Gov. Brian Sandoval said today he decided to expand the state’s Medicaid system in part because of the importance of getting health care to thousands of Nevadans who don’t currently have it. Although he said he remains opposed to the Patient Protection Affordable Care Act, he added he wasn’t going to turn away nearly 80,000 people based only on “principle.”
“As the governor, I have to deal with the reality of what’s in front of me,” Sandoval said in a meeting with the Review-Journal editorial board. “I have to make decisions that affect real lives. And I have to build a real budget.”
Sandoval repeatedly stressed that the state’s Medicare system would likely have seen nearly 90,000 new patients regardless of whether it was expanded, as currently eligible people signed up to avoid the tax penalties contained in the Affordable Care Act. The federal government will pay 63 percent of the medical costs for those patients.
But Sandoval’s decision to expand Medicare to people with incomes up to 138 percent of the federal poverty level — an additional 78,000 Nevadans — will actually save the state money, the governor said. Not only are the medical costs of these newly eligible people covered at 100 percent by the federal government, but mental health patients currently in the system can be shifted into the federal portion of the program, saving the state more than $16 million it would otherwise have had to pay from its general fund.
Politics on the horizon
Sandoval acknowledged one problem with the expansion — there likely won’t be enough doctors to treat all the new patients who will be seeking primary care. He said he would seek to expand scope of practice rules and enhance medical license reciprocity with other states to immediately allow more doctors to practice in the Silver State. “We definitely have identified that [reciprocity] as a method,” he said.
The Medicaid expansion will undoubtedly be popular with Democrats, but two parts of the governor’s plan may cause concerns. First, Sandoval wants to impose a small co-pay requirement on Medicaid patients — he said between $2 and $10 — to recoup some costs. And he wants to increase the exemption under the state’s Modified Business Tax (aka the payroll tax) to allow small businesses to better afford taxes they’ll be assessed under the Affordable Care Act.
Republicans, for their part, embraced Sandoval’s move. “Ensuring that poor Nevadans have access to primary health care through Medicaid is very simply the right thing to do, both for our citizens and our economy,” said state Senate Minority Leader Michael Roberson, R-Henderson. “It will reduce our rate of uninsured and provide individuals with greater economic security.”
A Republican Senate news release said the GOP supports the cost-sharing co-pay idea, but also included a proviso that might not go over well with Democrats: a sunset on the expansion if the federal reimbursement ever drops below 90 percent. (Under the Affordable Care Act, the federal government will pay a sliding scale of medical costs that starts at 100 percent for the first three years, but drops to 90 percent by 2020. How much of the cost the federal government will contribute beyond that is uncertain.)
U.S. Sen. Harry Reid — who previously said it would be foolish for the governor not to expand Medicaid — praised Sandoval in a statement Tuesday, shortly after news of the governor’s decision broke via the Associated Press. “This is wonderful for the people of Nevada and for the thousands of Nevadans who now will have health care,” Reid’s statement reads. “I commend Gov. Sandoval for taking this bipartisan step. This is a win-win. It will save the state money, is good for the economy, good for employers and most importantly will help people.”
Sandoval said the political impacts of his decision didn’t enter his mind, nor did the actions taken by fellow Republican governors. (Sandoval is the first GOP governor to announce an expansion of Medicaid in his state.) “I’m the governor of Nevada. I’m going to do what’s best for Nevada,” Sandoval said.
He said he made his decision only after carefully studying the numbers, the costs and the state’s ability to pay going forward. He said he wasn’t influenced by liberal or conservative groups and their varied stances on the issue. “A lot of it had to really come down to what would be the fiscal impacts,” he said. “I talked to people. But it wasn’t like there were people pounding on the gates,” he said.