Business groups have urged a legislative committee investigating ways to cover the state's nearly half million uninsured to rely on the free market rather than government subsidies.
The Subcommittee to Study Health Insurance Expansion Options met to discuss ways to provide access to more affordable health insurance.
The group is hoping to tap into the federal government's Health Insurance and Accountability (HIFA) program, which provides money to states with the goal of reducing their uninsured populations.
To take advantage of HIFA, though, Nevada needs to come up with matching funds and the subcommittee is working to do that using money that the state already spends.
Business groups are interested because more than half of Nevada's uninsured are employed, primarily by small businesses that routinely say they cannot afford the high cost of insurance.
In 2002, the most recent year for which statistics are available, about 416,800 nonelderly people in Nevada did not have health insurance, according to the Current Population Survey.
More than half 234,400 were employed, and about 60 percent of them were working for companies with fewer than 100 employees.
Premiums are also highest for that group of employers in Nevada.
According to the Medical Expenditure Panel Survey, the average total single premium per enrolled employee is $3,205 for business with fewer than 10 employees, $2,896 for companies with between 10 and 24 workers, and the highest, $3,530, for businesses with 25 to 99 employees.
The cost per employee for businesses employing between 100 and 999 workers is $2,864 and drops to the low of $2,644 for employers with 1,000 or more workers.
Business groups including the National Federation of Independent Businesses and the Las Vegas Chamber of Commerce testified that they'd rather see an industry solution that brings down health costs than a government subsidy that they said would be passed along to taxpayers.
"We hope that you will look at market competition rather than subsidized premiums," said Randy Robison, state director for the NFIB.
He suggested that the state could take the money it receives from a so-called HIFA waiver to subsidize a high-risk pool, which some claim drives up the cost of all health insurance, rather than subsidize premiums.
"Everyone on this committee would love to see the market take care of itself," responded Assemblywoman Barbara Buckley (D-Clark County), who chairs the committee.
"But since it hasn't Nevada is the fifth highest in terms of uninsured."
The subcommittee's technical working group run by EP&P Consulting Inc.
is now working to determine the panel's focus, including which population groups to cover, what benefits to provide, the costs of that coverage and where to get the money to fund it.
The core groups they're looking at are workers at employers with between two and 50 employees who do not offer insurance; small business employees with incomes below 200 percent of the federal poverty level who are offered health insurance but do not enroll; pregnant women between 133 percent and 185 percent of the poverty level; and parents of Medicaid and State Children's Health Insurance Program children.
They are also researching expanding coverage for groups that are already partly covered, including individuals covered for catastrophic health-care events and individuals who are receiving Social Security Disability benefits but who are not yet eligible for Medicare.
Several states, including Louisiana, New Mexico and Utah, now provide a variety of benefits through HIFA.
The cost of Nevada's program would be determined by both the number of people in each group as well the benefits offered.
And the committee is hoping to use money the state already spends to meet the requirement for matching funds.
The committee also talked about two states Arkansas and Maine that are trying to use money spent by employers to meet the matching funds criteria.
But Gretchen Engquist, corporate director for EP&P, warned the panel that such a plan for Nevada would likely fail.
"We believe this strategy will be cut at the knees, primarily because the federal exposure is enormous," said Engquist.
"Every state could solve their employed uninsured problems if they could get matching federal funds."
Engquist said the technical working group would deliver preliminary figures for groups' sizes and benefits costs by the subcommittee's meeting in May.
