Health care remains one of the largest expenses for individuals across the United States. This week, KFF Health News reported that many Affordable Care Act (ACA) customers now facing sharply higher premiums are unsure whether they’ll be able to keep paying for coverage throughout the year. It’s another blow to our already wobbly public health system.
For Nevadans with chronic conditions — mine is asthma — the stakes are even higher. We don’t have the luxury of choosing the least expensive ACA bronze plans. Managing complex conditions requires multiple primary‑care and specialist visits, costly specialty prescriptions and the occasional urgent or emergency room visit. These aren’t optional; they’re lifesaving.
While commiserating with another Nevadan about the difficulty of securing a specialist referral under an ACA marketplace plan, I learned something astonishing later verified by Nevada’s Division of Insurance: Nevada’s health exchange offers zero Preferred Provider Organization (PPO) medical plan options. That discovery led me to write a recent Nevada Current column outlining some of the policy failures that created this gap.
But the consequences extend far beyond individual patients. Nevada’s lack of PPO options is also an economic liability. It undermines our workforce and makes the state less attractive to entrepreneurs and small businesses. HMOs and EPOs — Nevada’s only medical insurance marketplace options — are narrow‑network plans that restrict specialist access, severely limit out‑of‑state care and require primary‑care gatekeeping. They consume time, delay care and create administrative hurdles that busy workers and employers can’t afford.
Where businesses choose to locate is shaped in part by the availability of robust, flexible health insurance. Nevada is putting itself at a competitive disadvantage. PPOs, which allow for out-of-state specialists, are the gold standard for remote workers and those who travel frequently.
Yet this economic dimension was lost on one of the state’s most influential lawmakers, Assembly Majority Whip Howard Watts. In response to calls for Nevada leaders to revisit the lack of PPO options, he offered a dismissive comment on X: “FWIW – Nevada legislators don’t get a premium subsidy for the state health plan, so most aren’t on it. It costs $885/mo to cover ourselves and $2083/mo for family coverage. I have a bronze public option plan from the exchange instead.”
Assemblymember Watts has access to a choice his constituents do not. $885 for a state plan with broad networks, age-neutral premiums, and coverage that doesn’t trap me in a narrow geographic corridor sounds like a great deal. My current 2026 individual HMO plan premium is $1,596.
At 38, he pays far less for his exchange plan than constituents one or more decades older. According to Salusion’s 2025 Nevada Small Business Health Insurance Snapshot, a 30-year-old pays an average of $356 per month for a bronze plan. A 60-year-old pays $851.
A more constructive reply from a member of the Jobs and Economy Committee would have been: “No PPOs on the state exchange? We need to look at this and see what can be done to change that.”
To his credit, Watts was one of the few legislators who publicly acknowledged the issue at all. And because he has the platform to influence his colleagues, I hope he’ll take a second look and help champion the policy fixes Nevada needs:
Require insurers to offer at least one PPO medical plan on the state marketplace
Strengthen network adequacy rules so HMOs cannot rely on distant or inaccessible providers
Create a public‑option PPO medical plan, as Washington State attempted
Join multi‑state compacts to expand network reach in rural areas
Incentivize carriers to reenter the PPO market
These are not impossibilities. They are policy choices.
Nevadans deserve a marketplace that offers real options, supports public health, and strengthens — not weakens — our economic future. As the state prepares its next legislative agenda, leaders must decide: Will they continue to ignore this PPO gap, or will they provide constituents with the same quality of care options available to themselves before another year of narrow networks and rising costs is locked in?
Pamela Mahoney Tsigdinos writes about policy, governance and how public‑sector decisions affect Nevada’s economy and residents.
NV exchange lacks PPO plans, raising health, economic risks | Opinion
