The first Republican governor who opted to expand Medicaid has decided that Nevada will not be the first state in the nation to attempt to open the government-subsidized health care program to anyone, regardless of need.
On Friday, Gov. Brian Sandoval vetoed the policy proposal that also requires federal approval just hours ahead of a deadline to act on the bill before it would have become law automatically.
The Democratic bid to further expand Medicaid would have moved next to President Donald Trump’s administration for consideration. Without a waiver from federal officials, Nevada could not have moved forward with the plan from Assemblyman Mike Sprinkle.
Sandoval’s decision in 2012 to expand Medicaid under former President Barack Obama’s landmark health law allowed more than 210,000 adults and 13,000 children to join the program. Just fewer than 645,000 Nevadans are enrolled in Medicaid, according to data from April that state health department spokeswoman Chrystal Main provided.
The legislation is a far cry from a fully socialized health care model, but proposals like Sprinkle’s to remove eligibility requirements from government-subsidized insurance make a significant step in that direction.
Medicaid eligibility in Nevada and every other state is currently limited to low-income residents who make up to 138 percent of the federal poverty level. Qualifying annual take-home pay this year is less than $16,600 for a single person, less than $22,400 for a two-person household and less than $40,000 for a family of five.
Assembly Bill 374, to some degree, would remove those barriers beginning in 2019 and let people with moderate incomes use existing federal health care tax credits toward certain Medicaid plans. Wealthy individuals could also participate, but they would not qualify for the discounts.
People would sign up through the state insurance marketplace established under the Affordable Care Act.
The new coverage option would have been established within Medicaid and deliver coverage identical to what Medicaid provides for people who do not participate in a managed care program.
The proposal came at a time when most states are moving away from the fee-for-service model, which can be preferable for people who are geographically isolated or seriously ill but inefficient for many others.
Nevada spent roughly $800 million on Medicaid coverage last fiscal year, and the federal government provided another $2.4 billion.
Fiscal analysts at the Nevada Department of Health and Human Services told the Legislature they could not determine how many people might sign up for further-expanded Medicaid, so a cost of the policy shift could not be determined.
The bill included $180,000 from the state general fund to administer the program.