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Public Option, State Efforts

Updates on Nevada’s Passage of the Public Option

Published On June 3, 2021

By: Liz Hagan, Rebecca Kunau

Nevadans have faced steep personal and economic losses over the last year as the COVID-19 pandemic compounded long-standing structural inequities. Among them, the Silver State ranks 49th overall in state health system performance and is consistently one of the least-insured states despite having expanded Medicaid. Racial disparities continue to widen, too, with the state’s highest uninsurance rates found among its Hispanic and Latino communities.

In this year’s legislative session, Nevada took a big step toward reducing those disparities and prioritizing equitable access to quality, affordable health care. The Assembly joined the Senate in passing historic legislation (SB 420) to create the nation’s second-ever public health insurance option, sending the legislation to the governor’s desk for signature. Governor Sisolak has committed to signing it into law, joining Washington state on a new frontier for health care access in the country.

What the bill does:

The Nevada Option is expected to significantly reduce both the cost of health coverage and the number of Nevadans priced out of health care. The following key measures in the bill will drive down costs and ensure that Nevadans are offered access to quality health care that they can afford:

  • Leveraging the state’s existing buying power to offer more affordable choices to Nevadans on the individual and small group markets. Insurers will compete to offer the public option, with all Medicaid managed care plans being required to submit a good faith bid to offer the plan. 
  • Providers that want to be in-network and be paid by a range of state insurance plans including state employee benefits and worker’s compensation will be required to accept at least one version of the public option coverage. The legislation allows public options to be made available to individuals working at small businesses, so it will benefit a wide swath of people in need. 
  • Providing high-quality and affordable coverage, the public option is required to lower premiums by 15% — and because it will be offered as a qualified health plan (both on and off the state marketplace), it will cover the Affordable Care Act’s ten essential health benefits. 
  • Once launched, it will have no tax cost to Nevadans. The plan will be paid for by the premiums that people pay into it. This bill also enables the state to maximize federal funds flowing to Nevada (through a federal program for health care innovation). It aims to use the extra funds to provide people with even more premium and other cost relief. 
  • By requiring providers and hospitals that participate in other state networks — like Medicaid, the public employee benefit plan, and workers compensation — to also accept one of the public option plans, people will have access to a robust network of providers. 
  • Providers will be paid at rates at least equal to those of Medicare. The bill also recognizes the unique role of safety net providers (e.g. critical access hospitals, federally qualified health centers, and rural health clinics) and requires these providers to be paid reimbursement rates that are comparable or better than their rates established under Medicare. The bill’s payment rates help level the playing field for providers statewide, especially for smaller and/or independent providers, which often lack leverage to negotiate a better deal with insurers. 
  • As previously uninsured people enroll in coverage, providers and hospitals will also see less uncompensated care and new incoming payments. 

The bill establishing the Nevada Option (SB420) includes a host of additional provisions to make insurance better and more affordable across the state. These include improvements to care for pregnancy under Medicaid — changes like extending coverage for new mothers and improving access to community health workers and doulas. The bill also requires the establishment of a statewide Medicaid managed care program, aiming for coverage improvements for all low-income Nevadans.

Federal Action Begins 

In the days after the Nevada State Senate’s vote, federal efforts toward a public option emerged with renewed vigor. Right before Memorial Day, the Chairs of the House Energy & Commerce and Senate HELP Committees recommitted to developing national public option legislation.

We’ve seen over and over again that innovative policy change almost always begins at the state level. Congress now has the opportunity to apply the lessons states have learned as they’ve worked on their own public options. The Committees have asked for just these sorts of feedback and lessons from stakeholders by July 31, 2021.


Nationwide, people are deeply concerned about their health care costs and are seeking affordable, dependable coverage that can support them through life’s changes. With public health insurance options, like that passed by Nevada’s legislature, garnering broad support, we are proud to celebrate our coalition partners — and excited to keep fighting for affordable, accessible, and more-equitable health care.