Pub­lic can’t see Med­i­caid growth costs

Las Vegas Review-Journal - - NEVADA -

NMed­i­caid ex­pan­sion has been get­ting a lot of love from Gov. Brian San­doval, Sen. Dean Heller and oth­ers who want Wash­ing­ton to con­tinue pay­ing the bulk of the pro­gram’s tab.

But if Ne­vada tax­pay­ers had to pay the full cost of the ex­pan­sion, it’d have less sup­port than Harry Reid run­ning for president of a Repub­li­can women’s club.

Un­der Oba­macare, the fed­eral gov­ern­ment paid the full cost of that ex­pan­sion from 2014 to 2016. Ne­vada pays 5 per­cent of the costs in 2017 and by 2020 will pay 10 per­cent of the bill.

Ne­vada of­fi­cials pro­jected a max­i­mum of 78,000 peo­ple would be added to the Med­i­caid rolls. In June, San­doval shared that 210,000 new adults have en­rolled. Oops. Bu­reau­crats were off by just 300 per­cent or so. (Re­mem­ber that the next time some­one touts the cer­tainty of gov­ern­ment pre­dic­tions.)

If Ne­vada had to pay the en­tire bill, it would cost the state $1.2 bil­lion a year. That’s about half of the Clark County School Dis­trict’s gen­eral fund bud­get. That amount would re­quire a 2-per­cent­age-point in­crease in the sales tax or a tripling of the Mod­i­fied Busi­ness Tax. A tax hike of that mag­ni­tude would al­most dou­ble the size of the 2015 tax hike San­doval pushed through, which was the largest in Ne­vada his­tory.

A mas­sive tax in­crease to give “free” health care to able-bod­ied adults above the poverty line would be a non-starter.

Be­cause of Oba­macare, Ne­vada’s share of those costs is about

$60 mil­lion in 2017. Leg­is­la­tors could have used that money for ed­u­ca­tion. Any­one know of a school dis­trict that could use an ex­tra

$60 mil­lion this year?

If you think the Med­i­caid ex­pan­sion won’t strain school bud­gets fur­ther, just wait. The state’s share of the ex­pan­sion is ex­pected to grow to about $120 mil­lion in 2020.

The more than $1.1 bil­lion Wash­ing­ton will spend on Med­i­caid in Ne­vada this year is fis­cally un­sus­tain­able. That’s one of the main rea­sons Repub­li­cans have been try­ing to re­peal and re­place Oba­macare.

The “free” money com­ing into Ne­vada is a mi­cro­cosm of our na­tion’s larger health care prob­lems, in which cost-shift­ing and third-party pay­ments hide the ac­tual price of care from tax­pay­ers and pa­tients. Ben­e­fi­cia­ries have no abil­ity to com­par­i­son shop and no in­cen­tive to seek less-ex­pen­sive care, be­cause


they can’t see the costs and don’t di­rectly pay them.

San­doval’s in­sis­tence on pre­serv­ing the flow of fed­eral funds con­tin­ues to put Heller in a po­lit­i­cal pickle. San­doval and Heller held a joint news con­fer­ence in June that doomed one Repub­li­can ef­fort to re­peal Oba­macare. San­doval’s ma­jor ob­jec­tion was any re­duc­tion to fu­ture fed­eral Med­i­caid fund­ing. Heller, who’s up for re-elec­tion this year, even voted against re­peal­ing Oba­macare en­tirely af­ter years of vot­ing to kill it.

If the Med­i­caid ex­pan­sion is so ben­e­fi­cial to the state and its peo­ple, shouldn’t Ne­vada’s top elected of­fi­cials be will­ing to ask Ne­vadans to pay for it them­selves?

Since then, Heller has drawn a se­ri­ous

pri­mary chal­lenger in Danny Tarka­nian and has taken steps to re­place Oba­macare. Heller has signed on as co-spon­sor to the last re­main­ing Oba­macare-re­place­ment pro­posal.

The key fea­ture of the plan is block-grant­ing money to the states and giv­ing them in­creased flex­i­bil­ity in how they spend it. While the plan leaves some Oba­macare taxes in place, it slowly de­creases fed­eral gov­ern­ment spend­ing.

San­doval’s spokes­woman didn’t pro­vide a state­ment.

To San­doval, pay­ing for fed­eral spend­ing is some­one else’s prob­lem.

You’re a state and fed­eral tax­payer. It’s your prob­lem.

Vic­tor Joecks’ col­umn ap­pears in the Ne­vada sec­tion each Sun­day, Wed­nes­day and Fri­day. Con­tact him at vjoecks@re­viewjour­ or 702-383-4698. Fol­low @vic­tor­joecks on Twit­ter.

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