CARSON CITY — Nevada won’t automatically accept expanding Medicaid coverage as called for under the federal health care law, Gov. Brian Sandoval said Thursday after the U.S. Supreme Court ruling left open the possibility that states could opt out of the requirement without jeopardizing all of its Medicaid funding.
“Given what we know today, the governor does not intend to automatically accept the Medicaid expansion,” Mary-Sarah Kinner, Sandoval’s press secretary, said in a statement.
“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.”
While the high court’s decision upheld the individual mandate that people could be required to purchase health insurance or pay a tax, it also said states cannot lose existing Medicaid funding if they don’t increase their Medicaid coverage levels for adults.
The governor’s office says more information is needed from the federal government before deciding how Nevada will proceed.
“The Supreme Court’s decision indicates states will have an option to expand Medicaid, but additional guidance is needed in order to understand the penalties for not expanding the Medicaid program and we must determine if there are savings to the general fund by shifting existing costs to the federal government,” Kinner’s statement said. “We will continue to examine today’s opinion to fully understand its implications.”
Earlier in the day, Sandoval, a first-term Republican who was critical of the law, said he may not agree with the decision, but he respects the process.
“The implications for Medicaid costs are still unclear, but Nevada will prepare to meet the serious financial implications of this decision,” Sandoval said in a statement. “I believe the Congress should act to reform this law and ease the serious burdens it places on the states and the nation’s businesses.
Later during an interview on KRNV-TV’s Nevada Newsmakers program, Sandoval said expanding Medicaid eligibility may require cutting education funding and “other horrible things.”
“As I sit here today, it wouldn’t be my intention to opt in,” he said.
An estimated 563,000 Nevadans lack health insurance, roughly 21 percent of the population, according to 2010 statistics from the U.S. Census Bureau.
Part of the Patient Protection and Affordable Care Act to take effect in 2014 would expand eligibility for more people to be covered under Medicaid, a safety net for the poor. State officials previously estimated that provision would cost Nevada $575 million over the first five years.
About 308,000 Nevadans are currently enrolled in the Medicaid program. State officials anticipate another 49,000 currently eligible but not enrolled will sign up as a result of the mandate to have insurance, increasing the cost by at least $60 million in the next budget cycle.
Additionally, the number of children covered under Nevada Check Up, an insurance program for needy children, is expected to grow by 20,000, even without expanding eligibility, at a cost of $11 million.
The federal law creates a new class of adults between the ages of 19 and 64 who are eligible for Medicaid and expands other criteria, such as relaxing the income eligibility to 133 percent of the federal poverty level. According to the Foundation for Health Care Coverage Education, that income threshold is currently $30,657 for a family of four.
Assemblywoman Debbie Smith, D-Sparks, said she has asked legislative staff and fiscal analysts to review the ruling and brief an interim legislative committee in August.
“We need to take our time, we need to have our staff fully understand the decision,” Smith said. “Are there variables in there? I don’t know that.
“We don’t want to rush into some kind of a statement on what we think before we’ve had a chance to fully understand the decision.”
Mark Hutchison, a private lawyer who championed Nevada’s case against the health care law by joining the lawsuit filed by 26 other states and a business group, said the court’s position on the Medicaid provision puts the issue of whether to expand coverage for the poor in the lap of the state and the Legislature “where it belongs.”
Hutchison, a state Senate candidate, said he was surprised the court upheld the constitutionality of the law.
“I don’t think anybody expected it to go this way,” he said.
Around the state, reaction to the long anticipated ruling was mixed along party lines, guaranteeing it will remain a hot issue in the November election.
“No one thinks this law is perfect,” Senate Majority Leader Harry Reid, D-Nev., said on the Senate floor, calling on Republicans to “stop refighting yesterday’s battles” and declaring that the health care debate “is settled.”
But his Republican colleague, Sen. Dean Heller, R-Nev., took aim and pledged to fight for its repeal.
“This law has now been affirmed as a colossal tax increase on the middle class, and its excessive regulations are stripping businesses of the certainty they need to hire at a time when Nevadans and the rest of the country are desperate for jobs,” he said.
“This onerous law needs to be repealed and replaced with market-based reforms that will provide greater access, affordability and economy certainty to our nation,” he said.
Repeal was the mantra of Republican officials and candidates.