Gov. Brian Sandoval, Sen. Dean Heller cast wary eyes on health care reform

Back in 2013, Gov. Brian Sandoval said saving money was key to his decision to expand Medicaid. Residents would become eligible for Medicaid anyway, the governor reasoned, but expanding the program would allow the state to recoup most of the costs.

But now, with House Republicans working on legislation to repeal parts of the Affordable Care Act, Sandoval may see those savings vanish.

Under the draft legislation, states that expanded Medicaid will continue to get federal subsidies for patients who enroll in the program by Dec. 31, 2019. Those subsidies will continue, but only so long as patients maintain their eligibility.

For patients who sign up for Medicaid after Jan. 1, 2020, states would get the standard reimbursement.

According to a list of talking points obtained by the Center for Media and Democracy, the Republican plan “responsibly unwinds Obamacare’s Medicaid expansion. We freeze enrollment and allow natural turnover in the Medicaid program to zero out the rolls as beneficiaries see their life circumstances change.”

As for Medicaid funding in general, the GOP plan initiates a “per capita spending cap model,” otherwise known as a block-grant program.

The governor says he’s concerned about people getting health care in the program, but is awaiting final details.

“The governor has asked his Department of Health and Human Services to assess the statewide fiscal impacts of the House proposal,” reads a statement released by spokeswoman Mari St. Martin. “The governor’s priority is to protect those who now have access to health care and ensure they’re able to maintain coverage. He will continue to engage in conversations with Nevada’s federal delegation and gubernatorial colleagues on these priorities.”

It would be something to overhear those conversations!

Nevada Sen. Dean Heller was similarly cautious, knowing the bill will likely change. But his office also mentioned Medicare.

“Obamacare is failing millions of Americans. Senator Heller supports delivering more access, better benefits, and lower costs to Nevadans,” said spokesman Neal Patel in a statement. “This bill is roughly 36 hours old. It’s still working its way through the House. The senator will be monitoring it closely. He will continue to work with the governor to advocate for Nevadans who depend on Medicaid, while also tackling the problems caused by Obamacare.”

To be sure, the Affordable Care Act had plenty of problems, not least of which was the lack of a public option. But its replacement has its own problems. Instead of a mandate to buy insurance (enforced with a tax penalty), the Republican plan allows insurance companies to impose a 30 percent surcharge on those who fail to sign up for coverage. (That penalty goes to insurance companies, not the federal treasury.)

The Republican plan suspends payments to Planned Parenthood for a year, despite the fact that it spends the vast majority of its money (and 100 percent of its federal grants) on providing health care other than abortions.

The Republican plan relies on refundable tax credits to help eligible people buy insurance, which more conservative members of the party think will become an entitlement. (In fact, overcoming intraparty objections will be this bill’s first test.)

But at least the GOP plan finally does something about all those lottery winners gaming the public health care system!

Instead of rolling back Medicaid programs, the government ought to consider expanding Medicare, allowing people younger than 65 into the system. This idea has challenges (controlling costs, ensuring access and maintaining adequate reimbursements) but it’s a hell of lot better than figuring out how to keep healthy the for-profit insurance industry, rather than human beings.

Steve Sebelius is a Review-Journal political columnist. Follow him on Twitter (@SteveSebelius) or reach him at 702-387-5276 or