End-of-year health-care rankings show Nevada's gradual improvement, still a long way to go

Nevada has been gradually making improvements to its health-care system over the last few years, but a couple of end-of-year health-care rankings show the state still has a long way to go.

The most noticeable improvement to health care in Nevada is the reduction of the state’s uninsured rate, which plummeted from 27 percent in 2013 to 15 percent in 2016 after the implementation of the Affordable Care Act (ACA). That dramatic drop was aided by Gov. Brian Sandoval’s decision to opt the state into an expansion of Medicaid allowed under the federal law.

The state has also taken steps to address its physician shortage with the opening of the new UNLV medical school and looking at opportunities to expand residency programs in the state to better train and retain doctors in the state. The governor has also prioritized addressing the state’s mental health needs and the opioid epidemic.

With an eye toward further improvements in the state’s health system, Sandoval was wary of congressional attempts this year to repeal the ACA without a viable replacement. He joined a bipartisan group of other governors multiple times over the course of the year to call on Congress to pass some sort of bipartisan health-care reform.

Congress’s decision to repeal the individual mandate, the least popular portion of the ACA, is expected to further destabilize Nevada’s health-care market, leaving more questions than answers to come in 2018.

Until then, read on for takeaways from a number of recent reports on the status of health care in Nevada and where the state stands headed into the new year.

Dramatic decreases in uninsured rates

A recent report from the Commonwealth Foundation found that, although Nevada has made significant gains in health care over the last three years under the Affordable Care Act, it still has a long way to go when it comes to catching up to other states.

Nevada’s rate of uninsured, non-elderly adults dropped drastically between 2013 and 2016, from 27 percent to 15 percent. That includes an 11-point drop in the uninsured rate for white adults, a 19-point drop for black adults, a 12-point drop for Hispanic adults and a 12-point drop for all other adults.

The rate of uninsured low-income adults also saw a 19-point percentage-point drop between 2013 and 2016. Nevada expanded its Medicaid program under the Affordable Care Act in 2014 to offer coverage to all individuals making up to 138 percent of the federal poverty level.

Nevada’s percentage of uninsured children also fell significantly from 2013 to 2016, from 14 percent to 6 percent. The rate of uninsured low-income children dropped from 20 percent to 9 percent over that time frame.

Still, Nevada hasn’t seen significant gains in terms of the percentage of adults who forego health care because of the cost. About 17 percent of Nevadans went without health care because of costs in 2013, compared to 15 percent in 2015 and 16 percent in 2016.

And Nevada still lags behind the national average in almost every category. The Commonwealth Foundation ranked Nevada 41st in overall access to care, with the state exceeding the national average for percentage of uninsured adults and children and adults who went without health care because of cost.

The state did, however, exceed the national average in one category. Between 2013 and 2016, 13 percent of Nevada residents had high out-of-pocket medical spending compared to the national average of 14 percent.

High number of drug deaths, violent crimes and low graduation rates

Nevada ranks 32nd in the nation overall for how it performs in several categories of behavioral determinants influencing health quality in the state, according to a recent report from United Health Foundation (a not-for-profit foundation arm of the health insurance company UnitedHealth Group.) The state ranks 49th for lowest high school graduation rates (71.3 percent of students), 42nd for number of drug deaths (20.8 per 100,000) and 32nd for physical inactivity (24.7 percent of adults).

The state performed better than a majority of states in four behavioral categories, though. Despite its “Sin City” reputation, the city came in only at 20th for excessive drinking (17.6 percent), 15th for binge drinking (15.8 percent) and 20th for smoking (16.5 percent). It also had the eighth best obesity rate of any state (25.8 percent.)

However, the state ranked near the bottom for its high violent crime rate — 678 offenses per 100,000 in the population — coming in at 48th. It also ranks 44th for poor mental health days and 39th for poor physical health days.

Other areas that Nevada ranks 40th or below in: suicide (40th), underemployment rate (48th), unemployment rate (44th) and access to vegetables (47th). The state is in the top 20 states for: seat belt use (9th), neighborhood amenities (14th) and income inequality (19th).

Nevada ranks well below national average on health policy decisions

The same report found that Nevada ranks 43rd in terms of its health-care policy decisions, which looks at its rate of immunizations and funding devoted to public health.

Nevada ranks in the bottom half of states in every immunization category except for children, where it came in at 24th. The state ranks 39th for number of vaccinations for the human papillomavirus (HPV) in females, 33rd for adolescent immunizations, 32nd for Diphtheria, Tetanus and Pertussis (Tdap) immunizations, 29th for meningococcal immunizations and 26th for HPV vaccinations in males.

Like the Commonwealth Fund report, the United Health Foundation notes that Nevada’s uninsured rate is significantly improved, decreasing from 13.8 percent in 2016 to 11.9 percent in 2017. But the state still ranks 44th for still having a high number of uninsured individuals.

To top it off, the state ranks 46th for access to primary care physicians (107.9 per 100,000), 30th for mental health providers (190.7 per 100,000) and 29th for dentists (52.9 per 100,000). It performs better than most states in preventable hospitalizations, coming in at 14th. It’s overall “clinical care” ranking is 35th.

Nevada comes in at 2nd for least number of salmonella cases and 8th for infectious diseases, outperforming most other states. It also ranks 6th for number of children in poverty, about 11.4 percent.

The state falls somewhere in the middle of the pool of states for chlamydia (27th) and occupational fatalities (27th). For air pollution, it comes in at 43rd.

Overall, all those factors contribute to the state ranking 35th in terms of overall health outcomes. Nevada ranks in the bottom half of states for: frequent mental distress (45th), frequent physical distress (40th), cardiovascular deaths (40th), diabetes (31st), and premature death (30th).

Story provided courtesy of The Nevada Independent www.nevadaindependent.com.