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September 23, 2014

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Carson City Memo:

Health care changes haven’t caused uproars in Nevada like they have in other GOP states

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Nevada Gov. Brian Sandoval delivers the State of the State address at the Legislature in Carson City on Wednesday, Jan. 16, 2013.

Republicans nationwide are assailing President Barack Obama for the deeply flawed rollout of his health care law.

But that campaign is muted somewhat in Nevada, where Republican Gov. Brian Sandoval has expanded the federal-state Medicaid program and has embraced a state-based health insurance exchange marketplace to serve about 600,000 uninsured Nevadans. Both programs are tenets of the Democratic president’s health care law.

Nevada Democrats were happy with the decisions, and most Nevada Republicans have been mum — with the exception of former Senate candidate Sharron Angle, who led protests against Sandoval’s exchange this month.

Such proposals have been controversial in other states with Republican governors. But Nevada is an outlier in both the decisions Sandoval made and the political comity surrounding his decisions.

New Mexico Gov. Susana Martinez is the only other Republican governor to have fully implemented both the Medicaid expansion and a state-run health insurance exchange, according to the Kaiser Family Foundation, a national nonprofit focused on health policy.

In other states, wealthy conservative groups have pilloried Republicans who have embraced the Medicaid expansion.

Republican governors in Ohio and Florida faced political fights in their attempts to implement the Medicaid expansion, which widens eligibility requirements for the government-run health care program for the poor with the federal government eventually paying 90 percent of the cost for the expansion and the states picking up the balance.

No such fights happened in Nevada. Legislators passed the exchange and Medicaid expansion bills without much debate.

“It definitely flew under the radar screen,” said Chuck Muth, president of conservative advocacy group Citizen Outreach.

Democrats and Republicans largely agreed on matters of health care, meaning there was little controversy to make headlines.

Now, though, it’s more difficult to criticize Obamacare at a state level.

“It’s their Republican governor who has done this,” Muth said. “Republicans are stuck between a rock and a hard place. It really puts the (GOP) Party in a bad spot.”

But the buck stops with Obama with this federal law.

Sandoval has said before that he’s reluctantly going along the law of the land so Nevada will have more control of its own destiny.

“I opposed Obamacare from its inception,” he said in a press statement Friday. “However, when the U.S. Supreme Court upheld it, every state and every American was forced to abide by it. As a state, Nevada’s only choice was whether to let the federal government control the process or manage the process ourselves. We rightly opted for the latter.”

That strategy appears to have worked.

Nevada’s state-run health insurance exchange is working better than the flawed national website, healthcare.gov.

Unlike other Republican governors, Sandoval didn’t “make political hay” out of the questions of running a state-based exchange or expanding Medicaid, said Fred Lokken, a political science professor at Truckee Meadows Community College.

“My hat’s off to Gov. Sandoval, who showed a willingness to have a more independent spirit than what was expected from the party,” Lokken said. “I think that the governor who was elected to serve his constituency and the state of Nevada acted in what was in the best interest of Nevadans in both of those federal program instances, and as a result, there is no controversy.

"He’s also a remarkable Teflon governor who can do things without having it stick to him. His personal popularity with voters is just rock solid.”

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