Medicaid rolls: State’s decision on expansion not easy

As far as Senate Majority Leader Harry Reid is concerned, expanding Medicaid in Nevada is a no-brainer. “(Gov.) Brian Sandoval has said he is going to look at it to see how it would work,” Sen. Reid, D-Nev., said last week in a radio interview. “Once he looks at it, he will have to take it.”

Of course, that’s what Congress wanted ObamaCare to accomplish – a federal mandate to states to enroll more residents in the joint federal-state health care program for the poor, disabled and some elderly. But then the U.S. Supreme Court, in upholding most of the controversial law, declared that Washington cannot punish states that refuse to grow the program.

Gov. Sandoval and the Nevada Legislature do indeed have a choice. And it’s not an easy one.

The offer from Congress is tempting. Starting in 2014, Washington for three years would cover all the costs of enrolling workers who currently are paid too much to qualify for Medicaid but can’t afford or refuse to pay for private health insurance. In 2017, the federal government would cover 95 percent of the costs for new enrollees. In 2020 and the years beyond, Washington’s share of the bill would be 90 percent.

Already, more than 308,000 Nevadans are covered by Medicaid, and nearly 50,000 more people are expected to join in the next biennium at a cost of $30 million per year. If the state chooses to participate in the ObamaCare expansion, Medicaid would take on an estimated 72,000 people who earn less than $14,400 per year, 133 percent of the federal poverty level.

We don’t yet know the costs that would be incurred. We do know that Washington has a history of underestimating the price of entitlement growth. We know that, five years from now, Nevada would have to come up with millions more tax dollars to keep the enrollment expansion intact. And we know that once such a program is expanded into the middle class, it will be politically impossible to roll it back.

More importantly, increasing the number of people in Medicaid does not guarantee them health care. Nevada’s Medicaid reimbursements were already low before the Great Recession clobbered the state economy. They’ve been cut back further in response to declining tax revenues – so much that scores of physicians won’t accept Medicaid patients, and more doctors are dropping them every year. Hospitals lose money on every Medicaid patient they treat, shifting those costs to the privately insured.

Putting an additional 120,000 Medicaid patients into Nevada’s health care system could overwhelm the medical offices that still take Medicaid patients and compel even more doctors to restrict the number of Medicaid patients they see – if not drop them entirely.

Before being lured by promises from Washington to embark upon a massive and costly entitlement expansion, wouldn’t it be better to try to shore up the existing Medicaid program to ensure it operates as intended – as a health care backstop for the impoverished?

Gov. Sandoval and the Legislature have difficult decisions ahead. They must consider their options carefully.

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