CARSON CITY - It's a rare occurrence that a governor calls a federal law "unconstitutional" one minute and advocates implementing that same law a minute later.
But that's what happened earlier this week when Gov. Brian Sandoval called for Nevada to move forward with creating the Nevada Health Insurance Exchange, one of the mandates under the Obama administration's 2010 health care bill.
"I firmly believe that many aspects of the law are unconstitutional, and I will continue to fight to have them overturned," he said during his State of the State address, alluding to his support of Nevada's lawsuit to overturn the federal law. "In the meantime, however, the law imposes many deadlines, and we cannot wait until litigation is resolved."
The Patient Protection and Affordable Care Act's first deadline requires states to establish a health care exchange, which is basically a one-stop shop for purchasing health insurance.
"A lot of people will come to us through the exchange," said Chuck Duarte, the Department of Health and Human Services administrator overseeing the team crafting Nevada's exchange. "What we hope happens is that the exchange becomes the primary portal, the primary shopping experience."
Duarte said earlier this month that it will be like Travelocity.
Sen. Steven Horsford, D-Las Vegas, said during a budget hearing today that he "would have picked Expedia," noting that it is a Nevada-based company and evoking laughs around the room.
To use the exchanges, Nevadans would provide relevant data to the state, and the software behind the health care exchange would find that person's best options for health care insurance coverage. It's similar to how someone can enter departure and arrival dates and times, preferred airlines and price ranges at sites like Expedia and Travelocity to find the best deal.
The governor is pushing ahead with a $500,000 general fund request to create the exchange. That's on top of a $1 million federal granted awarded to Nevada this past summer.
If the state cannot submit a comprehensive plan by Jan. 1, 2013, the federal government steps in and creates the exchange for Nevada.
The law mandates that the exchange needs to be up and running by 2014.
These two deadlines leave this upcoming legislative session as the window during which lawmakers will most likely approve the creation of the exchange.
Substantial challenges face the implementation team as they hurry to meet the deadline. First of all, the state needs to create the back-end computer programs for the exchange. They will also need to find funding for the exchange, which must be self-sustaining by 2014.
Finally, the state basically has to set up a business. State officials will need to decide who runs the shop and how big the shop needs to be.
"It needs to be nimble," Duarte said. "It can't be hampered with a lot of excessive regulatory, civil service requirements. ... It needs to be structured more like a private, business enterprise."
To that end, Nevada has two options. Sandoval could ask for the creation of a new state agency or a new division within an existing agency for the sole purpose of administering the exchange. Otherwise, the government could create a not-for-profit, quasi-state agency that would run the exchange.
But once the structure is set up, its leaders will have to decide how big the shop needs to be.
"We don't know if this is going to be the size of a bread box or a freight train," Duarte said.
Duarte's team can use the federal law's implementation schedule as a rough guideline for demand. In 2014, the controversial individual mandate begins to impose penalties for being uninsured. That same year, the law will expand Medicaid coverage.
Still, how many people will coming running to the health exchange come Jan.1, 2014 is anybody's guess. Of course, some would argue that the question is moot.
Las Vegas attorney Mark Hutchison joined other states in a lawsuit against the health care law under former Gov. Jim Gibbons. Now he has Sandoval's blessings.
That case is still working its way through the Florida court system. Twenty-six states have joined in the lawsuit.
The courts may rule that the law is indeed unconstitutional, but for now Nevada is pushing forward to meet implementation deadlines.
"Nevada will comply with the law until it isn't the law," said Mike Willden, director of the state's Department of Health and Human Services.
Officials from the agency will host four public meetings Wednesday, Feb. 2, in Carson City, Las Vegas, Elko and Reno to both inform citizens about the exchanges and to elicit response regarding how best to structure to exchange.