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November 23, 2014

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MEMO FROM CARSON CITY:

Nevada must confront decision of whether to expand Medicaid

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Gov. Brian Sandoval

Gov. Brian Sandoval threw cold water on the celebration of health care advocates for the poor last week by casting doubt on whether Nevada will expand its Medicaid program.

Sandoval cited the costs, which he said could eat into other budgets, like education.

But health care advocates said not expanding the system would save the state few dollars, compared with the money it would be giving up from the federal government. More importantly, they said, it would leave thousands of Nevadans without insurance.

So here’s the central question: Is expanding Medicaid a fiscally sound policy?

Before breaking down the numbers, here’s the background.

Under the Affordable Care Act, a central strategy for putting more people on health insurance was to force states to expand their Medicaid systems. Technically, the expansion was voluntary, but the federal government wielded a pretty mighty stick. If states didn’t expand their systems, their existing Medicaid money would be taken away — about $700 million for Nevada this year. That provision made the expansion voluntary in name only.

The U.S. Supreme Court ruled this approach unconstitutional. That sent the decision on whether to expand Medicaid back to the states.

Some states (led by Democratic governors) have said they’d accept the money and expand the program. Other states (led by Republicans) are hedging or expressing grave concerns about the expansion. Nevada falls in that latter category.

To be clear, no Nevada member of the Democratic leadership has come out explicitly for the expansion yet. Nor has Sandoval drawn a line in the sand.

Instead, both sides say they want more analysis.

“The governor does not intend to automatically accept the Medicaid expansion,” said spokeswoman Mary Sarah Kinner. She said the state, already under severe financial pressure because of the Affordable Care Act, must look at the costs and understand potential penalties.

No financial analysis has been done yet on what it would mean if Nevada opted not to expand.

But in 2010, the state’s Department of Health and Human Services did project how much the Affordable Care Act would cost Nevada: $574 million from 2014 to 2019. Most of that cost will be incurred regardless of whether Medicaid is expanded.

In 30,000-foot view terms, the Medicaid expansion would:

• Offer Medicaid coverage to about 100,000 additional Nevadans a month at its peak, in 2016.

• Cost the federal government about $1.18 billion in Nevada between 2014 and 2019.

• Cost the state about $63 million in matching funds and $133 million from the general fund for administrative costs.

But the Affordable Care Act would require much of that administrative cost regardless of the Medicaid expansion, according to health care advocates.

“We have to carefully analyze the situation for Nevada,” said Jon Sasser, an advocate for health care in Nevada. “I think when they do, we’ll find it’s a very, very good deal for Nevada.”

Geoffrey Lawrence, deputy policy director with the libertarian think tank Nevada Policy Research Institute, said the governor should not expand the program.

“Every dollar we spend on the Affordable Care Act is a dollar that can’t be spent anywhere else,” he said. “After several years of negative revenue growth, it’s pretty tough to say we should expand an entitlement program.”

The federal government would pay 100 percent of the medical costs for those newly eligible for Medicaid in the first three years. By 2020, however, federal funding would drop to 90 percent. It’s uncertain where the federal and state cost-sharing would go from there, Lawrence said.

“You have to ask whether the state can afford the burden in the long-term without knowing what that burden will be,” Lawrence said.

Making Medicaid more generous may not be up to the governor.

Kinner said it’s a budgetary decision. Expansion “requires legislation.”

That means the debate will continue through 2013.

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  1. Nevada must confront decision of whether to spend the money watching the Chinese Navy or provide supportive health care to promote the general welfare.

    Transplants aren't an option, but will Nevada recommend faith healing or modern science for general medicine? Will a person have to light the candles and fondle the beads or swipe their health care card and wait to be called?

    The answer to these questions will be on Nevada's virtual website for development. Without economic recovery, the Real Estate Market will wallow at the bottom for another 20 years or more and making sandwiches doesn't pay for health care.

  2. sgtrock...

    Tell us again how YOU begged and pleaded away your OWN MEDICAL BILLS, because YOU didn't have health care coverage, and how THAT should be the MODEL for health care coverage for the poor & uninsured/under-insured Americans...

    I believe you suggested that folks who can't pay their medical bills should do what YOU DID, and beg to have others pay them for you; like churches and charities.
    Tell us how that would work for the millions of Americans who need health care coverage, some of which are sick & dying RIGHT THIS MINUTE, but cannot afford proper care...

    That MAY have been when you were using jfnance32 as your screen name...not sure on that.

  3. There's a simple solution to this problem.

    All throughout recent history, Tea/Republicans focus only on money aspects of any issue. When the matter deals with the lives, health and welfare of people...compared to money...money always trumps the lives of people. Tea/Republicans HATE what they call "entitlements."

    Now here comes something that puts them in a quandary. They scream Constitutionality all the time. But now the Affordable Care Act is now deemed Constitutional, affirmed by the U.S. Supreme Court, the law of the land, but now Tea/Republicans are STILL against it and making up hokey excuses. Because they hate entitlements. They hate taking care of people. They hate spending money that they feel they should spend only on their purposes. Money is the ONLY thing to them. The lives of people here in Nevada. Eh. No big thing. They're expendable.

    Governor Sandoval is no different. He will pay lip service and say, oh, yes, sure, we need to do something. But in the end, he'll opt out and do nothing. Because he's hoping that if he does nothing, the Federal Government will come in and run the program. Then he will sit back and criticize every little thing they do. Which is stupid. Because that would have been avoided if he actually showed leadership and jumped onboard to manage it from the start for Nevada. He's more interested in pointing fingers and finding a scapegoat. In other words, he could care less about Nevada, its people and if this program is run right.

    People in Nevada need to wake up. Sandoval is not a moderate Tea/Republican. He's just the same as a Tea/Republican Governor from the Deep South.

    In short, he will kill off Nevadans through indifference, neglect and uncaringness. He's more interested in money than the health and welfare of the citizens that live here.

    Having said all that, the solution is easy.

    We need to get out from under this Tea/Republican Party warped view of the world that, as each day goes by, gets more and more selfish and greedy.

    Scorched earth policy. Get rid of all Tea/Republicans out of office.

    Hate to say it, but that's the only way Nevada can properly implement and effectively put in place the Affordable Care Act. The sooner we get rid of the bums, the faster we put Nevada on a road not only to help people, but also for cost savings further down the line.

  4. I believe the majority of Republicans need to have their vision checked as they all seem to be shortsighted. They are all about today and screw tomorrow. Good managers know how to see into the future and how actions today affect the future.

    Preventative care and catching illnesses early will save billions. Billions will be saved in supporting government subsidized hospitals (Clark County spent 64.8 million on UMC for uninsured medical costs of poor people). Employee sick time will be reduced saving billions in productivity. The list is endless but the true savings is difficult to quantify without moving forward.

    Many point to polls showing the majority are against ACA. But when you ask them WHY are you against it...half state they would prefer Medicare for all. So in reality while the ACA is unpopular, the reasons vary greatly.

    Search through old newspapers in 1965 when Medicare was created and you will find the exact same fear mongering from Republicans. They were wrong then and they are wrong now.

  5. Finally some coverage. I'm not sure we have any specifics on whether you can later opt out if a State opts in for say 5 years. Why are the administrative costs so blessedly high? And we don't even have nurses or pa's as first contact to resolve numerous "medical" issues for those who don't know any better--dispense hygiene, common sense, determine when something is critical. If we're gonna pay for every person who wakes up and isn't feeling real good today, we're all headed for insolvency. The way to trim health care costs is NOT to pay more to insurance companies--the way is to seek treatment only when it is needed. It is such a shame that American adults who have worked and supported this country for decades are turned out to pasture in pain and without consideration--just so every confused teenager who can't figure out how to support herself (or himself) can get free everything from the government.

  6. Nice to see Gov. Sandoval Crunching Numbers, however not a word is ever mentioned about Morally forcing 100k people to use the Hospital System (The Most Expensive Option to the State) or ethically margionalizing a population as undeserving of medical care because they are Poor.
    In Gov. Sandovals Play to be a National Figure, we'll see how large of a Republican Hack he really is.

  7. What about the millions of mostly young people who can afford insurance but refuse to buy it, right? You know, the lazys (Republican word for em) who drive cars, go skiing, or just plain get up everyday and live life. And if and when the accident happens, the ambulance will still show up, the E R. will still service them, the hospital will admit them, the pharmacy will dispense to them and the bill will be TENS OF THOUSANDS OF DOLLARS that you and I have been footing until WE can't afford it anymore...yes Republicans, THOSE lazys! I'm tired of paying for them. And you, my Republican friends, are always the first to scream about personal responsibility!

  8. Silly wabbits. It's a TAX not an ENTITLEMENT. We now have a National Health Tax; I want National Health Care. You can piss and moan but the thought of repaying and limiting Medicaid participation is laughable. Bob, you are a SURrealist. However, I do note a self exemption for yourself in your own post. How specious.

  9. Bob, the costs to collect "repayment" of benefits would exceed the amount collected--just ask Division of Welfare what it costs to collect fraudulent payments. But I like the idea of public notice / lien on recipients so that the few who win a lottery actually pay something back.

  10. howdy: So how about enabling and insisting law enforcement collect those ER bills from the young people who have accidents AND the illegals ripping us off at UMC? Any reason we can't have that legislation in addition to whatever the federal government decides to do?

  11. Medicaid needs to be converted to a consumer-driven or patient-driven health plan without insurance premiums. The State of Nevada has saved millions by putting employees on a consumer-driven plan. This is where the consumers / patients get preventive care and major medical assistance but pay their own way, or serious co-pays, for running to an MD or RX for every sniffle. Costs come way down when you "have some skin in the game", where you pay a price for neglecting your health, for being careless, for not using common sense.

  12. mred: those going to UMC with major problems are often illegal invaders--arrest and deport. Do NOT buy them insurance.

  13. We should all refrain from criticizing this law and work together to fix the apparent issues it creates for our State. Thousands of Americans file for bankruptcy each Month due to high cost of medical care. No law is perfect but it can always be amended and improved. Parents should not have to face a decision between selling their home and providing the best chance for their child to get better. Many older Americans suffer complicated illnesses requiring multiple tests and physicians. If given the chance, many of us would sign a law suit against any medical clinic if it would be in our best financial interest even if the discomfort would be resolved with an ice pack and time. Undocumented workers do use the emergency rooms placing strain on many Hospitals but a $6,000.00 ER visit is hardly the reason our current health care system does not work. I don't like President Obama; I don't think we have money growing out of our ears but I'm tired when the only legitimate reason to complain is that YOU or YOUR political party didn't come up with the solution first. We should be ashamed for turning the spirit of America into some 1930's Hitler's propaganda and campaign of "It's not our fault! Blame the (fill in the blank)". Brian Sandoval is a good governor. It's not an easy job to run a State government when the solution is for all of us to pitch in and having nobody wanting to give up anything.