Nevada Governor Brian Sandoval says a few remarks before introducing presidential hopeful Mitt Romney, Tuesday May 29, 2012. ( Christopher DeVargas )
By David McGrath Schwartz, Las Vegas Sun and U.S. News Agency / Asian
Gov. Brian Sandoval might have endorsed Texas Gov. Rick Perry for president and calls him a friend. But on policy, he’s no Rick Perry.
One example: Nevada is well on its way to setting up an exchange for individuals and small businesses to buy health insurance. Nevada is one of 14 states with legislation to create a state-based exchange, according to the Kaiser Family Foundation.
The Silver State Health Insurance Exchange has received $24.7 million in federal grant money and is firmly established. Its board has formed committees to figure out how to license “navigators” to help individuals buy insurance and how to fund the system when federal grants run out.
The Nevada law establishing the exchange passed without opposition and was embraced by Sandoval.
Perry, who Sandoval initially endorsed for president before dropping out of the race, has long been a foe of what critics call “Obamacare.” And last week Perry upped the conservative ante by announcing Texas would refuse to set up a health insurance exchange — a key provision in the health care law.
Perry also will refuse to expand Medicaid coverage to people making up to 130 percent of poverty level — one of the ways the Affordable Care Act envisioned helping a large number of low-income people comply with the mandate to carry insurance.
He’s not the only Republican governor to reject the expansion of Medicaid. Bobby Jindal of Louisiana, Rick Scott of Florida and Nikki Haley of South Carolina also are refusing to expand Medicaid.
Unlike his GOP cohort, Sandoval is still weighing that decision but has expressed concerns about the costs of the expansion. He is waiting for further analysis from health and human services staff.
But Sandoval didn’t waver when it came to setting up the Silver State Health Insurance Exchange.
The Sandoval administration noted that if states don’t set up the exchanges, individuals and businesses will still be able to participate, but on a system operated by the federal government.
While Sandoval opposed the Affordable Care Act on the grounds he believed it was unconstitutional, he said in his 2011 State of the State address that he would push forward with the exchange.
Nevada “must also plan for a health insurance exchange so that we — and not the federal government — control the program,” Sandoval said in the speech.
His spokeswoman, Mary-Sarah Kinner, said, “The Governor believed then, as he does now, that this course is more prudent for our state than the alternative — the risk of a federally imposed exchange that comes with a yet-to-be-determined federal price tag.”
She added: “The governor believes that each governor needs to decide what is in the best interest of his/her state.”
Federal grants will pay for the operation of the exchange through 2014, but by 2015, it’s expected to be self-sufficient.
Those constructing the exchange are crafting ways for the program to cover costs between $16 million and $22 million a year. The solution will likely be to charge insurance carriers a fee for people who buy a plan through the exchange. The monthly fee is expected to be between $7.36 and $11.50 per patient.
If the state opted to let the federal government design the program, carriers would likely be subject to a similar fee determined by federal officials instead of the state.
State Sen. Ben Kieckhefer, R-Reno, said keeping the exchange in state hands fits with Nevada’s character:
“It’s part of a long-standing Nevada ethos that says we’d rather make our decisions, with our citizens, for our citizens, rather than have the feds make them for us. That’s in line with what Nevadans expect.”