COMMENTARY: Public option dangers

Nevadans face a critical turning point that could dramatically alter the future direction of health care in the state for years to come. The Battle Born State Plan began on Jan. 1, putting Nevada on the brink of launching a government-controlled “public option” insurance scheme. It is essential to understand why this policy threatens patient choice and the long-term stability of health care for families across the state.

The state’s public option was created in 2021 through Senate Bill 420. Proponents claim it will expand access to health insurance by creating a new government-run program. But good intentions do not outweigh the law’s constitutional flaws and the significant risks it poses to patients, providers, and taxpayers.

From the perspective of state Sen. Robin Titus, a former family physician in a rural area, the challenges facing Nevada’s health care system are serious, from devastatingly low provider shortages to the rising cost of care. For its part, the National Taxpayers Union’s many advocates across the nation and in Nevada have long led the charge for constitutional tax and expenditure limits (including Question 11) as well as pro-taxpayer health care policy. That’s why we appealed to have the Nevada Supreme Court review the constitutionality of Senate Bill 420 — to defend fundamental principles that protect all Nevadans.

First, SB420 was passed without meeting Nevada’s clear constitutional requirement that any bill creating or increasing public revenue receive a two-thirds majority in both chambers of the Legislature. This requirement exists for a reason: to protect taxpayers. This safeguard was written into the state’s constitution to prevent unchecked fiscal expansions. SB420 plainly generates revenue, yet it ignores this clear rule.

Second, the law authorizes state officials to withdraw unspecified amounts from the public treasury without specific legislative appropriations. Article IV of our state constitution plainly states that no money shall be drawn from the treasury unless explicitly authorized under the law. SB420’s open-ended delegation of spending authority undermines both accountability and fiscal restraint.

Third, SB420 violates the separation of powers by delegating broad lawmaking authority to executive officials, without clear standards or legislative guardrails. Our constitutional framework exists precisely to prevent one branch of government from overstepping its bounds. This overreach bypasses the legislative process and concentrates unchecked power within the executive branch where it does not belong.

Beyond legal concerns, this policy would have real consequences for Nevada families. A one-size-fits-all, government-controlled plan will not fix these problems; it will likely make them worse. We’ve seen this time and again in every state that has implemented a public option. None has been successful. It won’t work in Nevada either. In fact, in the recent special session, the Legislature authorized $4.5 million in taxpayer dollars for brokers enrolling individuals in the Nevada public option system. Clearly, the public option is already raising costs for taxpayers.

We must ask ourselves: Do we want a health care system that empowers patients, rewards innovation and respects our constitution? Or do we want a system that expands government control without accountability?

The Supreme Court now has the chance to weigh in on this critical question. We encourage the justices to reaffirm that the Nevada Constitution matters, that laws must be passed correctly and that policies affecting millions of lives merit careful scrutiny before implementation.

Nevadans deserve a health care system that values freedom, choice and fiscal responsibility. This is why we have appealed to the Nevada Supreme Court to reject this unconstitutional, poorly designed policy proposal and protect our state’s health care system. Upholding our constitution is not just a legal obligation. It is the best way to protect patients, providers and taxpayers alike.

Dr. Robin Titus, a Republican, represents District 17 in the Nevada Senate. Pete Sepp is president of the National Taxpayers Union.