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.
Other bills on which Sandoval took action on the final bill deadline day of the biennial legislative session:
STATEWIDE ENERGY STANDARD
In one of Sandoval’s most highly anticipated decisions this session, the governor is nixing a Democratic initiative to increase — to 40 percent by 2030 — the minimum amount of electricity statewide that utilities must produce from renewable energy sources.
Nevada is currently working toward 25 percent renewable energy by 2025.
The state first established its renewable portfolio standard in 1997.
In a veto message, Sandoval said producing energy through renewable sources is a worthwhile goal, but the law’s “adoption is premature in the face of evolving energy policy in Nevada.”
Most of the 29 states that had enacted a renewable standard by February set their minimums at between 15 percent and 25 percent of total energy production, according to the U.S. Department of Energy.
Under Assembly Bill 206, Nevada would have tied Maine for the sixth-highest energy standard in the nation. Each of the higher states is at least 10 years from self-imposed deadlines to meet those rates except Maine, which is holding itself to a requirement for 40 percent renewables this year, according to information from the department.
NEIGHBORHOOD SOLAR SHARE
Sandoval vetoed Senate Bill 392, which would have provided various discounts and regulations to facilitate neighborhood solar energy systems of up to 12 megawatts for renters, landlords, shaded homes and people who can’t afford the high start-up cost of solar energy equipment.
(AB408) KEEPING MORE AFFORDABLE CARE ACT POLICIES
Assembly Bill 408, which Sandoval vetoed, would have aligned Nevada law with federal provisions that mandate coverage for people with pre-existing conditions; ban penalties if patients use or insurers promote preventative screenings; and require the availability of maternity and newborn care. It would have ensured all plans cover hospital stays for two days after vaginal birth or four days after cesarean section, unless doctors discharge mothers earlier. It would have allowed people to stay on their parents’ Nevada-based insurance plans until age 26 and prohibits insurance companies from discriminating against customers based on race, gender, mental ability or sexual orientation.
(AB474) TRACKING THE OPIOID CRISIS
Sandoval is building on his history of reforms to tackle the ongoing opioid crisis with legislation requiring doctors to ask more questions before giving people access to prescription painkillers and to track overdoses in real time by mandating that doctors and hospitals report to the state any drug overdoses they know of or treat. He signed Assembly Bill 474 on Friday.
(AB472) JUVENILE JUSTICE
First Lady Kathleen Sandoval joined the governor as he signed Assembly Bill 472, reforming how Nevada treats juvenile delinquents. Among the biggest changes are mandatory mental health screenings before final court judgments, greater data collection and gearing youth offender programs toward evidence-based practices. The bill also directs the Youth Parole Bureau to establish tiered punishments in order to respond proportionally when a juvenile offender breaks parole.
(SB546) PUBLIC PROJECTS
Sandoval signed off on continuing a 17-cent property tax necessary to cover Nevada’s bond obligations and finance public works projects that, among many other things, will front the long-awaited Northern Nevada State Veterans Home in Sparks. Federal funds are expected to eventually repay the state’s roughly $35 million investment. The bill also includes funding for a Department of Motor Vehicles office in Reno, an engineering building at University of Nevada, Reno and maintenance at mental health facilities, corrections centers, universities and other state buildings across Nevada.
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