Public Option Plan in Nevada Continues Healthcare's Cost Vs. Coverage Debate

"Creating a new set of health plans that look identical to other plans but with capped reimbursement rates does not address the underlying high costs of care, and will only serve to raise costs outside of the individual market as health care providers seek higher reimbursements to remain whole." — AHIP.

Under Nevada's new Public Option, small businesses and state residents who make more than 138% of the federal poverty level — the upper limit of Medicaid eligibility — could purchase a plan from bidding commercial payers. Despite pushback, it is unlikely that the state's largest plans would decline to participate. Contributing writer Laura Beerman has this report.

Also this week, UnitedHealthcare's attempt to "Monday morning quarterback" emergency room visits by retroactively denying emergency claims is not only likely a violation of the prudent layperson standard, but also "bad policy" for several reasons, says Doug Wolfe, co-founder and partner of the Miami-based law firm Wolfe Pincavage. Alexandra Wilson Pecci reports.

Must Reads

That's all for this week's Payer Briefing.

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Stay safe!

John Commins
Senior Editor

@ComminsCom