Jason Hidalgo

jhidalgo@rgj.com

Nevada no longer leads the nation in uninsured children.

The Silver State posted the largest improvement nationwide in reducing its rate of uninsured kids from 2013 to 2014, a report by the Robert Wood Johnson Foundation found.

An estimated 100,058 or 14.4 percent of Nevada children did not have health insurance in 2013, a rate that ranked 51st — or dead last — among all states and Washington, D.C. that year. By 2014, however, Nevada improved to 48th as its rate fell to 10 percent or about 69,300 uninsured children. The 4.4 percentage point reduction also represented the biggest improvement in the nation, according to the report, which was done by the University of Minnesota and uses the latest numbers available from the U.S. Census Bureau.

NV health exchange tackles key issues

Nevada’s improvement coincided with a nationwide increase in kids gaining insurance.

“This is the largest decline of uninsured kids we have seen since (we started doing the annual study in) 2008,” said Brett Fried, a senior research fellow with the University of Minnesota’s State Health Access Data Assistance Center.

Although the study did not specifically look at causes for the improvement in insurance coverage, Fried says the trend matches findings by other reports about the impact of the Affordable Care Act, which kicked off its first year of open enrollment in October 1, 2013. In addition to launching qualified health plan for individuals and families, the ACA also expanded coverage through Medicaid.

“It’s likely the case that more children gained coverage as eligible parents signed up for free or low-cost health insurance, and we’re likely to see that continue,” said Lynn Blewett, director of the State Health Access Data Assistance Center.

The improvement was welcomed by Gov. Brian Sandoval, who pointed out that Nevada led the nation in reducing its per capita rate for the uninsured as well. In addition to children, the state also has made gains in increasing coverage for vulnerable populations, Sandoval said.

"This drop in our uninsured rate has helped children across Nevada as well as the neediest among our communities by leveraging federal resources and saving precious state dollars," Sandoval said.

Seeing progress

The data from the Robert Wood Johnson Foundation backs up the gains seen among vulnerable populations and minorities.

“The interesting thing about Nevada is that it saw a large drop in the percent of Hispanic children that were uninsured and also for low-income children,” Fried said.

Low-income kids saw the biggest improvement in Nevada with a 7.5 percentage point reduction in uninsured children. Minorities saw a 4.5 percentage point reduction, with Hispanics posting a decrease of 5.5 percentage points.

The reductions in a state that has struggled with its rate of uninsured for many years is a big deal, said Kathy Hempstead, Robert Wood Johnson Foundation director of insurance coverage issues.

“Last year, we again marked progress in efforts to expand health insurance coverage to all children in Nevada,” Hempstead said. “Expanding eligibility and enrolling the eligible must continue until all of the estimated 69,000 uninsured children in Nevada can get access to coverage.”

At the same time, the state still has a ways to go. Despite its improvement, Nevada remains among the bottom five of states for its rate of uninsured children, behind only Alaska, Texas and Arizona. Florida rounded out the bottom five.

Sandoval says he's aware that more work needs to be done.

"I remain committed to working with our state an federal partners to continue improving access to healthcare services," Sandoval said.

Nevada should continue to see improvement in 2015 and this year as well based on ACA enrollment numbers, said Bruce Gilbert, executive director of the Silver State Health Insurance Exchange. The second year’s enrollment numbers for qualified health plans in Nevada, for example, doubled those of the first year. This year saw even bigger enrollment numbers for qualified health plans.

“We saw a significant increase with 88,145 Nevadans enrolling in health plans through the exchange,” Gilbert said. “That’s an increase of about 20 percent.”

State of the state exchange

The last enrollment period marked a redemption of sorts for Nevada’s health insurance exchange program.

The state exchange’s launch was marred by generous expectations and technical glitches from provider Xerox, which snowballed into all sorts of problems.

The latest enrollment numbers are a big improvement from the first year of the Nevada Health Link site, which saw only 35,000 signups for qualified health plans after initially posting a goal of 118,000 enrollments.

“In the first year, everything went about as poorly as they could,” said Gilbert, who became director during the second year. “The technology failed, the consumers weren’t happy and the broker-agent community was unhappy.”

The health exchange blowup was particularly vexing for Sandoval, who went ahead with the exchange after it became “the law of the land” despite its unpopularity in conservative circles where it continues to be labeled as “Obamacare.” After the failure of Xerox’s system, Nevada dumped the company and switched to a hybrid exchange that piggybacks on the federal system.

Although switching to a federal system gave the state exchange stability, it also come with its share of drawbacks. One is lack of direct access to data and analytics, which the state has to request from the federal government.

“(Information sharing is) a heavy lift,” Gilbert said. “The downside of utilizing federal technology is that we’re held captive by decision makers in Washington as to what information is important or essential and what is not.”

The state is also waiting for a final proposal from the Centers for Medicare and Medicaid Services for how much it will cost Nevada to remain on the federal system. Depending on the result, combined with the limitations of information sharing, Nevada could very well opt out and contract with the private sector for its own system again.

The difference this time is there are now systems out there with a proven track record, which should prevent a Xerox 2.0 situation, Gilbert said.

“This isn’t 2012 anymore so we’re not interested in building Frankenstein’s monster from scratch again,” Gilbert said. “The real challenge this time is going to be one of perception rather than technology.”

In the meantime, the state exchange plans to build on its outreach efforts from the last two years. This includes increased focus on Latinos, tribes and other minorities as well as self-employed and low-income populations.

“Those are the really hot-button populations for us because they create the most opportunities to make a difference,” Gilbert said. “We’ll also look at the last enrollment period and try to better identify which messaging works and what events work in reaching the populations that really benefit the most from our activities.”

TOP 5 STATES (lowest % of uninsured children)

Vermont: 1.2 percent

Massachusetts: 1.8 percent

Hawaii: 2.5 percent

District of Columbia: 2.7 percent

Iowa: 3.2 percent

BOTTOM 5 STATES (highest % of uninsured children)

Alaska: 12.3 percent

Texas: 11.8 percent

Arizona: 10.5 percent

Nevada: 10 percent

Florida: 9.6 percent

Source: University of Minnesota State Health Access Data Assistance Center