There will be no Medicaid-for-all option in Nevada.
Gov. Brian Sandoval waited until the last day he could — Friday — to veto a measure that would have offered a state-sponsored health insurance option to all residents regardless of income. If he hadn't signed it or vetoed it by midnight, it would have become law.
Had the Republican governor signed it, however, Nevada would have become the first state to attempt a Medicaid-for-all approach to health insurance. It also would have placed Nevada among the ranks of states including California that are looking for ways to solidify health insurance options for populations that will be risk if Congress and President Trump gut the Affordable Care Act.
In his three-page veto message released Friday night, Sandoval praised the sponsor of the bill for "creativity" in attempting to design a healthcare option for the state's 2.9 million people, but he ultimately reasoned that there were too many unanswered questions about how the program would work.
He wrote that the legislation was "an undeveloped remedy to an undefined problem" — and that it didn't get proper scrutiny before it was passed in a short time frame.
The bill was short — just four pages — and its sponsor, Democratic Assemblyman Mike Sprinkle, acknowledged that it would require a lot of work if it had become law. That's why, Sprinkle said, he put an implementation date of January 2019 within the bill's text.
In a statement, he expressed disappointment by the governor's veto.
"Healthcare is a right, not a privilege or a product. With this veto, Governor Sandoval has actively decided to veto a right that all Nevadans should have," Sprinkle said. "I won't give up on the fight to secure access to quality and affordable healthcare for every Nevadan — I will bring this legislation back next session."
The measure proposed selling a Medicaid-style insurance option on the Silver State Health Insurance Exchange. Called the Nevada Care Plan, it would have been sold alongside private insurance options. It would have operated within Medicaid, but it wouldn't be Medicaid — the latter has strict qualifications targeting low-income families.
There were worries among providers — including the Nevada Hospital Assn. — about the Nevada Care Plan reimbursing them at lower rates than the private insurance plans pay. There were also concerns — also mentioned by the governor — of the plan disrupting the current marketplace.
The legislation also faced a significant hurdle in that there would be no way for the Nevada Care Plan to be sold on the Silver State Health Insurance Exchange. The plan would also have needed permission from the federal government for consumers to use federal income tax credits to purchase it.
Sprinkle had said part of his reason for proposing the legislation was related to the uncertainty in Washington about the fate of Obamacare, which congressional Republicans and Trump have sought to repeal.
The House of Representatives successfully passed a bill to replace Obamacare, but Senate Republicans are crafting their own plan to do away with President Obama's signature achievement.
One of the chief worries for states like Nevada centers on what will happen to people who obtained health coverage under the expansion of Medicaid under Obamacare. Medicaid is a federal-state program that helps pay for healthcare for needy, elderly, blind and otherwise disabled people and for low-income families with children.
Sandoval was one of the few Republican governors to accept Obamacare's Medicaid expansion, and Sprinkle thought his bill might have a chance to get the governor's signature given Sandoval's vocal opposition to congressional moves to repeal Medicaid expansion.
In his message, the governor said the proposal — dubbed Sprinklecare — "does not end the conversation about potential coverage gaps or possible solutions, including Medicaid-like solutions."
Nevada has about 600,000 people using Medicaid and the Medicaid expansion. About 11% of Nevada residents remain without any healthcare coverage.
"Given the possibility that changes in federal law may put Nevada's expanded Medicaid population at risk of losing their coverage, the ability for individuals to purchase Medicaid-like plans is something that should be considered in depth," Sandoval wrote. "If done correctly, the proposals in AB374 could provide a necessary safety net for those who may no longer have access to traditional Medicaid."
Sandoval is term-limited and cannot seek reelection in 2018.
10:30 a.m.: This article was updated with a statement from Nevada Assemblyman Mike Sprinkle.