The Nevada Senate and Assembly have unanimously passed legislation (S.B. 440) to establish a health insurance exchange. The legislation went forward to Governor Brian Sandoval on June 4. It creates a Nevada Exchange governed by a Board of Directors consisting of five voting members appointed by the Governor, one voting member appointed by the Senate Majority Leader, and one voting member appointed by the Speaker of the Assembly. The Board will include three non-voting members representing the Department of Health and Human Services, the Department of Business and Insurance, and the Department of Administration.   The Board will be responsible for administering the Exchange, facilitating the purchase and sale of qualified health insurance plans, providing for the establishment of a program to help certain small employers in Nevada to enroll employees in qualified health insurance plans, and performing all other duties that are required of state-based exchanges under the Affordable Care Act (ACA).     

Nevada is one of several states acting on exchange legislation in recent weeks. Colorado Governor John Hickenlooper signed legislation (S.B. 200) on June 1 establishing the Colorado health insurance exchange.  Vermont Governor Peter Shumlin signed legislation (H. 202) on a state-based exchange on May 26.  Washington Governor Chris Gregoire signed such legislation (S.B. 5445) on May 11. Oregon’s legislature passed health exchange legislation (S.B. 99) on June 7. Hawaii passed such legislation (S.B. 1348) on May 6. Rhode Island (S. 0087A) and Connecticut (S.B. 921) recently passed legislation in their Senates.  These states follow California (S.B. 900 and A.B. 1602), Maryland (H.B. 166), North Dakota (H.B. 1126), and West Virginia (S.B. 408) which had already enacted such legislation over the last eight months.  
Many other states have drafted and vigorously debated state-based exchange legislation (Oklahoma, H.B. 2130; Virginia, H.B. 2434; Arkansas, H.B. 2138; Missouri, H.B. 609; and New Mexico, S.B. 68). States are also moving forward with exchange options analysis and planning under Executive Orders (e.g., Indiana, Georgia, and South Carolina). Massachusetts (Chapter 58, 2006) and Utah (H.B. 188, 2009) enacted legislation prior to the ACA, offering two distinctive approaches that have been widely studied. The ACA requires states to achieve certification of a state-based exchange under federal standards by January 2013 so as to be ready for full implementation in January 2014, and federal contractors will run exchanges in 2014 where certified state-based exchanges are not ready.   

PCG’s work on the Nevada Exchange, led by Bob Carey (PCG Health – Boston), has included a dozen stakeholder meetings, research on Nevada’s health insurance marketplace, discussions with Nevada carriers, planning the integration of the Exchange with Nevada’s Medicaid and Children’s Health Insurance Program (CHIP), planning and designing modifications to an eligibility system that will be the single point of entry for all related programs, and helping Nevada develop its Exchange establishment funding request to the federal government. The PCG health care reform team is also working in Alabama, Delaware, Tennessee, Rhode Island, Nebraska, and North Carolina.