Sisolak signs bill making Nevada the second state to adopt a public health insurance option

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.

Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) smiles after Gov. Steve Sisolak signed SB420 in Las Vegas on Wednesday, June 9, 2021. (Jeff Scheid/The Nevada Independent)

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 running ads 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.

Sisolak signs much-debated ‘Right to Return’ legislation into law

Gov. Steve Sisolak signed legislation on Tuesday that guarantees the rights of laid-off gaming and tourism industry workers to return to their jobs.

Sisolak’s signature on SB386, referred to as the “Right to Return” bill, came without any fanfare and was announced alongside a host of other bills that earned the governor’s written seal of approval on Tuesday. Sisolak held signing ceremonies for 10 bills, many of which were related to women’s health and criminal or social justice reform. He also signed 28 other bills, including SB386, into law on Tuesday.

Gaming representatives and the Culinary Union struck a deal on the high-profile worker rights legislation with less than a week left in the 120-day legislative session, agreeing to limit the scope of the bill and exempting certain employee classes including managers and stage performers.

Every vote on SB386 was on a straight party line with Democrats in support and Republicans opposed.

Even the addition of an amendment that exempted small businesses attached to casino resorts from complying with the legislation did not attract Republican votes. The change excused small restaurants and vendors that had 30 or fewer employees prior to the pandemic.

As part of the deal, revisions were made to SB4, a bill from the 2020 special session last summer that included government-imposed health and safety standards meant to prevent the spread of COVID-19, as well as expanded liability protections for major casino resorts. The changes relaxed requirements on cleaning, such as wiping down minibars, headboards and decorative items on beds, and changed directives to clean throughout the day to instead call for daily cleaning.

Critics of the legislation raised concerns that the bill in its original form would have made it too easy for former employees to sue. The new law offers recourse through the Labor Commissioner or through the courts, but only after an employee notifies an employer of any alleged violation and waits at least 15 days for resolution of the issue.

The Nevada Resort Association took a neutral position in return for those concessions, though not all casino operators were on board. Some of the casino industry's largest companies, including MGM Resorts International, Wynn Resorts and Caesars Entertainment, backed the changes. Opposition arose from Las Vegas locals casino companies.

The Resort Association declined to comment on the bill signing.

In a statement, Culinary Secretary-Treasurer Geoconda Argüello-Kline said passage of the legislation would “protect over 350,000 hospitality workers” in Clark County and Washoe County. 

“At the height of the pandemic 98 percent of Culinary Union members were laid off and currently only 50 percent are back to work,” Argüello-Kline said. “While a majority of unionized hospitality workers already have extended recall protections in their contracts, most hospitality workers protected by the new SB386 Right to Return law are not unionized.”

South Point Casino-Hotel attorney Barry Lieberman said of the final deal that was struck that many of the changes were still “particularly onerous for non-union smaller nonrestricted licensees.”

Lieberman, a long time Nevada gaming attorney and close adviser to South Point owner Michael Gaughan, said several amendments were “a confusing patchwork of vague, burdensome and non-helpful requirements,” and forced employers “to guess at their peril as to what the bill actually requires them to do.” He suggested the changes infringed on an employer’s right to rehire casino workers who have “superior skills” as opposed to other laid-off workers.

Among the bills that received a signing ceremony on Tuesday were SB190, sponsored by Senate Majority Leader Nicole Cannizzaro, which will allow women to obtain birth control at a pharmacy without a doctor’s visit; AB116, sponsored by Assemblywoman Rochelle Nguyen, which decriminalizes minor traffic violations; and AB404, sponsored by the Assembly Committee on Judiciary, which shields applicants for domestic violence-related temporary or extended protection orders from having to disclose their addresses or contact information in certain circumstances. 

The Tuesday events were the latest in a string of bill-signing ceremonies. On Monday morning, Sisolak visited a North Las Vegas elementary school to sign education-related legislation, including the mining tax bill, AB495, and in the afternoon, he held a separate signing ceremony for two bills (SB222 and SB318) that promote diverse communities.

Gun free zones in casinos, increasing justice court fees and licensing midwives among many casualties of legislative session

Lawmakers ended the 81st session of the Legislature on Monday night passing dozens of high-profile measures but many others, including an effort to license midwives and a bill allowing casinos to prohibit firearms, failed to advance.

Out of roughly 1,000 bills and resolutions introduced during the 120-day legislative session, more than 400 measures failed to pass through the Senate and Assembly and make it to Gov. Steve Sisolak’s desk. Many bills were left for dead at deadlines for committee or house passage, but some — including an effort to increase justice court filing fees — were in limbo until minutes before the clock struck midnight on Monday.

Other major bills that failed to advance included a measure aimed at transitioning Nevada residents away from natural gas use, several affordable housing bills and a bill that would have abolished the death penalty.

Here’s a look at some of the bills that died at the end of the session:

SB452: Prohibiting guns on casino properties

In the waning weeks of the session, Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) revived discarded portions of the session’s other major gun bill in the form of MGM Resorts-backed AB452, which aimed to grant casino resorts greater authority to ban firearms on their premises.

When Cannizzaro presented the bill, which would have required non-restricted gaming license holders (defined as more than 15 slot machines on property) to opt in to the provisions and would have prohibited individuals from bringing firearms onto casino property with certain exemptions, she described the measure as a way for lawmakers to further protect workers on the Las Vegas Strip.

Supporters said that the bill would largely mirror prohibitions on firearm possession at schools and libraries, but opponents — a broad coalition of Republicans, gun right advocates and criminal justice reform organizations — argued it would create uncertainty for gun owners and have a disparate racial impact.

The measure narrowly passed through the Senate in a 11-10 vote on Wednesday, but failed to receive a vote in the Assembly before sine die. During the joint committee hearing on the bill, many Assembly Democrats questioned its merits and expressed concerns about how the measure would affect minority communities.

“We are going to have situations where Black folks and brown folks are going to be the ones who are going to be not asked to leave, but who are going to be the ones that the police are called on,” said Assemblywoman Shondra Summers-Armstrong (D-Las Vegas) during the hearing.

AB387: Midwifery licensure board 

Nevada is the only state in the west that does not license midwives, but a proposed Board of Licensed Certified Professional Midwives nearly became a reality this session after falling just one vote short of a needed two-thirds majority late Monday evening.

During the last day of the legislative session, the Senate voted 13-8 on Democratic Assemblywoman Daniele Monroe-Moreno’s AB387, with Sens. Heidi Seevers Gansert (R-Reno) and Ben Kieckhefer (R-Reno) joining most Democrat senators in support. Sen. Mo Denis (D-Las Vegas) joined the Republican senators against the measure, ensuring the bill fell short of the needed two-thirds majority (because the bill required fees for licensure). 

The Assembly had previously passed the bill and its amendments with a 28-14 vote on May 28.  

The board would have been responsible for establishing an optional licensure process for practicing midwives and also would have set training and education requirements. 

An emotional hearing in the Assembly Committee on Commerce and Labor took place in April, in which several mothers shared their experiences with midwives and desire to have birth freedom while also having certain regulations and protections in place for all parties. 

Opposition to the measure was just as passionate, with opponents arguing that the board would overly restrict birthing options and punish midwives who may not want to be licensed or who have learned through apprenticeships rather than in a formal environment. 

SB437: Increased fees for justice court actions

An effort to double administrative fees for actions within the state’s justice courts fell two votes short of the two-thirds majority needed to pass on the last day of the session.

SB437, which would have increased the fee from $1 to $2 on the commencement of any action in a justice court for which a fee is required, in order to help fund the work of the state demographer within the Department of Taxation, passed through the Senate in mid-May on a 14-7 vote, but only after Sens. Kieckhefer and Pete Goicoechea (R-Eureka) switched from nay to yea votes.

Members of the Assembly then voted 26-16 along party lines on the measure, falling two votes short of the 28 votes needed to pass with a two-thirds majority. Republicans opposed to the bill, which was sponsored by the Senate Finance Committee, expressed confusion and concerns that it would tax the wrong people by imposing funds on litigants within the justice courts to fund the state demographer within the executive branch.

AB161: Study on summary evictions

A severely watered-down measure that would have created a legislative committee to study the state’s “summary eviction” process during the interim was left dead at the end of the session after failing to receive a vote in the Assembly.

The initial version of AB161, sponsored by Assemblywoman Selena Torres (D-Las Vegas), would have completely banned the “summary eviction” process, which involves possession of a rental unit and requires a tenant to either pay rent, vacate the property or respond to a notice through the courts within seven days. But the language in the bill was replaced with a study after lawmakers expressed concerns that there was not enough time to consider the consequences of upending the existing system in the midst of the eviction moratorium and amid staunch opposition from real estate groups.

The amended version of the bill, which received support from a slew of progressive groups, was passed out of its first committee in early April but never saw further action from lawmakers.

SB187: Limits on solitary confinement 

Sen. Pat Spearman’s (D-North Las Vegas) bill to limit the use of solitary confinement in Nevada prisons to 30 days never made it to an initial floor vote. 

SB187 also would have required regulations to limit solitary confinement to use only as a last resort. It also called for frequent mental health evaluations and giving inmates at least two hours of out-of-cell time daily, visitation and phone access.  

The Department of Corrections submitted a fiscal note stating that the measure would cost the department more than $40 million dollars for the biennium in order to modify policy at its seven major institutions and provide additional mental health support. 

“Even if they are guilty, they are still human beings, and we should treat them as such,” Spearman said of inmates during the bill’s hearing in the Senate Judiciary Committee on March 12. “If rehabilitation is the goal, then solitary confinement impinges upon that goal.” 

SB139: Prohibiting insurance companies from denying treatment for gender dysphoria

A bill that would have prohibited insurers from denying treatment for gender dysphoria – the psychological distress that results from an incongruence between sex assigned at birth and gender identity – did not survive after passing out of the first committee. 

Sen. Melanie Scheible’s (D-Las Vegas) SB139 aimed to require insurance companies, including Medicaid, to cover medically necessary treatment and surgeries for transgender Nevadans. 

The bill was meant to address instances of insurance companies denying coverage for treatment such as hormone replacement therapy and surgeries, despite existing laws and policies prohibiting the denial, exclusion or limitation of medically necessary health care services based on gender identity or expression. 

Advocates said that access to treatment should be considered medically necessary because without it, the mental health of people who have gender dysphoria suffers greatly. 

“When insurers fail to cover medically necessary care, people suffer anxiety, depression, social ostracism, and a higher risk of suicide,” transgender rights advocate Brooke Maylath said during the bill’s only hearing on March 12. “SB139 is designed to send a clear message to the greater healthcare community – discrimination is not acceptable in Nevada."

Although it received a deadline waiver, the measure did not advance after being referred to the Senate Committee on Finance on April 16. The state Public Employees' Benefits Program (PEBP) had submitted a fiscal note for $1 million for the biennium to extend the coverage for treatments. 

SB235: Additional marijuana licenses for unsuccessful applicants

A bill that became a lightning rod for marijuana industry criticism over a proposed amendment aimed at spurring the creation of scores of new dispensaries failed to make it to the legislative finish line.

The measure from Sen. Dallas Harris (D-Las Vegas), SB235, and a proposed amendment would have offered an alternative path to licensure for marijuana dispensary applicants who were unsuccessful in a 2018 licensing round. In that round, 61 dispensary licenses were issued to just 17 companies even though 127 potential businesses applied.

Those who lost out on the coveted permits pursued a massive lawsuit that ended with a judge saying there were flaws in the state’s process, but that the law did not permit her to order additional licenses as relief. An amendment to Harris’ bill that would have given unsuccessful candidates a path forward was forcefully criticized by the Nevada Dispensary Association, a statewide dispensary trade association whose representatives argued that it would threaten the strength and integrity of the industry.

Opponents also argued that the market could not support a large number of new stores without hurting existing ones; supporters countered with a competing analysis positing that the state could absorb nearly 1,300 new dispensaries.

The Cannabis Compliance Board submitted a fiscal note on the bill saying it would gain at least $610,000 over the biennium as a result of the increase in license renewal fees, and that it would cost an estimated $150,000 to complete a market study to determine demand for the issuance of additional cannabis licenses. 

The bill passed out of a Senate committee, was referred to the Senate Finance committee on April 20, and saw no further action before the end of session.

AB382: Regulating student loan servicers

A sweeping piece of student loan legislation that would have established new regulations on loan servicers in Nevada and would have granted more rights to borrowers was left for dead just a few days before the end of the session after falling one vote short of the two-thirds majority it needed to pass.

The bill was primarily aimed at enacting broad consumer protections through a borrowers’ bill of rights, as well as the licensing and regulation of servicers by the state’s Commissioner of Financial Institutions. 

Assemblywoman Jill Tolles (R-Reno) joined all Democratic Assembly members in voting in favor of the measure; however, some Republican lawmakers expressed concerns about the licensing fees that servicers would be required to pay. Student loan servicers Sallie Mae and Discover also opposed the bill, arguing that it could lead to greater costs for borrowers.

Bill sponsor Assemblyman Howard Watts (D-Las Vegas) said he adopted an amendment before putting the bill up for a vote that was aimed at addressing the concerns brought up by opponents.

“But some of the student lender interests decided to dig in on it. And unfortunately, again, all members of the minority caucus decided to side with them except for Assemblywoman Tolles,” Watts said, “in my opinion, picking those interests over borrowers that are in our state.”

SB462: Republican-backed effort to change redistricting commission

With the state set to handle the redistricting process in a likely special session sometime later this year, Senate Minority Leader James Settelmeyer (R-Minden) introduced an emergency measure, SB462, just two days before the end of the session that would have given Democrats and Republicans equal power in creating a redistricting commission.

That bill received zero action in the Democratic-controlled Legislature. Instead, members of both the Senate and Assembly adopted SCR13, sponsored by Senate Majority Leader Cannizzaro and Assembly Speaker Jason Frierson (D-Las Vegas), creating an interim reapportionment and redistricting committee composed of four Democrats and two Republicans.

Increasing awareness of mental health services

As the COVID-19 pandemic resulted in heightened mental health issues across the country, lawmakers in Nevada took steps to increase access to behavioral health care, typically through federal relief funds — but a pair of bills aimed at increasing awareness of mental health support services failed to advance out of the Legislature before the end of the session.

AB167, sponsored by Assemblyman Glen Leavitt (R-Boulder City), would have required K-12 schools and colleges to put information relating to mental health resources on student ID cards, including the phone number and text messaging option for the National Suicide Prevention Lifeline. After passing out of the Assembly on a 41-1 vote in late April, the bill did not receive a committee vote in the Senate.

AB315, which passed out of the Assembly unanimously a few days before the end of the session, would have required law enforcement agencies and fire departments to provide officers and firefighters with information about mental health awareness, prevention, mitigation and treatment, and provide two hours of mental health counseling within three months of retirement. The measure, sponsored by Assemblyman P.K. O’Neill (R-Carson City), passed out of a Senate committee on Sunday, but failed to receive a vote on the Senate floor during the final day of the session.

Public option likely all but a done deal after Assembly approves bill on party lines

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.”

Public option proposal advances as key Assembly leaders put their support behind the bill for the first time publicly

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.

Assembly taking time to get interested parties ‘all in the corral together’ before advancing public option bill

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.

Not all Nevada casino operators are on board with changes to ‘Right to Return’ legislation

A division has emerged among Nevada Resort Association members over revisions to legislation that would allow laid-off gaming and tourism workers to return to their jobs. One company vows to oppose the modified bill and even seek a veto from Gov. Steve Sisolak.

In an email sent Wednesday morning to the casino industry trade groups representatives, South Point Casino-Hotel attorney Barry Lieberman said many of the changes in SB386 – referred to as “Right to Return” legislation – were “particularly onerous for non-union smaller nonrestricted licensees.”

Lieberman, a long time Nevada gaming attorney and a close adviser to South Point owner Michael Gaughan, voiced concern over several sections of the revised legislation that was passed out of the Senate Commerce and Labor Committee Tuesday evening in a split vote. A deal on the bill was reportedly reached between gaming industry representatives and negotiators for Culinary Workers Union Local 226 with less than a week left before the end of the state's 120-day legislative session.

“We voted to oppose SB386 and seek a veto of the bill by the Governor if the bill passed the Senate and the Assembly,” Lieberman wrote.

Lawmakers voted along party lines, 12-9, in the Senate early Wednesday evening, less than 24 hours after the measure passed out of committee. The changes in the bill are apparently backed by some of the casino industry's largest companies, including MGM Resorts International, Wynn Resorts and Caesars Entertainment — Nevada Resort Association lobbyist Bob Ostrovsky told lawmakers on Tuesday that the association “officially on a majority position is neutral, and we will not support the bill and we will not work against the bill as an association, we are neutral.”

In an interview, Lieberman said the legislation treats “non-union resorts in the same manner” as properties with collective bargaining agreements. Representatives from other casino companies declined comment.

Lieberman termed several amendments to SB368 as “a confusing patchwork of vague, burdensome and non-helpful requirements.” He said the changes force employers “to guess at their peril as to what the bill actually requires them to do.”

He suggested the changes to the bill “impairs” an employer’s right to rehire casino workers who have “superior skills” as opposed to other laid-off workers.

Lieberman said the Nevada legislation’s passage will actually “discourage employers from hiring new employees.” Under the legislation, properties cannot hire a new employee for a position until all the provisions for full-time and part time employees “have been satisfied.”

Four sections in the legislation fail “to draw any distinctions between on-call, part time or full-time employees,” the attorney wrote in analyzing the 20-page document. The new language, Lieberman said, is “ambiguous” in describing the timelines for laid off workers and could be viewed as more favorable to part time employees as opposed to full-time employees.

The section requiring businesses to notify laid-off workers of layoffs “makes no sense.”

In the email, Lieberman said a decision was made by a majority of members of the Resort Association’s executive committee to remain neutral “in exchange for negotiating out of SB386 some of the more onerous provisions.” He said the decision was opposed by South Point.

The Culinary Union, which represents some 60,000 non-gaming workers in Nevada’s hotel-casino industry, has said just 50 percent of the workforce has been hired back since gaming reopened following a 78-day shutdown last year. Labor organization officials said SB386 is needed to ensure its members are able to return to their previous jobs.

AFL-CIO Secretary-Treasurer Rusty McAllister, in a statement, called the legislation a “common-sense measure that is urgently needed to create stability in Nevada’s workforce.”

As part of the agreement between the casinos and the union, revisions will be made to SB4, a bill from the 2020 special session last summer that includes government-imposed health and safety standards meant to prevent the spread of COVID-19, as well as expanded liability protections for major casino resorts. The amendment relaxes requirements on cleaning, such as cleaning minibars, headboards and decorative items on beds, and changes directives to clean throughout the day to instead call for cleaning daily.

Bill sponsor and Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) credited the Culinary Union, Nevada Resort Association and the governor’s office for working together to arrive at a consensus on the high-profile legislation.

SB386 would allow workers in the gaming and travel sectors a right to return to their jobs. The bill covers those workers laid off after March 12, 2020 and who were employed for at least six months in the year prior to the governor’s first COVID-19 emergency declaration.

The legislation is similar to at least a half-dozen other bills backed by the labor organization in other states. California Gov. Gavin Newsom, a Democrat, signed legislation last month that requires hospitality and service industry employers to offer new positions to laid off workers. 

This story was updated on May 26 at 8:18 p.m. to reflect that the bill passed out of the Senate.

Health care industry proposes amendment to reduce public option bill to actuarial study

A patient checks in at an urgent care

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.

Read the amendment below:

Gaming and labor leaders reach a compromise on ‘Right to Return’ legislation

Gaming and Culinary Union negotiators have tentatively agreed to revisions in legislation that would guarantee the rights of laid-off gaming and tourism industry workers to return to their jobs.

A deal on SB386 – referred to as “Right to Return” legislation – was reached with less than a week left before the end of the state's 120-day legislative session. Lawmakers wasted little time processing the bill — several hours after the initial publication of this story on Tuesday afternoon, members of the Senate Commerce and Labor Committee moved quickly to pass the amended bill out of committee on a split vote.

In an interview prior to the committee vote, bill sponsor and Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) credited the Culinary Union, Nevada Resort Association and the governor’s office for working together to arrive at a consensus on the high-profile legislation.

“I think you're really seeing what is a recognition of the greater good and how do we get started to work together to get everything back to where we need it to be,” she said.

As part of the agreement, revisions will be made to SB4, a bill from the 2020 special session last summer that includes government-imposed health and safety standards meant to prevent the spread of COVID-19, as well as expanded liability protections for major casino resorts. The amendment relaxes requirements on cleaning, such as cleaning minibars, headboards and decorative items on beds, and changes directives to clean throughout the day to instead call for cleaning daily.

Critics of the legislation had raised concerns that the bill in its original form would make it too easy for former employees to sue. The bill now offers recourse through the Labor Commissioner or through the courts, but only after the employee notifies their employer of the alleged violation and gives them at least 15 days to fix the issue.

“I think we've heard a lot of those concerns. We've tried to make sure that the bill still allows for enforcement while not opening up the doors of litigation,” Cannizzaro said.

In its original form, the bill required employers who declined to call back a former employee because that former worker lacked qualifications — and instead hired someone else for the job — to provide the person they passed over with a written notice and reasoning for the decision within 30 days of making it. The amendment limits the callback requirement, covering employees only if they accept or decline the job offer within 24 hours (revised down from 10 days in the initial bill) and are available within five days of receiving an offer.

Employers are also cleared of their obligations to re-hire someone if their job offers are turned down three times over a period of at least six weeks, or if mail or email is returned as undeliverable or a phone line is out of service.

The amendment specifies that managers and stage performers are also excluded from the provisions, and its provisions would not supersede or preempt any collective bargaining agreement already in place.

The amendment also covers areas of a resort casino that are leased to another operator, such as retail shops, restaurants, bars, and parking facilities.

Also, the amendment exempted restricted gaming operators which have 15 or fewer slot machines, such as bars, taverns, convenience stores, and grocery chains.

Bob Ostrovsky, a lobbyist representing the Nevada Resort Association, said the amended version of the bill would leave the association as officially “neutral” — promising not to support or oppose the bill as an association.  

He estimated that the industry was currently down about 66,000 casino resort employees from its pre-pandemic high, but estimated that only about 70 percent of the casino’s pre-pandemic workforce would end up returning to their previous positions, based on turnover history.

“We certainly have to think in terms of the masses of employees and the masses of paperwork that are required here, but I got to tell you, our members care,” he said. “Experienced and dedicated employees are what make these operations work. It's one thing to build a billion-dollar building. To operate it, you really need a well-honed team.”

Cannizzaro added in an interview prior to the committee vote that she hopes the bill will get bipartisan support because it “has a lot of buy-in,” although it does not need a two-thirds majority to move forward. 

Still, several Republican senators on the committee questioned portions of the bill. Sen. James Settelmeyer (R-Minden) asked why the measure did not have a small business exemption, and Sen. Keith Pickard (R-Henderson) said he was concerned about the proposed remedies for civil action.

“I think in many respects, this is better than some of the [collective bargaining agreements] I’ve reviewed in the past, and this is applying to nonunion shops that don’t ordinarily have to deal with these,” Pickard said. “I think it’s going to be a significant burden.”

Union leader softens testimony

Union and gaming negotiators had spent months trying to hammer out a compromise on SB386. The bill has a waiver that exempts it from legislative deadlines. Gaming sources have said there are stark disagreements between union and business interests over the bill’s language.

Earlier Tuesday, UNITE HERE President D. Taylor was prepared to tell a U.S. Senate subcommittee about the labor group’s support for SB386, but he departed from his prepared remarks that were posted to the subcommittee’s website that accused certain employers – including the Nevada casino resort industry – of using the pandemic to “reduce” jobs and leaving workers out of an economic comeback.

In April, Taylor testified in the only public hearing for SB386. The Culinary Union has hosted rallies and engaged in door hanging campaigns aimed at pressuring lawmakers to pass the legislation. 

Taylor, who spent 26 years in leadership for Culinary Workers Local 226 before being appointed UNITE HERE president in 2012, told the panel that is chaired by Sen. Jacky Rosen (D-NV) that the state’s hospitality workers play a frontline role in providing resort industry guests a safe and secure environment.

“The idea is not to view workers as a cost item but viewed as a service product that brings back (consumer) loyalty,” Taylor told the Senate Commerce Subcommittee on Tourism, Trade, and Export Promotion in response to a question from Rosen.

SB386 would allow workers in the gaming and travel sectors a right to return to their jobs. The bill covers those workers laid off after March 12, 2020 and who were employed for at least six months in the year prior to the governor’s first COVID-19 emergency declaration.

The legislation is similar to at least a half-dozen other bills backed by the labor organization in other states. California Gov. Gavin Newsom, a Democrat, signed legislation last month that requires hospitality and service industry employers to offer new positions to laid off workers. 

Taylor, in testifying Tuesday, softened his message in some areas, but stuck to the script in others.

He said employment is “lagging” in destination markets, such as Las Vegas, where 50 percent of union members in gaming have returned to work. In New Orleans, just 32 percent of the labor organization’s membership is back on the job.

Regional gaming markets, Taylor said, have had better success at bringing back employees, including Atlantic City, Ohio, Detroit and Mississippi. Those communities have returned 65 percent to 75 percent of UNITE HERE workers to their jobs.

In the prepared remarks, Taylor said opposition to SB368 by Station Casinos, the operating subsidiary of Red Rock Resorts, denies casino, hospitality, stadium and travel-related workers in Nevada their recall rights.

“In most cases, unless you have a union contract, there’s nothing that requires your employer to bring you back when the business returns,” Taylor wrote. “Workers who are terminated and replaced rather than 'recalled' make on average 11.8 percent less in wages when they get a new job,” Taylor said. “Of older workers who are laid off involuntarily, only one in 10 will ever earn as much again.”

At the outset of the pandemic, Station Casinos was one of just three casino operators, along with Wynn Resorts and Las Vegas Sands, that committed to pay employees through shutdown.  

During his appearance, Taylor named Wynn Resorts, along with Disney in Florida, as companies that have stepped up to support their workforces.

In an interview following Taylor’s testimony, Culinary Union Secretary-Treasurer Geoconda Argüello-Kline said SB386 is needed to ensure the labor organization’s members are able to return to their previous jobs.

Las Vegas casino operators have held nearly a dozen different job fairs in efforts to restaff hotel-casinos that were closed for 78 days a year ago and were hampered throughout the year by capacity restrictions and other COVID-19 operating procedures. Most casinos in Nevada are expected to return to 100 percent occupancy levels on June 1.

The $4.3 billion Resorts World Las Vegas is facing challenges filling out its planned 5,000-person workforce.

Scott Sibella, president of the 3,506-room Strip property that opens June 24, told the Nevada Gaming Commission last week some 120,000 potential workers applied for jobs during the pandemic.

"We feel comfortable and made offers, but we're concerned about people changing their minds," Sibella said. He added that Resorts World has contingency plans in place for bringing on workers.

Sibella, a former president of MGM Grand Las Vegas, told the commissioners the resort is competing with other Las Vegas resorts in filling jobs.

"The Venetian is holding a job fair. They haven't done a job fair in 20 years,” Sibella said.

Updated at 8:44 p.m. to add additional details on the amendment and reflect that the committee passed the bill.

Public health insurance option bill clears the Senate on party-line vote, heads to the Assembly

A cat scan machine

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 Independent the 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.