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twitterSticker shock: How the overhaul could exact a heavy toll on state finances
Feds may pay to cover many more with Medicaid, but state would have to chip in
Sunday, Sept. 20, 2009 | 2 a.m.
Chris Morris
Sun Coverage
Sun Archives
- Nationwide tour promoting health care reform ends in Las Vegas (9-18-2009)
- Desperate for insurance, residents share health care woes (9-18-2009)
- Harry Reid: Health care bill won't work for Nevada (9-16-2009)
- Grant to aid 400 waiting for Medicare (9-14-2009)
- Editorial: Lowering Medicare costs (9-2-2009)
- Medicare Advantage plans may lose federal cash (1-16-2009)
Washington — With a greater percentage of uninsured residents than most states, Nevada faces a key question arising from the health care debate: At what price is the state willing to expand its coverage of the poor?
Would the state pony up a nickel to gain an additional $1 in care if the federal government paid the difference? How about a dime? Or 18 cents?
For cash-strapped Nevada, it’s a vexing question — one that has set off a feud between the state’s Republican governor, Jim Gibbons, and its top Democrat, Senate Majority Leader Harry Reid, both of whom face tough reelection battles next year.
Under the health care bills before Congress, state Medicaid programs, which now primarily cover low-income children, parents, seniors and people with disabilities, would be expanded to include a new segment of the population — poor, childless adults.
The group makes up 21 percent of the uninsured nationwide, and a slightly larger share in Nevada. Many of them are poor, which the government defines as individuals making less than $14,400 a year.
With nearly 470,000 uninsured in Nevada and a soaring jobless rate adding to those ranks, uninsured, childless adults are a vast group. The state won’t hazard a guess at the number.
Under the legislation, the federal government would help states pay to cover them, but the states would have to chip in.
In Nevada, the money would come from the state’s sagging general fund.
One Washington estimate is that Nevada’s current $800 million Medicaid bill would grow by 5 percent, about $40 million annually.
Gibbons complains the feds are attempting to saddle the state with an unfunded mandate at a time when the tourism economy is in the tank and the state’s finances are in crisis.
Reid barked back that he is working to boost the federal share to Nevada — something he succeeded in doing this year and will likely be able to accomplish again.
Regardless, the state would have to pay more than it is currently. Hence the question: How much is too much for Nevada to pay to help cover its uninsured?
Nevada is a libertarian leaning state and has long avoided giving government a sizable role in health care. The result of that lack of government investment is that Nevada dwells at the bottom of national rankings on health care.
The state is in the top 10 for uninsured, with nearly one in five residents going without coverage — just eight states fare worse, according to the Kaiser Family Foundation’s statehealthfacts.org.
Nevada is ranked at the bottom for public assistance, sharing the cellar with four other states where just 11 percent of the population is enrolled in Medicaid, according to enrollment reports from the Centers for Medicare and Medicaid Services.
While other states have over the years pushed to expand Medicaid coverage by digging into state coffers to supplement federal contributions, “We’ve not, as a state, decided to do that,” said Charles Duarte, the state’s Medicaid administrator.
•••
Now, Medicaid expansion is at the center of the health care debate in Washington, where reform advocates see it as the simplest way to increase the number of people with coverage.
Both the House and Senate bills propose an expansion of Medicaid to cover those on the lower-end of the income scale as part of the new requirement that every American carry health insurance.
States have historically had great leeway to decide who is eligible for Medicaid as long as they cover the basics — children, pregnant women, parents, seniors, the disabled.
Nevada essentially offers the minimum program required — coverage for kids from poor households (income of no more than $24,300 for a family of three, and slightly less if the children are older), pregnant women (income below about $20,000), parents (income of no more than $16,600 for a family of three) and low-income seniors and the disabled.
Both the House and Senate bills would require states to loosen the income requirement, allowing those who make a few dollars more to qualify. The bills would also require states to cover that new swath of residents — low-income, childless non-senior adults.
Duarte won’t estimate how many childless adults earning less than $14,400 annually exist in Nevada — but he knows it’s a large number. High-rollers skew Nevada’s average income upward, but there are countless shift workers at casinos and mom-and-pop stores who are not covered by generous union health plans or company insurance policies and are not making much money.
Estimates put the number of uninsured childless adults under 65 in Nevada at 250,200, according to statehealthfacts.org. And 198,400 non-senior adults are classified as low-income.
Plus, Duarte worries about the “woodwork effect” — the estimated 70,000 Nevadans who are eligible for Medicaid but have not signed up and might come out of the woodwork once they are faced with the new requirement that all Americans have insurance.
The state saw a 9 percent jump in Medicaid recipients in fiscal 2009, which ended June 30, and because of the recession expects an 18.5 percent increase in fiscal 2010. That’s a lot of poor people needing health care.
“Huge,” Duarte said.
For the governor, nothing short of full federal payment would work.
“We can’t even afford our current coverage, much less an additional expansion of coverage,” said Stacey Woodbury, the governor’s deputy chief of staff. “We don’t have any money.”
Even if the federal government paid 100 percent of the costs, the state would still be wary, she said. “Will they pay it forever?”
But others see in that approach more of the same for a state that has historically lagged in caring for the poor and is suffering the consequences of that underinvestment — burdened emergency rooms and unpaid bills.
“Nevada’s Medicaid has always been one of the lowest funded in the country,” said Democratic Rep. Dina Titus, the former state Senate leader. If Reid can fix the formula to get Nevada a greater share, she said, “It’s worth looking at.”
•••
The House and Senate bills take a slightly different approach to funding a Medicaid expansion.
Currently, the federal government splits the Medicaid cost with Nevada 50-50. Some states with lower incomes get more federal help.
Under the House bill, the federal government would provide 100 percent — the full cost of covering the new category of childless adults — for the first two years. Then the federal share would drop to 90 percent by 2015.
That means the state would eventually have to pony up a dime for every new $1 spent.
Under the Senate bill, the federal government helps states with the toughest climb, those such as Nevada that are not currently offering much Medicaid. The feds would initially provide 87.3 percent when the law goes into effect in 2014, dropping down to 82.3 percent by 2019.
The bottom line: Under the Senate plan, the state would pay 13 cents to get $1 in expanded care now, and 18 cents on the dollar into perpetuity.
That’s a tall order for a state staring down a $2.4 billion deficit.
Duarte notes that the extra federal funding applies only to those newly covered by the program, low-income childless adults. For the woodwork-effect people, who could have been covered in the past but are only now joining Medicaid, the state would still be reimbursed at the 50-50 rate.
Assemblywoman Sheila Leslie, D-Reno, an early supporter of President Barack Obama and one of the state’s most liberal legislators, understands the state’s dilemma.
“One of the best ways to attack the high percentage of uninsured is to increase the number of eligible participants on Medicaid,” Leslie said. “But even if the state has to pay 10 percent of the cost, it’s going to be very difficult. We have no money.”
•••
A chart floating around Washington last week showed that under the health care legislation being debated in Congress, Nevada would have to increase its spending on Medicaid by 5 percent — the second highest increase in the nation. The average was 0.89 percent.
Reid called the increase for Nevada unacceptable and vowed not to bring a bill to the Senate floor unless the state got a better deal. “During this time of economic crisis, our state cannot afford to shoulder the second highest increase in Medicaid funding,” Reid said in a statement last week after the bill was introduced.
“I spoke to the chair of the Finance Committee and he assured me that this bill will be improved for Nevada before he takes it to the committee,” Reid said. “Let me be very clear, I will not bring a health insurance reform bill to the Senate floor that is not good for Nevada.”
Reid’s ability to address the problem is not overstated.
He made sure Nevada received the largest increase in Medicaid funding in the economic recovery act by changing the formula to consider states with high unemployment rates. Nevada’s jobless rate, 13.2 percent at last count, is among the highest in the nation.
The result was one of the unsung victories for Nevada in the recovery act. The state’s usual 50 percent match from the feds was temporarily boosted to 63.9 percent, bringing in an additional $125 million so far this year.
The Senate Finance Committee chairman, Sen. Max Baucus of Montana, confirmed to the Sun that various “senators have requests on Medicaid payments and we’re working with them.”
But even Reid’s clout is not likely to get Nevada a 100 percent match. Both House and Senate bills require states to chip in something. A nickel, a dime, maybe 18 cents on the dollar.
So the question now is: How much would Nevada be willing to pay to reduce the ranks of its uninsured?
Discussion: 41 comments so far…
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Obama told us he would not raise taxes. He did not tell us that our states would not have to raise taxes. All this free healthcare for those that cannot afford it, has to be paid for by someone.
This shouldn't be a surprise to anyone. Obama and clan are pathetic liars and the more time that passes without their reform passing the more America will learn.
When will people begin to understand what's hitting them upside the head, Obama and clan believe this is their time to pork American's over and get people even more codependent on the government. Their only goal is to create a country where working for a living is obsolete.
As you drive your communities look around and see the liberals, you can spot them, and they're obvious. They are the ones whining, complaining, and doing something they shouldn't be doing and getting away with it. If you're not sure what you need to look for then Google the highest crime rates in America and welcome to the land of Democrats.
THERE IS NO CONSTITITUIONAL BASIS FOR NATIONAL HEALTH CARE
The Tenth Amendment to the Constitution of the United States specifically provides that, "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people".
When Federal Politicians decided alcohol had to go, first an Amendment to the Constitution had to be passed to permit Prohibition.
By what authority does the Federal Government presume to take on Universal Health Care without first passing an Amendment? Providing health care is not one of the 11 enumerated powers of the Federal Government listed under general welfare!
WHAT STATUTE GRANTS FEDERAL GOVERNMENT AUTHORITY TO REQUIRE CITIZENS PURCHASE A HEALTH CARE POLICY
I have asked my US Congressman and US Senators to quote federal statutes granting them authority to require me to purchase a health care policy with after tax dollars. So far they have not replied.
If we the people allow this government intrusion, what will be the definition of disposable income? What other segment of the economy will demand government make us buy their product?
The Federal Government lacks authority to preach fiscal responsibility. Federal politicians have exhibited none in my lifetime and have reduced the wealthiest nation on the planet to world's biggest debtor nation.
It is instructive that during the decades America enjoyed great wealth the Federal Government expressed no concern for the plight of the uninsured!
Unemployment is 10% or higher and there is no free lunch. I challenge Washington to bring back and keep good jobs in the USA and there will be no uninsured problem! If they fail I am for Cap and Trade: hand the politicians there caps and trade them in for new ones!
Like the stimulus that was free money. Now the state unemployment system is broke and has to borrow against future tax increases.
The federal government will expand Medicaid and then require the state to divert funds from education and public safety to fund it.
I am from the government and I am here to help. They are so out of ideas they are just redoing old ideas with new names.
Go figure, Nevada is at or near the BOTTOM.
Maybe Gibbons should concentrate on one thing and one thing only! Getting illegals out of the State, if not the Nation?
If Gibbons could do this ONE thing, then maybe he could call himself our leader????
He will have to stand up against big business that "has to have" cheap labor; including the casinos; but if he has any fighter mentality at all or any desire to continue to be the Gov., time to be a "single seat" fighter pilot!
Obama Healthcare Bill will add 1 trillion to
the deficit. We are a bankrupt country already
and can ill afford more government, we already
have way too much & it isnt sustainable
Curious where all of these fiscal conservatives were during the run up to the Iraq war.
People should not throw manure on a windy day because the blowback is unpleasant.
Translated - "With nearly 470,000 uninsured in Nevada and a soaring jobless rate adding to those ranks,..."
Plain English - You may need health insurance coverage - soon!
sure pile on more taxes....liars! this present obama-reid- pelosi group has spent more money than the previous admministration in less than a year....
congratulations you have bankrupted this country and yes made the rich, richer.....
idiots...
Vote reid out in 2010 and obummer out in 2012!!!
Democrats: Bush ran up the deficit.
So.......we can do it BIGGER!!!!!!
We like what Bush did. He was a good example.
Go with that....go with that into the 2010 and 2012 elections.
Um, sorry to rain on your parade of delusional rants, but the Democratic proposals pending in Congress are actually paid for. They won't add to the deficit.
And Gibbons is being an immature crybaby. Medicaid costs have always been shared between the states and the feds.
Hey boingo, put down your bong and wake up to the real world.
I hate to say this but, "YOU LIED!"
Or you live in a permanent haze if you think that Democrat's health proposals will be paid for and not add to the deficit?
What do you base your statement on? Oh, the President told me so...
So let me get this straight - Obama wants to provide free healthcare to perfectly able (not disabled) adults that are capable of working. And those of us that get off our a$$ and work should pay for their free healthcare? I'm all for helping poor children and the disabled, but helping capable adults is bullsh|t.
Only tea bagging white trash are talking about free healthcare. Forcing employers to pay for healthcare is wrong.
Public option is the only answer.
Mr. Sun...one word...DUH!
Gov. Gibbons is not willing to pony up a single dime towards healthcare. He can't, we are broke. But also, this guy only care about Northern Nevadans. He had no problem taking money from Clark County and using it, yet he wasn't honest enough to propose tax increases himself.
Also, why did he come down and sign a contract to widen I-15 South? The Las Vegas Visitors and Convention Authority is paying for this. Why do Southern Nevadans have to pay for road projects? Because he wants to use State moneies to build and repair roads up north.
Public option is Nick's only answer.
His name calling is becoming quite rude.
He been talking quite crudely in regards to my mother.
I bet his mother is quite proud of the "Nick."
"He had no problem taking money from Clark County and using it,"
Uhhhh......It is the legislature that controls the budget and not the governor.
So if you are going to complain about that then you need to bitch on the legislature which is controlled by Democrats with many of them coming from Clark County.
Another proposed thieving socialist mandate of wealth redistribution deserving failure.
Like any other service offered in a capitalistic society, if you can't afford it i.e. healthcare, you don't deserve it.
Embrace the reality of capitalism for what it's always been -- literally, survival of the fittest.
: )
You can talk all you want about " who will pay their fair share ", " government run health care " and you can talk about politicians who got us into this " mess " but until you deal with the issue immigration and the " illegals " in particular, the subject of health care reform is a " pipe dream ". Politicians, or rather the people who have voted these " incompetants " in are the ones to blame. Let's start afresh America and begin with the person who has a " socialistic " agenda on his mind and oust him and his " minions " in 2012 if not sooner. You know Nevadans who I'm talking about!
"illegals" are NOT the problem. Uneducated low skilled workers demanding $14,000 EMPLOYER paid healthcare is the problem.
I dont blame employers one bit. I had an "undocumented" worker a few years ago that took 3 weeks off to get surgery in Mexico. He pays sales tax, property tax, gas tax and gets nothing in return.
Lazy american workers demand too much, Employers should not be forced to pay healthcare.
One worker six kids and a wife all get coverage? This is too much.
Look. It is simple. If you are paying in to the system you are going to be paying more after this is all over.
There will be winners and a lot of losers. From what I have read so far, doctors and hospitals are going to be big winners. A lot more "customers" are going to have coverage and a lot of deadbeats errrrrrrrrr, uninsured at the emergency department are going to have their bills paid in the future.
If these a**wipes in Washington could reduce "fraud and abuse" and save billions they already would have.
Let me give you an example of why medical care is so expensive:
A young, otherwise healthy woman passes out and is taken to hospital "A". She has a complete work-up and is found to be healthy and is discharged. No diagnosis is found after an MRI, CT scan, labs, EKG, brain wave test, consults by neurologist, cardiologist, etc. She just passed out.
Two days later she passes out again. Now she is in hospital "B". Guess what happens? Since you cannot get the test results from "A" you have to repeat all of the tests over again.
Another few days in the hospital, thousands of dollars of tests, etc. Of course she is uninsured and after the second complete work up she is diagnosed with panic disorder.
Total cost: Your soul.
Since you cannot get the test results from "A" you have to repeat all of the tests over again.
This is very common even with regular types of blood and lab tests. Quest is the worst. They will NOT send a copy of ANY test results to any other doctors even though it will say "send copy to Docotr B" on the original dr's reaquest form. I was told by Quest that Dr. B has to reaquest the tests him/herself. When I figured out their scam, I just get copies of everyting from Dr. A and send them myself to Dr. B, who doesn't really care for that but I don't want the insurance co. paying twsice for the exact same tests.
I agree with Nick that the uneducated, lazy, under-achiever workers shouldn't get the same employer health insurance for a family of 6 for the same co-pay and payroll deduction as people that have better jobs that require more expertise and responsibility.
BUT - don't most companies make you pay more for health coverage if you have a family of 6?
Don't know, I don't have a family of six...
But I do know that a "Bird in the hand is worth two in the Bush" Get it???
Nevadaapples, usually employee pay a small percent only.
That Baucus plan would mandate employers pay about 73%.
Imagine hiring a file clerk and being forced to pay for a huge family! We will need amnesty just to get payroll down.
yeah, I agree that it is bullsh|t. I am embarrassed to be an American with all of this proposed socialism which will basically penalize hard working Americans.
thanks a lot to the jack offs that voted for obama because they want a bunch of freebies that will build up debt
Perhaps all of you should look to Japan which, not too long ago, underwent a massive economic slide because of a large, aging population - their baby boom. Now look at what's emerging in the United States. It isn't necessarily just illegals that are the problem, nor is it necessarily lazy adults. You have a huge, HUGE baby boom population going into its elderly years. You don't think that's going to be a massive drain on our entire system? That's what happened to Japan, and it took them over a decade to finally start climbing out of it. I'm not suggesting we put the elderly out on icebergs to die; but I think you need to look at the much bigger picture and start figuring out how you plan to handle that.
CORPORATE GREED...has brought a lot of this on all of us...LIKE CASINO'S that seem to continue to build but rely on government to provide HEALTH CARE TO THE MAJORITY OF THEIR EMPLOYEES.
For quite some time now...it has become a regular pratice to hire employees and then reduce their hours to take away HEALTH CARE BENEFITS...Some even hire additional part time employees to lay off the Full Time Status...So why continue to blame just the GOVERNMENT...Perhaps the Government wouldn't have had to get involved with HEALTH CARE ISSUES IF Corporations had accepted their own responsiblities to conduct their businesses with INTEGRITY.
Well Well Well, looky here! Lets just see how many of the new jobs the CITY CENTER is offering
HEALTH CARE...Lets just see how many last until their PROBATION PERIOD ENDS and their Health Care Begins...LOL...POINT BEING...FEW WILL MAKE IT PAST PROBATION...and those that do will only have PART TIME STATUS...Now lets go figure JUST WHY THIS WILL BE?
CORPORATE GREED! Yet you all will continue to BLAME THE GOVERNMENT FOR THE LIABILITY OF THE UNINSURED. IF ONE CAN'T AFFORD TO TAKE CARE OF THEIR EMPLOYESS WHAT ASSINITY DO THEY PURPORT THEY SHOULD BE BUILDING CASINO'S?
For all those complaining about H.R. I would like to suggest you start surfing employment opportunities on all the CASINO SITES; then after you are convinced that the majority of postion are advertised PART TIME...BEGIN emailing all these CASINO'S with your obvious malcontent for the NATIONS UPROAR OVER HEALTH CARE REFORM...DIRECT YOUR COMPLAINTS TO THE REAL CULPRITS!
PUSH BACK THE BLAME WHERE IT BELONGS...CORPORATIONS THEN SHOULD START FIGHTING BACK with the INSURANCE PROVIDERS for an affordable plan to cover their employees. NEGOITIATIONS should have been between the GREEDY MONGERS in the FIRST PLACE! NO, instead everyone just past the problem onto the TAXPAYER AND THE GOVERNMENT is now held responsible to make it right for the citizens as well the working uninsured and poor. SOUNDS LIKE an issue of unethical business practices! QUIT RELYING ON THE MEDIA TO GET IT STRAIGHT...HAVE AN ORIGINAL THOUGHT to go figure this darn mess out.
Fox1 forgot to mention:
THIS HAS BEEN PAID FOR BY THE NICE PEOPLE AT SEIU....
Fox is nuts. It is not employers responsibility to provide you healthcare. man up and pay your own way loser.
$14,000 a year for healthcare plus wages? Are you nuts? These guys will go bankcrupt if they let low skill labor drain them. The money comes from customers and we aint paying more. Get a job get your own healthcare.
HEAH GOOFY NICK,,,I am certainly not what you professed...how about you stop hiring illegals to avoid your responsibility to our country.
and goofball...you more and likely didn't pay any employee min. wage...so how the hell could any employee of yours afford to pay for their own healthcare. Of course your employee had to go to Mexico to acquire his Surgery. Number one an ILLEGAL...Number two reason, he is only here to send his money back home anyway and many have to go across the borders these days to see a Dentist, Doctor so on. Seems Mexico isn't looking too bad these days to the illegals here.
Corporate America does not owe you medical care for life.
You are on welfare. Private welfare. Try pulling your own weight. We cant support you anymore.
Goofball Nick...I certainly do work, and not on government assistance. You should never assume others are lazy and corrupt as yourself. Per your own admission in a previous comment made states;
"I dont blame employers one bit. I had an "undocumented" worker a few years ago"
Very interesting info to forward on to the Governing Agency that investigates and fines businesses for hiring undocumented aliens. Paying taxes or not it's ILLEGAL!