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After Florida judge declares Obama law unconstitutional, Nevada government works to implement law


By Andrew Doughman, Nevada News Bureau: The logic of Gov. Brian Sandoval goes something like this: If you’re going to make me do it, let me do it my way.

That’s why he can applaud Monday’s ruling in Florida declaring President Barack Obama’s health care law unconstitutional while at the same time approve of today’s meeting between Nevada’s Department of Health and Human Services and stakeholders to discuss implementing the law.

If Nevada makes marked progress toward implementation, it has more control over how the law’s mandates take shape in Nevada. If the state doesn’t act, the federal government steps in to implement the law.

“We must also plan for a Health Insurance Exchange so that we – and not the federal government – control the program,” Sandoval said in his State of the State address earlier this month.

Today’s discussion revolved around setting up that health insurance exchange, which officials have repeatedly said will look something like the airfare websites Travelocity and Expedia. Nevadans buying health care insurance would access the exchange and find the best insurance plan for them.

To be on target for implementation, the state Legislature should pass a bill this session that sets up the skeleton structure of the exchange. Should they not, the federal government might intervene and create that structure for Nevada.

States Legislatures across America are also taking up the issue.

Pending legislation, today’s meeting served as a public forum to raise questions for the state, the insurance industry, hospitals, businesses and individuals.

Nevadans might be wondering: who will I be able to buy insurance from? Who can I talk to if I’ve never bought insurance on my own and need help? What are the options for me as a small business owner? Can the insurance exchange show me if I qualify for government subsidies?

The state will have to answer all of these questions by Jan. 1, 2014, when the federal government has mandated that the exchanges open for business. That’s also the deadline for the “individual mandate,” the controversial aspect of the law that requires most people to purchase health insurance.

That means thousands of first-time buyers will probably seek coverage through the state’s insurance exchange.

Given the enormous task of setting up a market to serve thousands of first-time buyers, Nevada’s Division of Health Care Financing and Policy has contracted with Public Consulting Group to aid in designing the exchange.

Bob Carey, one of the consultants, said he helped implement the Massachusetts health care law that preceded and informed the national law.

He said, however, that he won’t be pushing to make Nevada “Massachusetts-West.”

“What we are going to work towards is a market mechanism or exchange mechanism that reflects the views and desires of the Nevada community,” he said.

He and the state’s health care policy division want a broad dialogue about crafting Nevada’s exchange. That means more stakeholder meetings.

Today’s meeting involved about 60 people in Carson City, Reno and Las Vegas, many of whom represented businesses, hospitals and insurance companies. Future meetings will have larger venues and, perhaps, more private citizens in attendance.

On Monday, a judge in Florida ruled that the health care law is unconstitutional, which bumps the case to an appeals court and one step closer to the U.S. Supreme Court.

But today’s meeting was an apolitical policy meeting, not a courtroom debate. Audience members seemed more concerned with how they could make the exchange work best for them.

“We all know about the litigation results from yesterday. All of the states are kind of moving on two concurrent paths: One is the litigation path …and the other is the health care reform implementation process,” said Gloria MacDonald, a state health care official on the implementation team.

Since the law is on the books until the U.S. Supreme Court decides whether to keep it or not, Nevada is marching along toward the law’s implementation deadlines while at the same time suing to do away with the law completely.

On track one, expect more constituent meetings about implementation. On track two, expect an eventual ruling from the U.S. Supreme Court that could halt track one.

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