000 contribution from an entity called “Majority 2020,” a political action committee that lists her as its president.

But the only contributions taken in by “Majority 2020” this election cycle have come from state Sens. Chris Brooks and Joyce Woodhouse — both of whom have already contributed the maximum allowable amount of $10,000 to Cannizzaro’s campaign.

In a statement, state Senate Democratic Caucus Executive Director Cheryl Bruce — who is listed as the PAC’s registered agent — said the “contributions were made in the normal course of business of the committee for political action during an election season, as demonstrated by their disbursement dates.” Roberta Lange received her contribution ahead of a contentious state Senate primary; Cannizzaro received hers shortly before the fundraising period ended.

Brooks said in an interview that he gave money to the PAC to support Democratic candidates, and said “where it goes from there, obviously I have no control.” Woodhouse declined to comment in a text message sent after this story was published.

Deputy Secretary of State Wayne Thorley said in a text message that the contributions would violate state law if they "were made to the PAC with the knowledge and intent that the PAC would use the money to give to Cannizzaro."

Nevada’s campaign finance laws and restrictions are not particularly challenging to evade; many businesses opt to give more than the $10,000 contribution limit through making contributions via different business entities, and many donate campaign dollars to PACs, which are allowed to accept unlimited contributions but are subject to the same $10,000 donation limit to individual candidates.

It’s not unusual for legislators in safe races or in leadership positions to distribute campaign funds to candidates running in more competitive races. Brooks is not up for re-election until 2022 and Woodhouse is termed out of office.

But use of PACs to boost candidate fundraising numbers has in the past come under legal scrutiny. Former gubernatorial candidate Rory Reid was fined $25,000 in 2011 after it was discovered his campaign had set up a main umbrella PAC that took in more than $900,000 in contributions and dispersed them to more than 90 smaller PACs (all registered at the same Las Vegas address), which in turn contributed the maximum amount allowable to Reid’s campaign.

Though on a much smaller scale, the contributions from Cannizzaro’s PAC to her campaign appear to fit a similar bill.

Here’s how it happened: On March 31, the “Majority 2020” PAC received two separate $5,000 contributions from the campaign accounts of two Democratic state senators — Brooks and Woodhouse. Those are the only contributions the PAC has received this year.

Then, the Majority 2020 PAC reported making two expenditures on its most recent quarterly campaign finance report — $5,000 to the campaign of state senate candidate Roberta Lange on April 24, and $5,000 to Cannizzaro’s campaign on June 26.

But both Brooks and Woodhouse have previously contributed the maximum amount allowable under state law ($10,000) to Cannizzaro’s 2020 re-election campaign in the years and months prior.

Brooks made his donations in four chunks between late 2017 and 2020, with the total amount of contributions equaling out to $10,000. Woodhouse has also maxed out contributions to Cannizzaro’s campaign; a $618.85 contribution in February 2018, another $5,000 in September 2019 and finally a $4,381.15 contribution in December 2019.

Usually, contributions from a PAC to an individual candidate’s campaign account would not raise any eyebrows, as legislator-led PACs typically take in money from a variety of sources and not just other legislators. 

While PACs are not required to report their cash on hand, publicly reported campaign finance totals indicate that the “Majority 2020” PAC only had about $716 in its account at the start of 2020 — meaning that the contributions to Cannizzaro had to have come from either Brooks or Woodhouse’s campaign accounts. 

Both Brooks and Woodhouse also donated $5,000 to Lange’s campaign last year, so an additional $5,000 contribution would not put them over the legal limit. Brooks, however, did contribute another $5,000 to Lange through his “Brunch in Nevada PAC” in April and June 2020.

The Majority 2020 PAC has been operational since at least the 2012 campaign cycle, and has been used as a vehicle by Senate Democratic leaders to direct funding to their most in-need candidates. The PAC (then known as Majority 2016) distributed $30,000 to three state Senate candidates during the 2018 campaign cycle, for example.

Cannizzaro narrowly won election to her Las Vegas-area Senate District in 2016, defeating former Assemblywoman Victoria Seaman by slightly more than 1,000 votes out of more than 56,000 cast. Cannizzaro is facing off against Republican attorney and first-time candidate April Becker in the November 2020 election.

Updated on July 23 at 11:42 a.m. to include a comment from Sen. Joyce Woodhouse.

GOP senator backs out of deal with Senate Democrats directing new mining tax proceeds toward K-12 education

Senate Democrats announced Saturday morning that they had reached a deal to revive legislation removing several mining tax deductions and direct the revenue toward education, which was expected to take a major hit as lawmakers try to close the state’s $1.2 billion budget shortfall.

However, just three hours later, that deal appeared to be off the table.

Republican Sen. Keith Pickard was expected to make a motion to reconsider the measure, which failed in the Senate early Friday morning, and join Senate Democrats in support of it with an amendment directing the additional money toward a hard-fought weighted funding formula. However, Pickard told the Las Vegas Review-Journal just before noon on Saturday that he would not be supporting the measure and hinted the Senate Republicans have come up with their own plan.

“The one thing that we realized is that there is so much more to this picture than we can divine in 48 hours and there are opportunities we have the money to fill the gaps and we've proven that with our announcement,” Pickard said in a subsequent interview with The Nevada Independent on Saturday, referring to an alternative plan Senate Republicans revealed on Thursday for finding additional revenue and backfilling cuts. 

Pickard said that Sen. Joe Hardy has a plan that will generate $600 million to be spent on education, though he did not elaborate on the details. The previous plan Senate Republicans revealed was expected to tap into an estimated $162 million in restored revenue, previously adopted legislative changes and anticipated, but uncommitted, federal Medicaid dollars.

“It makes this plan look like a pittance,” he said. “I’m not willing to sacrifice our potential success for this deal. It just doesn't make sense anymore.” 

Hardy confirmed that his plan involved a 1.5 cent per kilowatt hour export tax on wholesale renewable energy sold from Nevada to other states. He proposed the concept in 2017 as the bill SB336, but the measure died without ever getting a hearing in the Democrat-controlled Senate.

Major solar projects announced in recent years have sought to interconnect with California’s grid with the goal of turning sunny Nevada into a net exporter of clean power. The Silver State could draw significant economic benefits from helping its populous neighbor to the west meet its goal of using 100 percent renewable energy by 2045.

Senate Democratic Caucus Executive Director Cheryl Bruce in a statement earlier Saturday morning said that Senate Majority Leader Nicole Cannizzaro and Pickard spoke “several times” Friday evening and reached a deal on the measure, AB4.

“Leader Cannizzaro offered to amend AB4 to put the additional revenue towards the SB178 K-12 funding formula, and Senator Pickard agreed to make a motion to revive the bill,” Bruce said. “We expect a vote in the Senate this morning to raise revenue that will serve some of the most disadvantaged students in the state."

Lawmakers in the 2017 legislative session passed SB178, a bill championed by Senate Democrats that allocated millions of dollars toward implementation of a long-sought weighted funding formula. It gives schools that are not already receiving Zoom or Victory program investments a $1,200-per-student boost for each child in the lowest quartile for academic performance or who is receiving free or reduced-price lunch. 

The $70 million backing that measure, along with several other marquee K-12 education initiatives such as a $31 million Read by Grade 3 literacy program created under Republican leadership, have been on the chopping block. Democrats introduced a budget restoration plan late Thursday restoring about $127 million in planned cuts, which only included about $4.1 million in K-12 restorations.

Pickard told The Nevada Independent on Friday that he would be willing to vote for the tax if the money was earmarked for education, after making a statement during the floor vote on the bill early Friday morning to that effect.

“If they were to come back and create language in the bill that moved this money to education, I already said I’m a yes,” he said in an interview on Friday. “So it’s not a change in position for me.”

Clark County Education Association Executive Director John Vellardita confirmed in a text message Saturday morning that he spoke with Pickard on Friday and encouraged him to back the mining proposal if the additional dollars went toward education. 

The powerful teacher’s union played a key role in electing Pickard to office in 2018, endorsing him over Democrat Julie Pazina, and helping carry him to a 24-vote victory. That prevented Democrats from holding supermajorities in both chambers of the Legislature, requiring them to win over at least one Republican to pass any taxes.

During floor sessions late Thursday and early Friday, Democratic lawmakers pitched the hastily introduced bill as bringing equity to a tax structure that has long favored mining companies. Republicans, however, criticized how fast the bill was moving through the legislative process and raised concerns that the bill could have unintended consequences for the mining industry.

The legislation proposes limiting companies to 60 percent of the deductions they would normally take and, in combination with another bill requiring double payment of mining taxes this year, would generate an additional $102 million in revenue for lawmakers to apply to their $1.2 billion budget shortfall. In 2019, the mining industry grossed $7.8 billion, but taxes were only applied to the $2.5 billion in net proceeds that year.

Tyre Gray, the head of the state’s mining association, said he wasn’t informed until shortly before the bill was announced about the plan, and joined a chorus of pro-business groups in a statement criticizing efforts to tax single industries as opposed to designing taxes more broadly.

If the Senate does end up reconsidering the measure and approves it, it will need to return to the Assembly for members there to concur on the amendment. Assembly Speaker Jason Frierson said his members are supportive of the plan.

"If AB 4 is returned with an amendment directing money towards SB 178, my members would be onboard," Frierson said in a text message.

Dozens of progressive activists and others had testified in favor of having the mining industry pay more as the state reels from coronavirus-related shutdowns. Since statehood, the industry has had its more favorable tax structure focusing only on the net proceeds enshrined in the Constitution, and over the years has been allowed a growing list of additional deductions for the costs of doing business.

On Saturday morning, groups that had repeatedly made the pitch to raise mining taxes over the 11 days of the special session celebrated word of an agreement.

“We are pleased to hear this news! The pressure put on the Legislature through our rally as well as the thousands of letters, calls, and public comments by educators demanding new revenue and funding healthy schools has worked,” the Nevada State Education Association said in a tweet.

Jackie Valley contributed to this report.

‘A lot of little things’: Incremental health policy changes favored over sweeping reform in 2019 legislative session

Lawmakers this session took patients out of the middle of negotiations between providers and insurance companies over out-of-network hospital bills in a landmark bill decades in the making and codified the Affordable Care Act’s protections for people with pre-existing conditions amid ongoing threats at the federal level.

But, by and large, the changes that the Legislature pursued this year to improve health care in the state weren’t big or flashy. Instead, lawmakers passed a number of incremental changes — such as establishing a maternal mortality review panel, allocating additional state dollars for family planning services and commissioning studies on prescription drugs and a state public option — that experts say will slowly begin to move the needle on health care.

“There were some little tweaks that were made that are going to have a big impact,” said Catherine O’Mara, executive director of the Nevada State Medical Association. “I think sometimes it doesn’t seem that exciting because there’s not these huge reform bills but, in the aggregate, there were a lot of little things that were done that are actually going to positively impact people.”

Part of that emphasis on smaller health policy items over the sweeping change that had seemed possible when a Medicaid buy-in proposal was the subject of conversations between the 2017 and 2019 legislative sessions was signaled early on by Gov. Steve Sisolak, who during his campaign promised the creation of a Patient Protection Commission charged with a top-to-bottom review of health care in the Silver State.

When Sisolak first proposed it last year, the commission was framed as a blue-ribbon panel that would bring together patients, doctors and other policymakers and, after convening for 100 days, recommend changes to be implemented by the Legislature.

In light of that, there was initially some speculation that the panel would operate similarly to an advisory panel that Sisolak established in January to map out sweeping regulatory changes to the marijuana industry. But Sisolak took a different tack with the Patient Protection Commission, proposing legislation, SB544, to create that body in mid-May and charging the body to return to the 2021 legislative session with its recommendations in the form of two bill draft requests.

“For a first-session governor to create a Patient Protection Commission I think is really prudent,” O’Mara said. “The administration didn’t just jump in and say, ‘We’re going to change health care.’ He said, ‘We’re going to jump in and hear from everybody and figure out where all the pain points are and go from there.’”

Some in the industry see a model for the commission in the success of the landmark surprise emergency room billing legislation that passed this session, which was a byproduct of extensive conversations between insurers, hospitals and doctors between sessions and a mandate from Assembly Speaker Jason Frierson that they reach a compromise. Industry representatives who were a part of those conversations said they weren’t completely happy with the end result, but it was something that they were willing to live with.

“The surprise billing issue has been around and hasn’t come to any level of resolution for years, and a giant step was taken in that bill passed,” said Tom Clark, a lobbyist for the Nevada Association of Health Plans. “Kudos to Assemblyman Frierson, the speaker, for taking that bull by the horns and really making sure that all of the stakeholders got together and figured that out.”

Similarly, Sisolak has made it clear that the commission, an 11-member panel made up of industry and patient representatives, will be a working body. He warned at an industry briefing before the legislation was introduced that the overall goal is compromise, and anyone not working toward that could those their seat at the table.

“I think the way it’s being structured is going to give all sides of the issue a chance to be at the table and facilitate the development of good regulation and good legislation, whichever the case may be,” said Bill Welch, president and CEO of the Nevada Hospital Association.

Questions still remain about how the body will work with the interim health committee, a panel of lawmakers that studies issues between sessions to develop policy to bring forward when the Legislature meets again and with two health-care studies that have been commissioned. But industry representatives — from doctors and hospitals to insurers and pharmaceutical companies — are optimistic about the commission’s potential.

“For our part, we want to come to the table with proposed solutions and ideas and an openness to address the challenges Nevada’s health-care system is facing,” said Priscilla VanderVeer, a spokeswoman for the national drug lobbying association Pharmaceutical Research and Manufacturers of America, in an email. “We believe this is a real opportunity to work together across the broader health-care system and the political spectrum to enact real change and we look forward to being a part of it.”

Part of that optimism comes from the hope that the commission will look at the root cause of some of the state’s health-care ills with an eye toward prevention and mitigation early on to prevent poor health-care outcomes down the line. For instance, lawmakers approved rate bumps for hospitals providing intensive care to some of the state’s sickest babies, but the broader question of how to expand access to prenatal care so those babies are born healthy remains.

“When I hear from hospitals or skilled nursing facilities or certain provider types, their messaging is very good, but we need to be looking at the whole landscape of health care and where we need to move the dial and where the opportunity is,” said Richard Whitley, director of the Department of Health and Human Services. “If it can be prevented, if we can intervene early, we ought to intervene.”

Here’s a look at some of the other health policies that passed this session, and others that didn’t:

Studying (again) a state public option

A last-minute bill, SCR10, introduced by Senate Majority Leader Nicole Cannizzaro is tasking the Legislative Commission with studying the feasibility of allowing Nevadans to buy into the Public Employee Benefits Plan, or PEBP, which provides health insurance to state workers.

Cheryl Bruce, executive director of the Nevada Senate Democratic Caucus, framed the legislation as a way for the Legislature to continue to explore the idea of a public option. Conversations on the topic waned following the resignation of Democratic Assemblyman Mike Sprinkle, who had led the interim conversations on a Medicaid buy-in proposal.

“We think this is a good first step to get more information before moving forward with any future legislation,” Bruce said in a text message.

Some in the industry have raised concerns that the legislation is too narrow because it specifically targets the interim study to the feasibility of a PEBP buy-in and that it focuses on access to insurance without also targeting access to care.

“I did talk with the sponsor of the bill, and they assured me that some of the things I wanted to amend into the bill and include the bill are generically incorporated in the bill already,” Welch, the hospital association CEO, said. “I want to make sure they are focusing on the full picture.”

The overarching question that the study will have to address is who a public option plan aims to help. Conversations about increasing access to health insurance in Nevada have generally centered around increasing access to rural residents who only have one plan available to them for purchase on the exchange, improving access to residents across the state who are increasingly priced out of exchange plans or targeting the state’s undocumented population, which faces severe barriers to accessing insurance and care.

Before Sprinkle’s resignation, some of the conversations around Medicaid buy-in focused on how the proposal could help the state’s rural residents and possibly other populations on a limited basis.

“At the end of the day I will be shocked if this study shows much more than that again. I only say that because if you bring all of this uninsured population to the state’s health benefit plan it will change your actuarial mix of who are insured,” Welch said. “You’re going to be bringing in individuals potentially who have chronic medical conditions that will change how you actually set your premiums.”

Codification and stabilization of the Affordable Care Act

The most sweeping bill related to the Affordable Care Act that passed this session was AB170, which codified the federal health-care law’s protections for people with pre-existing conditions into state law. A similar measure last session was vetoed by former Gov. Brian Sandoval, who said at the time that it would have locked into law “requirements that may be unnecessary, imprudent, or simply unaffordable in the years to come.”

Approval of the legislation comes amid an ongoing legal challenge to the Affordable Care Act on the federal level that could strike down the law entirely, including its popular pre-existing condition protections.

“Who knows if the federal administration is ever going to actually overturn the Affordable Care Act, but they certainly are chipping away pieces of it,” said Elisa Cafferata, lobbyist for Planned Parenthood. “It’s good to have those protections in place because what everybody really liked about the Affordable Health Care was the preventative health care and pre-existing conditions.”

The compromise pre-existing condition language was first crafted a different bill spearheaded by Democratic Sen. Julia Ratti who, as chair of the Senate Health and Human Services Committee, worked to ensure the legislation would codify the protections in the Affordable Care Act as they stand now — no more and no less. The work on that bill, SB235, was then folded into Democratic Assemblywoman Ellen Spiegel’s AB170.

The legislation also requires health insurance plans to provide to the Governor’s Office for Consumer Health Assistance the phone number of a navigator or case manager who can help patients make an appointment with a doctor in a timely fashion. The bill had initially proposed requiring insurance companies to cover out-of-network doctor’s visits at no additional cost to patients if no in-network physician was readily accessible, but was amended down in a compromise with insurance companies.

Though it’s a small change, those in the health-care industry say it stands to improve access to care for patients.

“Our take is that AB170 is a very simple little bill that will actually have a practical impact in helping patients,” O’Mara said. “It’s one of those bills that isn’t flashy but will make a difference.”

The Legislature also passed two Affordable Care Act stabilization bills — SB481 and SB482 — that place additional restrictions on two types of health insurance plans with potentially skimpier coverage than that required under the federal health-care law and direct the state to apply for a federal innovation waiver to allow the state to explore other options to stabilize the individual health insurance market.

Heather Korbulic, executive director of the Silver State Health Insurance Exchange, said that together the bills “could have a dramatic impact on getting people connected to plans that are right for their needs.”

Lawmakers additionally approved the exchange’s budget, which included the funding necessary to become an entirely state-based exchange instead of the hybrid model that the exchange has been operating under now. Exchange officials have said that a Nevada-run platform will both save the state money and allow them to know who is actually purchasing individual plans through the exchange and better target their outreach.

“That itself lends a lot of autonomy and control,” Korbulic said. “Lawmakers were cognizant of that potential flexibility.”

Changes for hospitals

Lawmakers passed two bills this session that strike at the core of what it means to be a hospital and what services those facilities should and ought to provide.

One of them, Democratic Assemblywoman Maggie Carlton’s AB317, shifts the responsibility of determining whether to establish any additional trauma centers from the local level to the state. It comes amid renewed discussions over Southern Nevada’s trauma need and whether to approve additional trauma centers. Welch said that the change “might potentially create some additional time to make those determinations going forward” but that “overall the approach is a balanced approach.”

The legislation also requires every off campus facility that a hospital operates — such as a microhospital or freestanding emergency department — to have a unique national provider identifier number. The goal is to help the state better track and understand how those facilities are utilized compared to traditional hospitals.

Another bill advocated for by the hospital association, Democratic Assemblywoman Rochelle Nguyen’s AB232, requires all hospitals in the state to be certified by the federal Centers for Medicare and Medicaid Services (CMS). The legislation specifically targets a tourist-focused microhospital near the Strip, Elite Medical Center, which doesn’t bill Medicaid or Medicare.

In hearings on the bill, Elite argued that its business model isn’t based around providing care to Medicaid and Medicare patients and that it would rather write off the cost of uncompensated care it provides to those individuals than go through the onerous process to become Medicaid and Medicare participating. But lawmakers sided with the hospital association, which argued that hospitals should have the responsibility of taking care of all patients.

“We’re not opposed to microhospitals,” Welch said. “We’re supportive of microhospitals, but we’re supportive of them coming in and being a part of the integrated health-care delivery system.”

The legislation gives Elite until July 1, 2021 to be certified by CMS.

The Legislature also took steps to address the financial needs of the state’s hospitals, which have long argued that they are increasingly strained by the number of Medicaid patients they treat. Lawmakers approved a 25 percent bump in the per diem Medicaid rate to care for babies in the neonatal intensive care unit (NICU) and a 15 percent bump in pediatric intensive care unit (PICU) rates to ensure that hospitals are able to maintain the current level of services that they are providing to the community.

Welch said the hospitals are “ecstatic” about the increases.

“What it is going to do is ensure that those beds that we do have are not going to close, because there has been a lot of discussion over the last 18 months about whether certain hospitals were going to be able to continue providing services at that rate,” Welch said.

Hospitals also got a last-minute boost in the form of SB528, an appropriations bill passed in the final two hours of the legislative session that included a 2.5 percent increase to the state’s acute care per diem rate for Medicaid. Welch said that he had asked for a 20 percent increase at the beginning of the session but didn’t know whether hospitals would get any rate bump until those final minutes.

“Between those three things, that will help us immensely,” Welch said. “It won’t get us anywhere near cost, but at least it’s moving us in the right direction and hopefully will help us be able to sustain the services.”

After negotiation between proponents and the hospitals, lawmakers also passed SB364, Democratic Sen. David Parks’s bill requiring hospitals to identify patients by their preferred name and pronouns, representing a significant victory for the state’s transgender community.

Drilling down on drug costs

At the beginning of the session, there were several sweeping proposals to tackle the high cost of prescription drugs, including a mandate that the middlemen in the drug pricing process pass along rebates they negotiate with drug manufacturers to consumers and a Prescription Drug Affordability Board with the ability to examine high cost prescription drugs and limit what payers can spend on them.

Neither of those ambitious proposals moved forward this session, but lawmakers did vote to expand a diabetes drug transparency bill passed in 2017 to require manufacturers of asthma drugs and drug pricing middlemen, or pharmacy benefit managers (PBMs), disclose certain costs and profits to the state.

The bill, Democratic Sen. Yvanna Cancela’s SB262, requires manufacturers of asthma drugs whose prices have increased significantly in the past year or two to report specific data to the state for each drug including the cost of producing it, administrative expenditures such as marketing and advertising costs, profit earned, financial assistance provided to help patients, and coupons and rebates offered. PBMs are also required to report any rebates they negotiated and any profits they retained associated with asthma drugs that experienced significant price increases.

“The hundreds of thousands of Nevadans living with asthma deserve to know that the price they’re paying for their medication they need to breathe is fair, and this bill will help shed some light on factors affecting these drug prices,” Sisolak said at a bill signing last month.

But drug manufacturers, who sued over the diabetes drug transparency legislation two years ago, raised concerns during hearings on the bill that regulations adopted by the state in 2018 to keep confidential information companies deem to be trade-secret protected would only apply to diabetes drug reporting and not the new asthma drug reporting.

VanderVeer, the PhRMA spokeswoman, said that she couldn’t speculate on whether there will be litigation related to the new asthma drug transparency law.

“We will be closely monitoring and engaging in the regulatory process,” VanderVeer said.

Another bill, Republican Assemblywoman Melissa Hardy’s AB141, builds on some of the prohibitions on gag rules inserted by PBMs into contracts with pharmacists — preventing them from disclosing certain information to patients — passed in the 2017 session. The legislation prevents PBMs from stopping a pharmacist from providing information to patients about the availability of a less expensive drug and from penalizing a pharmacist for selling a less expensive generic drug to a person.

Lawmakers, in passing Cancela’s SB276, have also directed the Legislative Commission to appoint a committee to conduct an interim study concerning the issue of the costs of prescription drugs, including the impact the PBM rebates have on prices.

VanderVeer said that PhRMA was “glad to see a discussion about the broader pharmaceutical supply chain taking place in Nevada this year,” though the association still believes it was unfairly targeted in 2019.

“While we continued to see a one-sided political attack that took place in 2017, we are glad that there was some recognition of the broader pharmaceutical supply chain and the importance of protecting patients’ access to needed medicines and the future development of new treatments and cures,” VanderVeer said.

Access to care

Lawmakers tackled a number of broader access to care issues this session, too, including patients’ ability to access mental health, dental and family planning services.

One bill, which emerged from one of the regional behavioral health policy boards created by the Legislature in 2017, establishes a new endorsement for psychiatric hospitals to be deemed a crisis stabilization facility and mandates that those stabilization services be covered under Medicaid. The need for crisis mental health services in the state was brought into sharp focus in 2018 when WestCare abruptly closed its crisis triage center in Reno and Clark County had to shell out additional funding to keep the doors of the company’s Las Vegas crisis triage center open.

“These could be game changers from the impact they could have on reducing emergency room and jail holds on patients,” said Chuck Duarte, CEO of Community Health Alliance and chair of the Washoe Regional Behavioral Health Policy Board. “I’m hopeful we’ll see some of these facilities developing in Nevada. I think they’ll have a significant impact on unwanted institutionalization.”

The bill, AB66, also requires the state to adopt regulations to license and regulate providers of nonemergency secure behavioral health transportation services to transport people experiencing a mental health crisis. Right now, a significant portion of the burden of transporting individuals undergoing a mental health crisis falls on law enforcement, particularly in rural Nevada.

Another piece of legislation passed, Cannizzaro’s SB425, requires Medicaid to provide additional home and community-based services, including tenancy support services. Under federal law, states are allowed to implement tenancy support services for people who are elderly or disabled.

“It doesn’t solve the housing problem” Duarte said. “But this establishes the sustainable revenue stream.”

Other bills drilled down into the issue of access to dental care. One of them, Ratti’s SB366, establishes a new mid-level dental provider type, known as dental therapists, who will be allowed to perform a number of routine dental procedures currently performed only by dentists, including extracting loose teeth, filling cavities and applying sealants.

The dental therapists will only be allowed to practice in underserved areas, including federally qualified health centers, rural health clinics, tribal health clinics, and any other clinics that primarily serve Medicaid patients or other low-income, uninsured individuals.

Duarte said that it “makes a lot of sense” for federally qualified health centers, including Community Health Alliance, to be able to lean on dental therapists to provide services, particularly when non-emergency adult dental services are not covered by Medicaid in Nevada.

“Right now with Medicaid not covering adult dental services, it’s hard to provide comprehensive care to adults without insurance,” Duarte said.

Lawmakers also approved AB223, sponsored by Democratic Assemblywoman Dina Neal, requiring the Department of Health and Human Services to seek permission from the federal government to establish a pilot program to provide dental care to adults with diabetes.

Women’s reproductive rights were another key focus for lawmakers this session with the passage of SB179, a bill sponsored by Cancela that removes longstanding criminal penalties on abortion and removes requirements that doctors explain to women the emotional implications of undergoing the procedure, and SB94, which clarifies how state family planning dollars can be spent. Sisolak also allocated and lawmakers approved $6 million in state family planning funds this session.

“It’s going to significantly increase the access to family planning services around the state,” Cafferata, the Planned Parenthood lobbyist, said. “Especially for rural Nevada that bill is going to be significant.”

One family planning bill that did not advance last-minute was Cannizzaro’s SB361, which would have required the state’s chief medical officer to issue a standing order allowing for self-administered birth control, essentially allowing patients to skip a doctor’s visit and go straight to the pharmacy for their medication. Those involved with the legislation said there were some last-minute tweaks to the bill and that lawmakers ran out of time to get the bill finalized.

But Whitley, the director of the Department of Health and Human Services, said it may be possible for the state to take action on the issue in the interim, particularly to increase access to birth control in communities where it’s difficult to get in to see a doctor.

“The Board of Pharmacy has authority to explore their existing authority through regulation for that,” Whitley said. “I’d like to work with them to see if there is something we can do since we do know that much of our state is a health-care workforce shortage area.”

Public health solutions

Beyond the industry-specific changes they made, lawmakers also signaled their interest in focusing on public health issues, from maternal mortality to vaping.

AB169, sponsored by Democratic Assemblywoman Daniele Monroe-Moreno, established a maternal mortality review panel amid rising concerns nationally over the recent rise of maternal deaths and complications. To fund the board, Nevada is applying to the federal government for a slice of a $43.5 million grant from the Centers for Disease Control and Prevention dedicated to investigating the causes of pregnancy-related deaths and complications.

“It wasn’t controversial at all but the Maternal Mortality Review Board, which actually passed quite early, was a really an important step for the state to take,” Cafferata said. “It was one of those quieter bills, because it didn’t have a lot of controversy around it, but I think it will be a significant bill for all of us.”

Lawmakers also made changes to an opioid prescribing law passed in 2017 that was aimed at tamping down on the overprescription of opioids but that doctors said was unduly burdensome and harmful to patient care. The new bill, AB239, allows providers more discretion when writing prescriptions for controlled substances to treat acute pain.

Another bill, Ratti’s SB263, places a 30 percent tax on e-cigarettes and their accessories and directs a significant portion of the $8 million a year in revenue it is projected to generate back to vaping prevention activities. Whitley said the legislation puts Nevada ahead of the curve when it comes to prevention in this area.

“[It] is really a first in our state for taking a behavior and not waiting” for the FDA to take action, Whitley said. “If you look at the history of tobacco use or alcohol use or gambling or other behaviors that can in excess cause harm, really the response in vaping, we’re with the group of states that are ahead in starting to tackle this.”

A final public health-focused bill to establish an all-payer health insurance claims database, SB472, failed to move forward in the final minutes of the session. The bill would have required the state to compile a database of billing information from insurance companies to better understand health-care costs.

Whitley said that he believes it was another case where lawmakers ran out of time, but that he’s already exploring options for the department to pursue such a database on its own in the interim in conjunction with the UNLV School of Public Health.

“An all-payer database would allow us to actually see where services are occurring and where maybe we need to give focus,” Whitley said. “We’re going to continue to work with community partners and the university to see if we can do it as a voluntary database to build the system.”