Is Nevada All-in with Medicaid-for-All?

Gov. Brian Sandoval receives a standing ovation at the conclusion of his state of the state address at the Legislative Building in Carson City, Nev., on Jan. 17, 2017. (Chase Stevens/Las Vegas Review-Journal via AP)

Nevada Assemblyman Mike Sprinkle (D) thinks he may have come up with a model for healthcare reform the nation could embrace.

Sprinkle’s idea only took four pages of paper to explain to his fellow legislators who approved the proposal June 2. He just wants to provide a Medicaid-style insurance program to everyone in Nevada, regardless of income.


“If we do this right, we potentially are going to be laying groundwork and framework for all the other states in the nation,” Sprinkle told the Nevada Independent.

By the end of the week, Sprinkle will find out if Gov. Brian Sandoval (R) feels the same way. Sandoval has until June 16 to veto Sprinkle’s legislation, sign it into law, or ignore it and let AB 374 become law without his signature.

Sprinkle wrote in an op-ed published by the Reno Gazette-Journal that his proposal was motivated by the underlying belief that “healthcare is a right — not a privilege,” as well as by what he called the GOP effort to tear down the healthcare reform created by former President Obama.

“They passed a healthcare bill that cuts coverage, increases costs and eliminates protections, despite bipartisan opposition,” Sprinkle wrote. “They ignored the 83 percent of Americans that made it loud and clear they did not support this bill.”

“The repeal of the ACA will undoubtedly leave millions of Americans uninsured—including some of the most infirm and poverty-stricken,” Sprinkle added.

However, Sprinkle also admitted that the way Nevada is doing healthcare, which he described as “antiquated and complicated,” just doesn’t work.

But Medicaid, he proclaimed is one of the “largest, if not the largest source of healthcare coverage in the United States” that already provides coverage for more than 300,000 Nevada residents.

Sprinkle’s Nevada Care Plan — if Gov. Sandoval signs the legislation — would give everyone in the state a chance to purchase a plan with Medicaid-like benefits on the private insurance market through the Silver State Health Insurance Exchange. Residents who qualify for Obamacare tax credits would be able to put those credits towards the purchase of Medicaid coverage.


The medical community’s reaction could be a problem for the Nevada Care Plan. As much as Sprinkle likes Medicaid, the collective wisdom is doctors don’t like the federal program.

“One out of every three physicians in this nation aren’t seeing Medicaid patients,” Health and Human Services Secretary Tom Price said. House Speaker Paul Ryan said, “More and more doctors just won’t take Medicaid.”

The Centers for Disease Control and Prevention’s National Center for Health Statistics showed 68.9 percent of physicians accepted new Medicaid patients in 2013, as compared to 83.7 percent who accepted new Medicare patients and 84.7 percent who welcomed new privately insured patients.

Lobbyists for hospitals in Nevada expressed what the Nevada Independent described as “reluctant opposition” to Sprinklecare.

“We’re supportive of that concept but concerned about reimbursements to the provider community,” Nevada Hospital Association lobbyist Bill Welch said.

There are still some major legislative housekeeping details to be worked out. For instance, the text of the bill doesn’t lay out any specifics on how the exchange would handle traditional deductibles and co-payments. And there has not been an estimate of how many Nevada residents might take advantage of the plan, nor does the legislation include the cost of the program. Nobody knows yet how much it would cost to sign up.

“Once the bill gets through the governor, we’re going to have a very active working group that will build off this framework to determine these things through regulation,” Sprinkle told Vox.


Sprinkle has reason to be optimistic. Gov. Sandoval issued a statement indicating his approval of the bill.

“I will review the final language this week and work with healthcare experts to evaluate how this would impact the current market, potential state costs and risks, make a determination if this is needed, and whether or not this is something that can be effectively implemented,” Sandoval said.

However, there would be one more hurdle to be cleared after a gubernatorial signature. The Trump administration would have to sign off on the idea, even as the White House tries to cut Medicaid funding by as much as $1.3 trillion.

But those details aside, as far as Sprinkle is concerned, the opportunity provided by the Nevada Care Plan is clear.

“Nevada has an opportunity to not only provide healthcare access to all Nevadans,” Sprinkle wrote, “but also establish itself as a pioneer in healthcare reform.”



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