Nevada Sen. Dean Heller is in a no-win situation on the repeal and replacement of Obamacare, and his fellow Republican, Gov. Brian Sandoval, keeps putting him in the hot seat.
To understand Heller’s double bind, context on Obamacare is essential. President Donald Trump’s famed negotiating skills notwithstanding, it’s impossible to make everyone happy when it comes to repealing and replacing Obamacare. That’s because our country could never afford all the “free” stuff Obamacare promised.
Exhibit A is Medicaid expansion. Sandoval was the first Republican governor to embrace Obamacare by expanding Medicaid to those making more than the poverty line, including for the first time in Nevada, healthy, childless adults. Sandoval estimated that 68,000 newly eligible people would sign up.
He was off by a factor of four. Nevada’s Medicaid rolls have grown by 276,400 since expansion, with 266,000 being from the newly eligible population. This wasn’t impossible to predict, either. A prediction on Medicaid expansion from the Nevada Policy Research Institute, published while I worked there in 2011, was off by only 10 percent.
(Keep that margin of error in mind when you see predictions from the Congressional Budget Office treated like gospel.)
Not that Sandoval cared how many signed up. Obamacare covered the cost of the newly eligible for three years. Costs to Nevada didn’t go up until 2017. But by the time the costs fully kick in, in 2020, estimated by NPRI to be hundreds of millions of dollars a year, Sandoval will be term-limited out of office.
This is like buying a new $10 million office complex with no payments for 36 months, retiring from your job and letting your replacement worry about how to pay for it. You get all the credit for the expansion but skate on the accountability. This is why it’s so ironic that Sandoval writes letters telling Congress that Trump’s Obamacare replacement plan “does not ensure the resources necessary to make sure no one is left out.” Sandoval doesn’t have to figure out how to pay for the “free” stuff.
This puts Heller, up for re-election in 2018, in a difficult spot. Around Nevada, grass-roots Republicans range from lukewarm toward Heller because of his lack of personal outreach since he won in 2012 to furious over his treatment of Trump in 2016. Heller’s announcement Friday that he doesn’t support Trump’s current health care proposal in the House of Representatives isn’t improving those opinions.
There are problems with Trump’s current proposal — mainly that it doesn’t repeal much of the underlying regulatory framework of Obamacare. Lawmakers need to repeal the ability of bureaucrats to create insurance mandates and let consumers purchase plans that better fit their needs. These can include low-premium, high-deductible plans that actually reduce the cost of health insurance.
But to the healthy adults above the poverty line currently receiving Medicaid, nothing will appear cheaper than “free.” Even if Heller supports an improved health care plan, Sandoval’s created a constituency used to receiving something for nothing. Although it’s unsustainable, they’re going to resent Heller for taking their unsustainable handout away.
Over the next 18 months, Heller will face a lot of heat on Obamacare. Sandoval needs to quit fanning the flames.