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VEGAS INC C OV E R STO RY Most large employers will be charged $63 for each worker they insure next year HEALTH CARE, From page 1 But that – and more – could change next year when the main provisions of President Barack Obama's Affordable Care Act kick in. They have the potential to overhaul Nevada's health care sector. The law will essentially force almost everyone to have insurance and will require large companies to offer workers coverage. A state-run website will help Nevadans find affordable health plans, and at least 70,000 more people statewide are expected to join Medicaid. Insurance companies will be barred from denying coverage or charging higher rates to people with pre-existing conditions, and companies will be banned from imposing annual spending limits on many health plans. Many Nevadans are expected to benefit from the expanded coverage and tighter controls on insurance companies. Hospitals also could improve their bottom line with more paying customers. But many business executives say the law will raise costs and lead to higher insurance rates for millions of people. What's more, Nevada has a physician shortage, and a surge of newly insured patients might cause longer wait times at doctors' offices. ••• In 2011, Nevada had the second highest rate of uninsured residents in the nation, almost 23 percent. That was slightly below Texas' 24 percent but well above 14 20130401_VI01_F.indd 14 Republican Gov. Brian Sandoval, though a staunch opponent of the health care law, agreed in December to expand Medicaid in Nevada. The federal government will pay all medical costs during the first three years of the expansion, and the state will help pay administrative costs. State officials expect 70,000 previously eligible Nevadans to enroll in Medicaid because of the Affordable Care Act's insurance mandate. Another 78,000 people will become eligible for the program. the national rate of 16 percent, according to the U.S. Census Bureau. Officials hope the rate drops next year when residents can shop more easily for health care plans on the Nevada Health Link website. Advocates envision insurance companies using the site to compete for new customers by offering good rates. Nevadans can start using the site in October, but coverage won't take effect until next year. The Affordable Care Act requires every state to have an online insurance marketplace in 2014, such as Nevada Health Link. Insurance companies don't have to participate, but it's likely they will. All of the major carriers are eyeing Nevada's system, said CJ Bawden, spokesman for the Silver State Health Insurance Exchange. "They're interested in tapping into a new market," he said. State officials want to burst out of the gate and hope that 118,000 people use the website to buy insurance by May 2014. Enrollment goals slow considerably in the following years, with an aim to have 173,000 people signed up by 2017. As part of the law, low-income residents can get tax credits to help them buy insurance. People without insurance will face financial penalties. Next year, an adult without coverage will pay the federal government $95 or 1 percent of his or her income, whichever is greater. That fee will rise in 2015 to $325 or 2 percent, and by 2016, it will climb to $695 or 2.5 percent of a person's income. Other Nevadans will become insured another way: The law allows for expanded eligibility of Medicaid, a federally and state-funded insurance program for the poor. Republican Gov. Brian Sandoval, though a staunch opponent of the health care law, agreed in December to expand Medicaid in Nevada. The federal government will pay all medical costs during the first three years of the expansion, and the state will help pay administrative costs. State officials expect 70,000 previously eligible Nevadans to enroll in Medicaid because of the Affordable Care Act's insurance mandate. Another 78,000 people will become eligible for the program. Altogether, the expanded coverage in Nevada should lead to a drop in unnecessary emergency-room visits – or at least get more people to pay for that care, hospital executives say. Federal law requires ERs to treat people for any ailment, regardless of whether they can pay. As a result, financially strapped Las Vegans often use the emergency room, rather than a physician or specialist, for all their health needs. About 40 percent of ER patients at the Brannman Clark County-run University Medical Center on any given day are uninsured, CEO Brian Brannman said. | 1 APRIL 2013 | 3/28/13 2:48:41 PM