Will Health Care Reform Cause Nevada To Drop Out Of Medicaid?

Last month, I noted the possibility that health care reform could give states an incentive to withdraw from Medicaid. Health care reform legislation currently includes approximately $25 billion in unfunded state Medicaid expansions. But many states are in terrible fiscal shape and would have a tough time coming up with the cash to pay for the expansion. Now, the governor of Nevada is saying that his state's response could be to simply drop out of Medicaid—a voluntary program—entirely.

In the latest in a series of conservative policy initiatives released by the Republican governor, Jim Gibbons is considering whether Nevada should drop out of the federal Medicaid program, one of the cornerstone safety net programs that provide health care to the poor, disabled and elderly and that cover thousands of Nevadans.

Health and Human Services Director Mike Willden was asked to “take a serious look” at opting out of the massive federal program this week. Triggering the interest is concern about the health care reform bill being debated in Congress, said Stacy Woodbury, Gibbons’ deputy chief of staff.

The state has estimated that the federal requirement to expand Medicaid under the bill will cost Nevada $636 million from 2014 to 2019, when the 100 percent federal subsidy in the health care reform bill expires.

This wouldn't necessarily mean that the poor couldn't get care: Instead of Medicaid, residents would get federal subsidies to buy insurance through the exchanges that the health care bill would set up. Those subsidies would be entirely federally funded, helping to relieve pressure on the state's budget.

Is this a serious proposal or a threat intended to illustrate the potentially dire effects of health care reform on state budgets? It's tough to say. But even if it's a just an illustration, it's a good one.

Still, it's not without risk. Given that Nebraska Sen. Ben Nelson, who cut a sweetheart deal to get federal funds to cover the Medicaid expansion in his state, is pushing to extend Nebraska's deal to all states, it could result in Congress deciding to mitigate state grumbles by ponying up the requisite extra funding for every state.

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  • Brian Sorgatz||

    Welcome to the wonderful world of unintended consequences.

  • Old Mexican||

    The state has estimated that the federal requirement to expand Medicaid under the bill will cost Nevada $636 million from 2014 to 2019, when the 100 percent federal subsidy in the health care reform bill expires.

    And it is bound to be even greater once people start to massively jump the border and migrate to Nevada . . . from California.

  • Fist of Etiquette||

    ...it could result in Congress deciding to mitigate state grumbles by ponying up the requisite extra funding for every state.

    I hope they also mandate in the legislation a new definition of what "deficit-neutral" means.

  • Gilbert Martin||

    They've already gamed the Congressional Budget Office out the wazoo for the phony balony cost estimates they've got on the plan as it is.

  • Fist of Etiquette||

    I agree, it was nice they thought enough of the voters to at least fudge the numbers for our sake. When they stop even bothering to do that, then what do I have to hang my hat on?

  • ||

    I think I've seen this disingenuous con before, back when several states floated a line that went: "We just won't take any highway money, that way we can keep the drinking age under 21." how to give a guy good head | how to perform oral on your boyfriend

  • ||

    Why doesn't the state take all of its money to Las Vegas, put it all on Red 19, and hope for the best?

  • TXLimey||

    Who wants to bet that Medicaid will cease to be a voluntary program if Nevada tries to actually do this?

  • D.R.M.||

    Hmm?

    The Feds can't make a state spend money on social programs. The best the Feds can do is make federal bribes to the states contingent on state compliance.

    The Feds might try making, say, highway funding dependent on participation in Medicaid. Or they might federalize the program entirely, removing the state funding component. But they can't just pass a law and order Nevada as a state to participate in Medicaid.

  • oaktownadam||

    That won't help; Nevada already refuses federal highway money.

  • ||

    No, no, it will all remain voluntary. Like paying income tax is voluntary.

  • If You Say So||

    "If Scott Brown wins, it'll kill the health bill," [Barney] Frank told reporters today.

    From NRO.

  • brotherben||

    Do the dems still need 60 to move that turd through the bowels of Congress?

  • ||

    Yes.

    However, the Mass. Secretary of State has already stated that he's going to require that counties give the full 10 days after the vote to get and count all the absentee votes, and the counties have 5 days after that to certify the vote. Since the interim Senator remains until the new one is sworn in, they're going to drag this out such that even if Brown wins, it won't change anything when it comes to ObamaCare.

  • brotherben||

    If I'm not mistaken, they have to give that 10 days for absentee ballots and for military that are out of country. It is the law.

  • not the real jb||

    Except in 2006 that same sec. suspended the waiting period to get a house member in sooner.

  • ||

    Auntie made The Law in Bartertown - sounds like she moved to MA after the big brouhaha with Mad Max

  • If You Say So||

    I'm hoping that if Brown wins, the Dems up for re-election this year will be too scared to be willing to appear to be rushing ObamaCare through. Letting Brown get seated will be the perfect escape for Dems who don't want to vote either for or against something they know will pass and most constituents hate. If they know it won't pass (thanks to Brown), then they can keep the party happy while being spared the heat of having a hated law on their backs.

  • ||

    ""I'm hoping that if Brown wins, the Dems up for re-election this year will be too scared to be willing to appear to be rushing ObamaCare through. ""

    Does anyone like this bill? The dems seem willing to sacrifice their seats.

  • ||

    There is a post just up at the Weekly Standard saying that regardless of when the election of the new Senator happens the interim guy is done as of election day.

    I'm just posting this for info, not taking a position on it

  • ||

    Don't know about a whole state, but plans in NY are already pulling out of medicaid plans in counties where the lose ratio is 10% to 25%. The state won't increase premiums, so now the providers can send the bills directly to the department of health.

  • ||

    Can I pre-emptively drop out of Medicaid? You can keep everything I've paid in to date. Put it on Red 19...

  • oaktownadam||

    Sure, as long as you accept progressives' definition of "opt-out"...you keep paying in, but don't get anything out.

  • ||

    Wow thats pretty messed up dude! Serioualy.

    RT
    www.online-anonymity.se.tc

  • thenino85||

    Don't know why you bothered adding in that last paragraph; isn't it crystal clear to everyone that the only reason Brown is pretending to try to get that deal extend to all the states is to make good on his phony story about trying to get that written into the healthcare bill? Once he learned that it was so unpopular, even the governor of his own state was refusing to accept "free" government funds, something governors usually trip over themselves to acquire to show their constituents that they're "bringing money home?"

  • Silentz||

    So I'm all for reducing government programs, but if states pull out of a government program that they have to partially pay for, only to put people on a program that the feds pay for, how is that a good thing?

    Isn't it still my money paying for the healthcare? Just from a different pot? And isn't that what the feds want anyway, a switch-over to a totally federal system?

  • ||

    We all know that none of the politicians will allow grandma to go without her heart medicine and free electric scooter so the feds will rush in and give Nevada more $ to pay for their medicare program. The Senators and Representatives from Nevada will also make this happen by selling their votes on some bill to benefit another state. This means that this extra money will eventually need to be paid with an increase in federal income tax rates rather than Nevada income tax rates. That way the Nevada Governor can blame the politicians in DC for raising taxes rather than accepting the blame himself (or herself).

    Economics 101 in one simple sentence: There is no free lunch..

  • Good Old World||

    I think I've seen this disingenuous con before, back when several states floated a line that went: "We just won't take any highway money, that way we can keep the drinking age under 21."

  • Global Exporters||

    a switch-over to a totally federal system?

  • ||

    We now have the situation where states challenging the constitutionality of forcing people to buy health insurance are claiming reimbursement benefits under the same law! Ironic to say the least! Reiki Courses Online

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