In a Nevada-like scenario, private payers would continue to compete for Medicaid insurance lives as the state leverages aspects of the Medicaid program to reform commercial markets. Brokers would continue to sell group and individual market plans. Employers would continue to offer insurance, although fewer would likely offer over time given the tax advantages associated with qualified small employer health reimbursement arrangements.
Regardless of what scenario occurs, the broader industry trend of states engaging in thoughtful attempts to innovate amid difficult market conditions is one that will likely have broader impacts across the country. While the US health insurance system is unique in its reliance on the private market to facilitate and manage health care coverage, much of the regulatory construct of the market is still shaped by the federal government.