Nevada’s needy would give thanks for Medicaid

It's decision time for Gov. Brian Sandoval.

Up until Nov. 6, there was a chance the Patient Protection and Affordable Care Act (otherwise known as "ObamaCare") might be repealed. That chance died with Mitt Romney's loss in the presidential race.

And that means Sandoval must decide whether he'll expand the state's Medicaid program under the Affordable Care Act, extending health care coverage to an estimated 71,000 Nevadans in the process.

Back in July, I reported that while the federal government will pick up 100 percent of the medical costs of newly insured people, there were other costs to consider. The state splits administrative costs 50-50 with the federal government. State officials are not saying publicly what their estimates of an expanded Medicaid system might be.

But we know that of the estimated $88 million it will cost to pay for people currently eligible but not yet on the Medicaid rolls, the vast majority of that cost - $78 million - represents medical expenses. Remember, in an expanded Medicare system, the federal government will pick up all the medical expenses for newly eligible people, so the additional administrative expense won't be nearly as high.

Sandoval is certainly under no obligation to expand the Medicaid program; the U.S. Supreme Court's ruling determined the federal government could not force states into the program by holding current Medicaid funding hostage. States including Florida, Oklahoma, South Carolina and Louisiana have decided to reject an expansion, while states including New York, California, Massachusetts and Oregon have decided to expand.

Sandoval has been asked repeatedly, but he says he won't make a final decision until his budget is prepared for the Legislature.

But let's be honest: There are more reasons in favor of expanding the program than there are against it, so Sandoval should do it.

First, and most important, expanding the program will save lives.

It doesn't take a Harvard University study to know people with access to health care have a greater chance of avoiding illness, or recovering once they get sick, than those who don't.

There is, however, such a Harvard study, concluding that an expanded Medicaid program saved lives when compared with states that haven't expanded the program.

Second, the cost. While there will be additional money spent, it's still cheaper than using our emergency rooms as primary care clinics.

Third, the only real argument against it is that introducing so many new people into the system could result in less access for everybody, with doctors already declining to see Medicaid patients because of low reimbursement rates. (Instead, some conservatives advocate a voucher-style system that pays Medicaid rates for doctors who accept the program, or higher fees for those who don't. Anybody want to guess who gets to make up the difference when the voucher runs short?)

A smart solution here is to make sure reimbursement rates fairly compensate doctors for their care, not to gut the system for everybody.

Fourth, Sandoval has shown himself to be a moderate, someone who's unlikely to reject an expansion of Medicaid for purely partisan reasons.

The governor has already moved forward with a state-based insurance exchange, another feature of the Affordable Care Act.

There's more evidence to show he's inclined to expand the program than he is to reject it.

Plenty of people will be affected by Sandoval's decision, especially lower-income Nevadans who need health care. Let's hope Sandoval won't disappoint them.

Steve Sebelius is a Review-Journal political columnist and author of the blog SlashPolitics.com. Follow him on Twitter (@SteveSebelius) or reach him at (702) 387-5276 or ssebelius@reviewjournal.com.