More & Better Health Care: It Just Makes Sense.

Shortly after the Affordable Care Act (ACA) was (mostly) upheld by the US Supreme Court in June, all eyes turned to state houses to see how they would begin implementing it. So far, Nevada has begun implementing the health care Exchange part of the law. However, there's been uncertainty over the state going along with expanding Medicaid.

That may actually be changing soon. Last week, a consortium of 15 health care organizations urged Governor Brian Sandoval to implement Medicaid expansion. They were quickly joined by SEIU.

[Last Thursday], SEIU Nevada delivered more than 300 hand-signed letters to Gov. Brian Sandoval urging him to expand Medicaid coverage as he crafts his budget for the 2013 legislative session.

“Going forward three years, the state would be paying just one dime for a dollar’s worth of health coverage,” said Mayra Ocampo, SEIU Director of Governmental Affairs. “So often we see our government offer big tax breaks to lure businesses. In this case, we’re getting the incentive and it makes no sense to reject it. We can’t think of any financial reason why the governor wouldn’t expand Medicaid. Rejecting the federal money will just put a greater strain on Nevada’s budget.”

Even uber-insider Republican consultant and Brian Sandoval adviser Pete Ernaut went on Jon Ralston's show last week to express support for fully implementing the ACA.



It's finally starting to look like there's a critical mass in favor of expanding Medicaid. Why is this? Perhaps this is happening because it's good policy that makes sense (and $).

1. Under Obamacare, states no longer have to finance health insurance for people above 133 percent of the federal poverty level. Many states fund health insurance programs which cover residents living at more than 133 percent of the federal poverty level (FPL). Obamacare makes residents at higher than 133 percent of the FPL eligible for subsidized health insurance through state insurance exchanges at no cost to states. For example, Idaho would no longer have to fund health insurance for its 63 percent of uninsured residents who are above 133 percent of the FPL, reducing its $47 million annual uncompensated care cost to $17.3 million.

2. Under Obamacare, states pay billions less to cover people below 133 percent of the federal poverty level. States pay billions in health insurance programs for residents living at less than 133 percent of the FPL. After five years of Obamacare, the federal government will cover 90 percent of insurance costs for state residents making less than 133 percent of the FPL. For the first three years of the expanded Medicaid program, the federal government will cover 100 percent of Medicaid costs. The surveyed states will save $4.2 billion (100 percent of their uncompensated care costs) annually for the first three years, and $3.0 billion annually starting in 2019. For example, Michigan pays $212 million annually in uncompensated care costs. After five years of Obamacare, Michigan would have to pay only $68 million annually in the expanded Medicaid program.

3. By making health insurance universally available, Obamacare slashes the “hidden tax” states pay in health insurance premiums. States pay a “hidden tax” in the form of higher insurance premiums to account for the cost of covering the uninsured. “By greatly reducing uncompensated care,” the Council explains, Obamacare works to “reduce this hidden tax.” For example, North Carolina would see its annual $58.6 million insurance premium “tax” reduced to reflect a much smaller number of people without health insurance.

So in addition to covering more Nevadans, the Medicaid expansion provision of the Affordable Care Act will ultimately save Nevada money if implemented. And since Americans using Medicaid are overwhelmingly happy with their health care, it's not as if the state will be adding people onto a troubled program. Again, it just makes sense.

And here's another way this makes sense: The $300 million that Nevada will be receiving under the ACA to expand Medicaid is money that will be injected into our economy. And this will mean more jobs in the health care sector. So even when looking at the economics of expanding Medicaid, it just makes sense.

So what is Brian Sandoval waiting for? Perhaps some politically convenient excuse to do it (a la the last budget)? Or is there something else? Whatever the case, he eventually has to look at the numbers and realize that it just makes sense to expand Medicaid and fully abide by the ACA.