State law stays in place even as U.S. rules have changed

In some ways, the Affordable Care Act doesn’t resemble the bill that passed in 2010.

The Obama administration has made more than 30 changes to the law, issuing executive orders that delayed the employer health insurance mandate, suspended a tax on high-dollar “Cadillac” coverage, and put off the launch of the Small Business Health Options Program.

The Centers for Medicare and Medicaid Services has made its own tweaks, most notably deciding in March that small businesses and individuals could keep noncompliant health insurance policies through 2015, two years longer than the law initially allowed.

But insurance professionals lament that a state law has taken away Nevada’s ability to benefit from federal orders that blunt the Affordable Care Act’s effects.

Brokers and attorneys met recently with officials of the state’s Insurance Division to discuss the federal rule extending noncompliant policies, only to hear that Assembly Bill 425, passed in June 2013, is firm: All Nevada plans — no exceptions — must comply with Affordable Care Act’s underwriting mandates as of Jan. 1. AB425 has no wiggle room, even though the feds have changed the rules.

“We were saddened to see that the Nevada Legislature inked a bill that had no flexibility to allow federal changes in the Affordable Care Act to be reflected in small-group or individual policies,” said Frank Nolimal, a broker with Assurance Ltd. in Las Vegas.

To address the issue, Chamber Insurance and Benefits, the insurance brokerage that runs the Metro Las Vegas Chamber of Commerce’s group plan for members, has hired a prominent insurance industry attorney and lobbyist to study the law for potential loopholes, although there may not be any workarounds to find.

Another option — although unlikely, brokers say — would be to seek a special session so the Legislature could rewrite the law to allow grandfathering.

Without changes, 100,000 Nevadans who bought plans individually or through a small-business employer could face double- and triple-digit premium hikes this summer and fall, Chamber Insurance and Benefits President Bill Wright said.

Brokers continue to work with state officials in an effort to massage the law. Gov. Brian Sandoval’s office has asked brokers for a report on expected rate increases facing the chamber’s 1,700 insurance members, Nolimal said. A builder’s association in Reno may also share rate jumps its members are seeing, he said.

Several Western states, including Arizona, Utah and Colorado, already have agreed to federal grandfathering guidelines, Wright said. If Nevada fails to do the same, employees of small businesses will pay more for less, he said. And those costs could pass through to employees.

One small company with nine younger, male employees is paying $1,000 a month for a plan with a $500 deductible and 20 percent copays. The same coverage will cost $1,500 a month come renewal time in fall. The only way to get those premiums back down to $1,000 will be to kick up deductibles to $1,000, and boost copays to 30 percent to 40 percent of costs, Wright said.

“This is going to have a huge impact on Nevada,” Wright said. “Do businesses make fewer capital improvements because their health insurance costs double, or are they able to absorb that? Instead of increasing costs, are they forced to pass those costs on to employees? That’s what a lot of businesses are doing.”

■ We’re getting a number of emails from people who wonder how the exchange board’s May 20 decision to drop contractor Xerox will affect their ability to sign up for coverage.

We’ll start with the basics. It’s after May 30 and special enrollment has ended, so you’ll have to wait until the next open sign-up period to buy a plan through the exchange’s Nevada Health Link website. It’s not a short wait: Enrollment doesn’t launch again until Nov. 15.

You could be eligible to buy sooner if you have what’s called a qualifying life event, or a situation that changes your residence or your dependent status. That means marriage or divorce, a new baby or relocating. If you lose your job, or your employer drops coverage, that counts, too. And if income changes affect how much federal premium subsidy you qualify for, you could buy before open enrollment.

If you do need to buy before November, nothing will change at Nevada Health Link. Xerox is managing the site until Nov. 14, at which point the state exchange will begin borrowing eligibility and enrollment functions from the federal system. In the meantime, Xerox’s call center and website functions will operate uninterrupted.

Don’t forget: The only reason to buy coverage through the exchange is if you qualify for a federal tax credit that helps cover the cost of your premiums. If you make too much for the subsidy — more than $46,000 a year for a single and $93,000 a year for a household of four — then you can buy coverage off the exchange at any time.

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512. Follow @J_Robison1 on Twitter.