An unhealthy veto
Nevada had a chance to lead the nation in health care access last week, but it was not to be. Gov. Brian Sandoval’s veto of the Legislature’s “Medicaid-for-all” bill disappointed progressives across the country who have longed for a public option for health insurance since the formative days of the Affordable Care Act.
The Nevada Care Plan would have allowed any Nevadan to purchase health care through the state-operated Medicaid program. Advocates affectionately nicknamed the concept “Sprinklecare” after its primary sponsor, Assemblymember Mike Sprinkle, a Washoe County Democrat and chair of the Assembly Health and Human Services Committee.
Nevadans could have taken advantage of the prices negotiated by Medicaid for its hundreds of thousands of enrollees. While others, most notably Senator Bernie Sanders, have touted Medicare-for-all as a public option, no other state has pursued opening up their Medicaid program to everyone. As a reminder, Medicaid is the public insurance program originally designed to assist the poor and disabled, while Medicare is public insurance for those 65 years and older. Both programs were enacted by Congress in 1965.
Sprinkle told the Los Angeles Times that the Nevada Care Plan would fill a vital gap if Republicans in Congress carry through with their threat to replace the Affordable Care Act with the most decidedly unaffordable Affordable Health Care Act: “It’s the responsibility of government to be more involved in providing adequate healthcare to its citizenry. So we spit-balled some ideas around and came up with this: The one package people are highly pleased with is Medicaid. Let’s mirror that.”
I’d argue with the “highly pleased” rating for Nevada’s Medicaid program, which offers the bare minimum of services. Other states have exercised options to improve coverage, expanding the state’s commitment to the program. Also, Nevada’s Medicaid program struggles to find sufficient providers who will accept Medicaid patients in a timely manner due to low reimbursement rates. Nevertheless, for someone with no access to affordable health care, Medicaid is vastly preferable to being uninsured.
The bill would have required the Division of Insurance to conduct an actuarial study to determine how many people might buy in and what the average premium would be. Hospitals and other large providers might balk at the low Medicaid reimbursement rates when compared to private insurance, but, again, when compared to zero reimbursement rates, Medicaid keeps the hospitals running.
Although Sandoval cited the “uncertainty” the bill might create in an “already fragile health care market,” the real reason for the veto is probably concerns from private insurance companies that the plan would offer Nevadans more health care coverage at a lower cost, providing evidence that a single payer health care plan is more efficient and effective in terms of cost and health outcomes. Nevada would have become the test laboratory for a nationalized health care plan for the United States, a model utilized by every other industrialized country in the world. If it succeeded, other states might do the same, leaving commercial carriers with a much smaller share of the market.
Sandoval is clearly worried about the stealth health care reform plan being rushed through Congress this summer with no public hearings or debate. He signed on to a letter objecting to the plan passed by the House because it “fails to provide the necessary resources to ensure that no one is left out, while shifting significant costs to the states.”
Meanwhile, the Senate is secretly preparing their own plan to repeal and replace Obamacare even though the House version is wildly unpopular everywhere. One meta-analysis of current polling data shows that just 28 percent of Nevadans approve of the AHCA, knowing that millions will lose their health care and rates for everyone else will likely rise.
Sprinklecare may be back before we know it.