Sando Sez, "No Health Care for You." (Does #NVLeg Agree?)

So ACA has (mostly) been upheld. This is the end of the health care saga. Right?

Wrong. Yesterday, Brian Sandoval threaten to withhold affordable health care from 91,000 Nevadans.

The Affordable Care Act is estimated to cost Nevada about $574 million between 2014 and 2019, most of that in additional Medicaid costs.

But if the state decides not to expand its eligibility, it's unclear how much of that money would be saved. The federal government has promised to pay almost all of the costs of those newly eligible. The additional cost to Nevada comes from those who currently qualify but, for whatever reason, don't participate in the program. The state also must bear the full price tag of administering the program.

"In my opinion, it’s a great deal for the state," [ Jon Sasser, statewide advocacy coordinator for state legal services agencies] said. "There's not any real rational reason for not doing this, other than some sort of political decision."

Sandoval isn't ready to jump at the deal, though. His administration estimated Medicaid costs will begin to swell as soon as next year. By the end of 2014, Sandoval's office estimates as many as 141,000 new people-- including 20,000 children-- will seek health coverage through the state. [...]

Assemblywoman Debbie Smith, D-Sparks, said she has asked legislative staff to research the legal and fiscal ramification of the opinion for a presentation to an interim committee in August.

"Personally, I want to see more people with coverage, and, yes, more people need to have access to health care," she said. "But I need to know what my options are here. What are the different options within the ruling?"

Are they serious? Our elected "leaders" are really debating whether to deny health care to at least 91,000 Nevadans? What's going on here?

OK, I really know. They're all whining about "the spending, the SPENDING!!!" And apparently, they can't see the giant pot of gold right in front of them!

Republican governors will face pressure to reject the Medicaid expansion or risk being accused by conservatives of willingly embracing a big part of ‘Obamacare.’ But there’s an incentive in the other direction; namely: a huge cash gift from the federal government, which covers the full cost of the first three years of expansion.

“It’s very easy for these Republican governors, pulled by the tea party, to say, ‘Oh we’re going to pull out,’” Sen. Chuck Schumer (D-NY) told reporters Thursday after the Suprme Court decision. “When they see what it does to pull out … they’re going to lose the incentives. They’re going to lose the dollars. They’re going to lose the new people covered. And their small businesses are going to lose the subsidies. I don’t think they’re going to be so eager to do that when they actually look at the benefits to the states in the Medicaid provisions of the bill.”

“It will be interesting to see what happens in the 26 states that challenged Obamacare,” said Adam Winkler, a professor at UCLA School of Law. “Will they go through with their threats of not expanding their own Medicaid coverage? Or will the promise of federal money persuade them to expand coverage?”

The federal government actually pays for ALL the cost of the Medicaid expansion for the first three years, and has promised to subsidize 90% of the costs after that. This is not some "unfunded mandate", far from it. And in fact, Nevada will save money in expanding Medicaid because it will mean more Nevadans receiving preventive health care and fewer Nevadans being forced to use the hospital emergency room as "primary care". And yes, preventive care is much cheaper than the ER.

Hopefully, Sandoval and the Legislature won't give into temptation to be penny wise and pound foolish. We gain nothing in turning down Medicaid expansion. Rather, our people just lose needed health care.

In a press conference following the court opinion, Sen. Harry Reid warned governors against opting out of the Medicaid expansion.

"I think those governors that are now saying some things, if they continue along saying them, they will wish they hadn’t, because they will not... help their constituents like the states that have," Reid said.

They all need to listen to Harry Reid. After all, he helped create the Affordable Care Act. And he knows what Nevada will lose out on if our elected "leaders" in Carson City are too stupid to realize that.