Dive Brief:

The Nevada legislature approved a bill Friday that would let uninsured Nevadans join a Medicaid plan regardless of income level.

The Nevada Care Plan would allow people who qualify for tax credits under the Affordable Care Act to use the credits to buy Medicaid coverage. The Medicaid plan would likely compete against private health insurance plans on the state’s health insurance marketplace.

The buy-in coverage would be the same as traditional Medicaid, except it wouldn't cover emergency medical transportation.

Dive Insight:

There are still many hurdles to go before the bill would become a reality — namely, Gov. Brian Sandoval. Sandoval has supported Medicaid expansion, but hasn't said whether he will sign the bill. There are also plenty of outstanding questions, such as the plan design and plan costs.

Single-payer activists have promoted the idea of Medicare for all, but Nevada could be the first state to implement Medicaid for all. The state/federal system usually pays doctors and hospitals less than Medicare and much less than private payers.

Medicaid expansion has helped cover more Americans and reduced uncompensated care, but it also means more patients with coverage that pays less than private insurance. Uncompensated care is much smaller in Medicaid expansion states, but that additional coverage comes with lower payments from Medicaid. Any further expansion of Medicaid will change a hospital’s payer mix, which will mean hospitals would need to make up the payment gaps in other ways.

Another issue is President Donald Trump’s proposed Medicaid cuts. Trump proposed a $610 billion cut from Medicaid over 10 years, which would force states to decide how to cut benefits, coverage and access to care. If Nevada were to implement Medicaid for all, the state would also need to raise more funds to pay for the program.

This Medicaid for all proposal has largely flown under the radar while the single-payer healthcare system in California has seen all the headlines. The California bill is now with the state Assembly and has a $400 billion price tag.

The Nevada bill doesn't have a cost attached yet and still needs the approval of a Republican governor, so it's also a long ways away from reality. However, left-leaning states are watching Nevada to see what the more centralist state does and could potentially follow suit if Nevada tests the waters.