Nevada governor vetoes Medicaid-for-all bill

LAS VEGAS – There will be no Medicaid-for-all option in Nevada.

Gov. Brian Sandoval waited until the last day he could – Friday – to veto a measure that would have offered a state-sponsored health insurance option to all residents regardless of income. If he hadn’t signed it or vetoed it by midnight, it would have become law.

If the Republican governor had signed it, Nevada would have become the first state to attempt a Medicaid-for-all approach to health insurance. It also would have placed Nevada among the ranks of states that are looking for ways to solidify health insurance options for populations that will be risk if Congress and President Donald Trump gut the Affordable Care Act.

In his veto message, Sandoval praised the sponsor of the bill for “creativity” in attempting to designs a health care option for the state’s 2.9 million people, but he ultimately reasoned that there were too many unanswered questions about how the program would work.

He wrote that the legislation was “an undeveloped remedy to an undefined problem” – and that it didn’t get proper scrutiny before it was passed in a short time frame.

The bill’s sponsor, Democratic Assemblyman Mike Sprinkle, acknowledged that the proposal it would have required a lot of work if it had become law. That’s why he put an implementation date of January 2019 in the bill, he said.

The measure proposed selling a Medicaid-style insurance option on the Silver State Health Insurance Exchange. Called the Nevada Care Plan, it would have been sold alongside private insurance options. It would have operated within Medicaid, but it wouldn’t be Medicaid, which has strict qualifications targeting low-income families.

There were worries among providers – including the Nevada Hospital Association – about the Nevada Care Plan reimbursing them at lower rates than the private insurance plans pay. There were also concerns – also mentioned by the governor – of the plan disrupting the current marketplace.

The legislation also faced a significant hurdle in that there would be no way for the Nevada Care Plan to be sold on the Silver State Health Insurance Exchange. The plan would also have needed permission from the federal government for consumers to use federal income tax credits to purchase it.

Sprinkle had said part of his reason for proposing the legislation was related to the uncertainty in Washington about the fate of the Affordable Care Act, which congressional Republicans and Trump have sought to repeal.

The House of Representatives successfully passed a bill to replace the health care law, but Senate Republicans are preparing their own plan to do away with President Barack Obama’s signature achievement.

One of the chief worries for states like Nevada centers on what will happen to people who obtained health coverage under the expansion of Medicaid in the Affordable Care Act. Medicaid is a federal-state program that helps pay for health care for needy, elderly, blind and otherwise disabled people, and for low-income families with children.

Sandoval was one of the few Republican governors to accept the current law’s Medicaid expansion, and Sprinkle thought his bill might have a chance to get the governor’s signature given Sandoval’s opposition to congressional moves to repeal Medicaid expansion.

In his message, the governor said the proposal “does not end the conversation about potential coverage gaps or possible solutions, including Medicaid-like solutions.”

Nevada has about 600,000 people using Medicaid and the Medicaid expansion. About 11 percent of Nevada residents remain without any health care coverage.