As multitudes of Nevadans continue to lose health care benefits in the middle of a pandemic, there’s some good news on the insurance front.
More relatively low-cost health care options are available in Nevada than ever before, subsidies for those who qualify remain in place, and no matter how the Supreme Court may rule on a pending Affordable Care Act case, the plans and subsidies available under the state’s health insurance exchange will likely stay intact through 2021 and beyond.
“In Washoe County, (the state health insurance exchange) now offers 45 plans, at different levels, available from HPN, SilverSummit, Anthem HMO Co., and Friday Health Plans, which is new for us this year and is available statewide” said Heather Korbulic, executive director of Silver State Health Insurance Exchange. “In the rural counties, we have three different carriers, an increase of one. If you remember back in 2017, we were looking at having some bare counties when insurers pulled out.”
More than 120,000 Nevadans uninsured
She noted that in 2019, the Guinn Center estimated that 120,000 Nevadans remained uninsured, yet were eligible for coverage through the exchange. Those are people who aren’t enrolled in the federal Medicare or Medicaid programs and did not have access to employer-sponsored health plans.
“About 80% of people who apply are eligible for subsidies,” Korbulic said. “They really are finding affordable options. Many are subsidized almost fully for their insurance.”
It’s unknown how many more Nevadans became uninsured when they lost their jobs during the COVID-19 pandemic. As cases of the virus continue to surge and another business shutdown looms, more layoffs will follow.
Open enrollment period rolling
There are more than 77,000 people covered through the insurance exchange now and the current enrollment period for the 2021 benefit year continues through Jan. 15. Those who enroll before midnight on Dec. 31 will have health insurance coverage effective Jan. 1, 2021; those who enroll between Jan. 1 and Jan. 15 will have coverage effective Feb. 1, 2021.
The state exchange is no longer part of the federal Healthcare.gov system, which gives Nevada more flexibility in adding carriers and lowers costs, Korbulic said.
“If you are uninsured, go to Nevada Health Link and click on the Get Help box to find one of our more than 600 brokers or navigators and make an appointment. It’s free and you will want help from a professional to find a plan that is right for your individual needs, such as how many times you go to the doctor; how many prescriptions you have; your financial situation… Working with a licensed professional is the best way to move forward.”— Heather Korbulic, executive director of Silver State Health Insurance Exchange.
With the pandemic raging, this is no time for anyone to be without health insurance, Korbulic said. Available plans include vision, dental and mental health coverage. Freelancers, gig workers, service workers who depend on tips for the bulk of their incomes are all eligible.
Gig workers, freelancers covered
Sal Gentile, founder and CEO of Friday Health Plans, said Nevada’s large number of relatively young service workers and gig workers made the state a natural fit for his company’s expansion into the state this year. He noted that the Affordable Care Act didn’t require companies with 50 employees or fewer to offer health insurance and so a lot of workers were left without coverage.
That segment of the workforce is often young and often forgoes health care coverage, studies show. “Fridays is a consumer brand especially designed for those workers,” he said.
Unlimited mental health benefit
Gentile said the plans also are a good fit for entrepreneurs, freelancers, contractors, early retirees and small business owners, “people of all ages from 18 to 64 who make their own decisions about health insurance.” The rates are designed to be less than what is usually offered on a spouse’s or parents’ group insurance plan, he said.
The carrier also is the first in the U.S. to offer an unlimited mental health benefit along with an unlimited primary care benefit as part of its coverage plans. The pandemic and the increased stress that it brings makes affordable mental health care coverage an important part of a health care tool kit, he said.
Supreme Court mulls ACA case
The Affordable Care Act, which protects 133 million people with pre-existing conditions from being denied insurance coverage and provides health insurance for 120 million people, has survived four years of assaults by the Trump Administration. Its fate is now in the hands of the U.S. Supreme Court, which on Nov. 10 heard arguments in a case involving Congress’ repeal of the individual mandate.
If the court decides that the repeal of the individual mandate, a provision of the Affordable Care Act that requires everyone to have health insurance or pay a penalty, can’t be separated from the entire law, then the ACA will die in the midst of the worst pandemic in more than a century.
But if the justices rule that the mandate is separate from the law, the Affordable Care Act, and its benefits, will continue. Millions will stay insured. The panel is expected to rule on the case next summer.
Parts of the law have wide support
Both Gentile and Korbulic said they are optimistic that the high court will allow the law to stand. But even if the ACA falls, they doubt protections for preexisting conditions and a system of health care subsidies will vanish with it.
“I have a high degree of confidence that subsidy waivers and preexisting conditions protections are here to stay,” Gentile said. “Those parts of the law have wide support. There are too many people just rich enough not to be eligible for Medicaid and yet don’t otherwise have access to employer-sponsored health care.”
Korbulic said a repeal of the ACA “would be devastating” because it would throw millions off the Medicaid rolls, including 256,000 people covered under the Medicaid expansion in Nevada. Striking down the law also would eliminate billions in federal subsidies for private insurance plans. In addition, the law’s protections against lifetime insurance benefit caps would disappear.
Arguments were heard this month
Even so, those who sign up for plans in the 2021 benefit year likely won’t be affected, she said.
“If the worst-case scenario were to play out, if the court was to overturn the Affordable Care Act, it would be put down to the lower courts to determine how to start unwinding it,” she said. “That will take some time.”
She watched the Nov. 10 oral arguments in the case, she said, and she believes the justices are leaning towards ruling on “what Congress intended to do, eliminating the individual mandate and letting the rest of the law stand.”
Then, she said, there will be no impact on those who get insurance under the Nevada exchange. The ACA will be here to stay.
“It is a little more hopeful to think about building on policy rather than tearing it apart,” she said.
The state’s health insurance exchange, Nevada Health Link, can be reached on the web. Nevadans who may not have access to a computer or prefer phone communication may call the exchange’s free assistance line to speak to a licensed enrollment professional at 1-800-547-2927.