- Associated Press - Friday, June 30, 2017

CARSON CITY, Nev. (AP) - Frustrated with a lack of input from insurance companies on how to keep thousands of Nevadans from being kicked off the health exchange, Gov. Brian Sandoval wrote to four industry executives on Friday, calling them to his office and insisting they work with state officials to find a solution.

Thousands of people will lose their insurance in 14 of Nevada’s 17 counties if two companies move forward with plans to exit the marketplace next year and no other insurers step in.

Anthem Inc. announced this week it will exit the exchange in rural Nevada and Prominence Health Plan will leave the state system entirely on Jan. 1.

In letters obtained by The Associated Press, the governor appealed directly to Anthem Blue Cross and Blue Shield President Michael Murphy, Aetna Executive Vice President Francis Soistman, SilverSummit Health Plan CEO Garrett Leaf and United Health Care Vice President of Operations Kyle Clingo.

Those four companies are slated to participate in the exchange next year in Clark, Washoe and Nye counties, and proposed that rates increase an average 38 percent, insurance officials said Friday. About 81,000 Nevadans are currently insured through the marketplace in those counties.

Sandoval asked for company representatives to fly to Carson City for a mid-July meeting to determine what they would need in order to also cover Nevada’s rural counties. His office has been inquiring about federal incentives to lure insurers.

Phone and email messages requesting comment from the four companies went unreturned Friday evening.

The scarcity of doctors and medical facilities in vast, thinly populated areas can mean higher costs to insurers. But Nye County, which borders Las Vegas’ Clark County, is one of the state’s largest rural counties - and all four companies will participate there.

“It is puzzling to me how carriers are ensuring full county coverage to Nevada’s neighboring states, yet are at a potential loss about how to offer insurance for all but three of Nevada’s counties,” Sandoval wrote the same executives earlier this week.

He told them that leaving the exchange vacant in 14 counties will set back years of work to nearly halve Nevada’s uninsured rate.

On Tuesday, he wrote “Please understand in no uncertain terms the confidence, faith, and importance that I am placing in your ability to find either a collective, or individual, solution towards offering subsidized health insurance to these 8,000 Nevada lives.”

They did not help, Sandoval wrote on Friday, noting that their only feedback on the issue has focused on market performance.

“I am disappointed and had hoped by now that possible solutions might be proposed,” he wrote.

State officials are considering other options for the state to backstop coverage. The only sure alternative is a nonprofit, “shared-responsibility” basic medical provider called Access to Healthcare Network.

Various insurance companies recently filled in county-wide gaps in Tennessee and Washington, meaning those states were able to avoid the issue of “bare counties” that Nevada currently faces.

The health care exchange offers federal discounts for low-to-medium-income residents through former President Barack Obama’s landmark health law.

In statements on its exit from Nevada and Ohio markets, Anthem cited market volatility and the uncertainty of federal operations as Republicans in Congress continue to debate an overhaul of “Obamacare.”

While much of rural America has shifted to government-backed insurance, which is typically less expensive than alternatives for those who qualify, private options have declined and people now face a tax for going uninsured. Nevadans who had insurance before entering the exchange would likely find their former plan is now out of their price range or no longer available to them.

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