Obamacare, Money and the Future of Nevada

Eight Supreme Court justices agreed that the Affordable Care Act has nothing to do with taxes, but Chief Justice John Roberts disagreed to tip the scales to 5-4 to uphold Obamacare, née Romneycare, over the frighteningly medieval dissent of four right-wingers. Now comes the question: What will the cost be for Nevada?

Answer: next to nothing, if the Legislature does its job.

Some of the potential benefits include making it easier for primary-care physicians to practice in poorer neighborhoods, since health insurance will be more available in those areas, and perhaps even wider-ranging residency programs and opportunities for University of Nevada School of Medicine students. Nevadans with pre-existing conditions will continue to have access to insurance they might otherwise have lacked, possibly reducing costs down the line. Businesses insuring early retirees will get help with their costs. Children up to age 26 can get insurance on their parents’ plan. Most of this has been around since the bill’s passage.

Gov. Brian Sandoval, who had been as sure of this measure’s unconstitutionality as he was of Arizona’s immigration law (he was a federal judge, after all), said the state may take advantage of the opportunity to opt out of expanding Medicaid. A statement from his office said, “These serious budgetary implications, including the impact on education spending, require further analysis—not just of the next biennial budget but of the long-term costs.”

So what are the costs? According to the state:

• About 49,000 more Nevadans probably will enroll in Medicaid, costing the state about $60 million in the next biennium.

• Another 20,000 uninsured children would add $11 million to state costs by joining the Nevada Children’s Health Insurance Program.

• Expanded Medicaid eligibility for those between ages 19 and 64 could add still another 72,000 to Medicaid, which the federal government pays for over the next two years, then passes on to the states. A 2010 state analysis showed this could cost $574 million over a 6-year period.

Republican Assembly leader Pat Hickey suggested $20-30 co-pays for recipients to offset costs. Meanwhile, Assembly Democrats appear to be folding up like a $2 suitcase, saying the costs may be too great, and we need to examine our options—at least Mo Denis, the state senate’s Democratic leader, said everybody needs to sit down and talk it over.

Sandoval already is playing a political game by suggesting that expanding Medicaid could cut into education. No new taxes, and all that. But here are a couple of suggestions for legislators:

• Nevada business leaders have been talking up medical tourism, thanks to the presence of the Ruvo Center and its connection to the Cleveland Clinic, and the Nevada Cancer Institute and its ties to the University of California, San Diego. Tony Hsieh may have some plans for downtown, too. Nevada can put itself even more on the front lines in this area by being part of programs that may improve medical care and costs nationally. In turn, our emergence as a town with a reputation for both high-end care and taking care of our own on a daily basis will create jobs that require more advanced training—and that, in (another) turn, will force us to embrace better education at all levels.

• Clark County will have more than 70 percent of the membership of the next Legislature. If these legislators vote as a unit, instead of as partisans, they can pass any legislation they want and override any veto from Sandoval.

• Progressive Leadership Alliance of Nevada, whose state director, Bob Fulkerson, has suggested that Sandoval and company are exaggerating the potential cost to the state. But for the sake of argument, let’s say they aren’t exaggerating. Nevada generated $6.6 billion in gold production in 2010, but mining companies, thanks to our state constitution and the Legislature’s unwillingness to increase their tax burden, paid taxes on less than half of that amount. Increasing their tax burden from $2.7 billion to about $3.6 billion would enable them to keep almost all of the profit they are enjoying and pay for these measures.

Mining is far more important to the rest of the state than it is to Clark County and its more than 2/3 legislative majority. All Clark County legislators have to do is vote for their county’s interest, and at the same time serve the interests of their state, their country and humanity. How tough would that be?