Nevada officials react to judge's ruling on health care overhaul

Gov. Brian Sandoval on Monday said he was pleased with a federal judge's decision to declare a federal health care law unconstitutional and hoped the legal fight over reform will be settled soon.

Sandoval was among Nevada Republicans who praised the decision by U.S. District Judge Roger Vinson in Florida that declared that Congress did not "operate within the bounds established by the Constitution" when it enacted reform.

Sandoval, a former federal judge and attorney general, during his campaign came out in support of a decision by former Gov. Jim Gibbons, then his primary election opponent, to include Nevada on a list of states challenging the law in federal court.

Although Sandoval says the Patient Protection and Affordable Care Act "has serious constitutional questions" he has directed state workers to continue working to implement regulations associated with it while the case is in court.

"Time is of the essence in settling this issue because we are being forced to implement portions of this law," he said.

Sandoval wants to limit state general fund spending to $5.8 billion in the 2011-13 biennium, a goal that requires deep cuts to everything from education to Medicaid reimbursement rates for health providers.

Mike Willden, director of the Department of Health and Human Services, said implementation of the law will cost about $2 million in general fund spending over that time.

But it could also bring in $8 million in savings if $1.5 million in spending on Medicaid waste, fraud and abuse reduction yields anticipated results.

"That actually saves us money," Willden said.

New costs to the state from 2014-19, however, exceed projected short-term savings, Willden said.

The latest estimate is that if the law goes into effect in 2014, it will cost about $574 million over the next five years.

Much of the cost is expected to come from people currently eligible for Medicaid who don't use it. Willden expects that once the so-called "individual mandate" forces people to buy insurance or face a penalty, those eligible for Medicaid today will sign up.

Reaction to the ruling by Nevada's elected officials broke down by political affiliation, with Democrats criticizing it and Republicans praising it.

"This lawsuit is nothing more than an attempt by those who want to raise taxes on small businesses, increase prescription prices for seniors and allow insurance companies to once again deny sick children medical care," said Senate Majority Leader Harry Reid, D-Nev., alluding to tax breaks and other incentives in the law.

Rep. Shelley Berkley, D-Nev., echoed Reid.

"I am disappointed by this decision, which comes as yet another setback in our effort to cover more than 600,000 uninsured Nevada residents and to improve access to care and increase affordability for those who are now insured," Berkley said.

Reps. Dean Heller and Joe Heck, both R-Nev., said the ruling affirmed their votes with the GOP majority in the House of Representatives to repeal the law, an effort that appears to be dead on arrival in the Senate, which is controlled by Democrats.

"It was irresponsible to pass a law that is probably unconstitutional," Heck said. "I am confident that, in the end, the worst parts of this law will be repealed, the good parts will remain and the parts that need to be fixed will be fixed."

Heller called the insurance mandate "unprecedented" and added, "Ultimately, the U.S. Supreme Court will have the final say on the constitutionality of this bill. "

Nevada Attorney General Catherine Cortez Masto, who last year refused demands from Gibbons to represent the state in the lawsuit, said she stands by her decision, which prompted Gibbons to hire Las Vegas attorney Mark Hutchison to represent the state on a pro bono basis.

"From my perspective, it is playing out just as I thought it would," Masto said. "Some courts have found it unconstitutional and some courts have found it constitutional."

Contact reporter Benjamin Spillman at or 702-477-3861.