Heller and Sandoval are wary of a bill that may cause rural residents to lose coverage. Sandoval was the first of many Republican governors to expand Medicaid under the ACA. "The prospect of losing ACA coverage in every rural county is a reversal of fortune for a state whose embrace of the 2010 health-care law has brought dramatic results. Before the ACA, 23 percent of Nevadans were uninsured, one of the worst rates in the country. Today, it is 12 percent," reports Goldstein.
But "months of uncertainty about the ACA’s future have heightened insurers’ qualms in Nevada about whether its marketplace is a financially safe space to be," writes Goldstein. "The sole company that had been expected to remain on the state exchange in Lyon County and Nevada’s 13 other rural counties announced otherwise last month and will be gone by January. Unless Anthem or another insurer reverses course, 8,000 people across hundreds of miles will be left without any ACA insurer next year — by far the largest such bare patch in the nation."
|Bloomberg map shows Obamacare insurers by county; yellow counties have none.|
Sandoval's Chief of Staff Mike Willden said state officials are talking to federal officials about creative solutions to keep rural Nevadans enrolled in health care if Anthem leaves the exchange. "Perhaps they could let people enroll in the health plans available in Reno and Las Vegas, though their doctors would be farther away. Perhaps the state’s four ACA regions could be collapsed into one, so that any insurer wanting to stay in the urban areas would have to sell health plans in the rural places, too. And a study is going to look at a novel strategy endorsed this spring by the legislature — letting any Nevadan pay to join a Medicaid health plan," reports Goldstein. In the meantime, Sandoval and Heller remain vocal critics of the Senate's health-insurance bill.