Nevadans pay more now and later

Last December, Gov. Brian Sandoval became the first Republican governor to expand Medicaid under the Affordable Care Act. This October, the state unveiled its Obamacare website, Nevadahealthlink.com. Nevadans pride ourselves on being self-reliant. With Medicaid expansion, we are jumping over the cliff of increasing debt and dependency on the federal leviathan. You don’t have to love Ted Cruz to see that Nevada cannot rely on the federal government to keep its promises to reimburse us for new patients for long. Sandoval will not be governor in 10 years, but whoever is will have to bear the costs.

The Supreme Court gave Nevada the opportunity to forgo expansion, but that is now lost. There is no provision in current law to opt out once you opt in.

By creating a state-run exchange, Nevada has punted on joining lawsuits challenging whether federally run exchanges qualify for subsidies. While state-run exchanges appear to function better than the train wreck that the federal government’s website has been, it is still too early to call them successful. And now Nevada is actively pushing for people to sign up for an inferior product. Nevadans are already feeling sticker shock. According to the Nevada Policy Research Institute, a single, 25-year-old Nevadan would need to pay a monthly premium of at least $184 to be ACA-compliant. Before the ACA, coverage would be $85.

The governor claims that the Medicaid expansion will amount to 70,000 newly covered individuals. But critics believe it will be at least twice that many. When was the last time you saw a government program that came in under its projected costs?

Isn’t it a good thing to provide health insurance for the poor? Perhaps, but not with Medicaid. Let me explain.

Medicaid is a cruel bait and switch for many people. The number of doctors who are refusing to accept new Medicaid patients is expected to reach over 40 percent. Dr. Annette Tiejeiro, state coordinator for the Nevada Chapter of the Association of American Physicians and Surgeons, says, “Medicaid patients are usually the most demanding, least compliant, the most litigious, the most labor intensive in workforce costs—heck, the regulatory red tape is exhausting—and yet the lowest reimbursed.”

Insurance is not health care. Canada’s single payer system is illustrative. Sure, if you break a leg in Canada, you will be treated for no charge. This obscures the problems with doctor shortages, and other supply problems leading to long waiting lists for more complicated procedures. Many in Canada live with unnecessary pain or even die waiting for treatment that is months longer in coming than in America—at least for now.

Medicaid increases unemployment. Many on Medicaid will not work for fear of losing coverage. Like many government entitlements, Medicaid can limit the standard of living and keep clients in kind of a roach motel. Like the states who have expanded Medicaid, many will find once they check in, they can’t check out.

Medicaid does not provide medical care that produces measurable outcomes. Many studies have concluded that Medicaid patients are no better off than the uninsured in measurable health outcomes. The primary benefit of Medicaid is a feeling of security you will not be bankrupted by medical expenses. The free market approach of medical savings accounts coupled with catastrophic health insurance provides the same feeling, while actually lowering medical costs. Even if you want the government involved, there are ways to provide security from catastrophic medical occurrences without stiffing doctors or creating more trapped government dependents.

As libertarian humorist P.J. O’Rourke once wrote, “You won’t know how expensive health care really is, until it’s free.”