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Las Vegas health systems continue to focus on smaller expansions, adding towers to existing campuses and building out unued space. The market's physicians will be left out of Optum's purchase of DaVita Medical Group because of Optum's strong market position. Centene has quickly grown into a market player through health insurance exchange and Mediciad business. The 2019 legislative session could improve Medicaid reimbursements and the possible return of a Medicaid-for-all proposal.