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Are Dems ignorant, or too cowardly to back Obamacare’s Medicaid provision?

Hugh Jackson
Hugh Jackson

After the Supreme Court ruled states didn’t have to expand Medicaid coverage as initially required under Obamacare unless they wanted to, the attorney who represented Nevada’s challenge to the law was noncommittal.

Mark Hutchison, also a Republican candidate for the state Senate this year, preferred not to say whether Nevada should expand Medicaid until he had a chance to more closely analyze the costs and benefits. The important thing, Hutchison said, was that states be allowed to make the choice on their own instead of being forced to expand the program.

Hutchison’s point appeals to the right-wing’s hostility to federal government.

But as a practical matter, it’s silly. There is little in recent history to indicate that a Nevada governor and Legislature would take steps on their own volition to cover tens of thousands of low-income Nevadans who have no health insurance

Brian Sandoval says he’s not inclined to expand Medicaid. Even though the federal government will pay 100 percent of the costs for the first three years, and then never less than 90 percent of the cost thereafter, Sandoval says the state can’t afford any additional costs. He couldn’t be more wrong.

But he’s not alone. April Mastroluca, the chair of the Assembly Health and Human Services Committee, sounded positively Sandovalian when, citing additional cost, she told the Review-Journal, “I don’t think it would be in our best interests to expand right now.”

In other words, the Democratic chair of the Assembly Health and Human Services Committee is less open-minded about providing health-care coverage to low-income Nevadans than the Republican lawyer who wanted the Supreme Court to scrap the law in its entirety.

The Democrats slated to lead their party in the Legislature when it meets next year, Assemblyman Marcus Conklin and Sen. Mo Denis, are only slightly less feckless studies in Nevada Democratic futility. Displaying the same timidity that precludes them from taking positions on the initiative to establish a broad-based business tax, Conklin and Denis are evasively echoing Hutchison’s wait-and-see approach.

Under Obamacare, people who make between 100 percent and 400 percent of the federal poverty level, but who don’t have insurance through their employer, can buy into their state’s insurance exchange — sort of an Expedia for health insurance — and receive subsidies to keep their costs low. People who make 133 percent of the poverty level or more must prove they’ve got coverage, or pay a penalty.

People who make less than the poverty level, however, are not eligible for subsidized coverage on the exchange. Under the law, Medicaid was supposed to cover those people. Then the Supreme Court ruled differently.

Medicaid historically has been limited to single mothers, some senior citizens, the disabled and a few other groups. Low-income adults without children at home have not been eligible. And those are the folks who will fall through the cracks if Nevada doesn’t expand Medicaid.

University Medical Center, the county hospital in Las Vegas, provides more than $70 million in care to uninsured people every year. Taxpayers pick up the tab. The financial burden of providing care to uninsured at UMC, as well as Nevada’s for-profit health-care providers, is also shifted to everyone else through higher insurance premiums and higher treatment costs.

That’s why Harry Reid told KNPR last week that Nevada would be “foolish” not to expand Medicaid.

Rob Lang of Brookings Mountain West, Larry Matheis of the Nevada State Medical Association and others have also noted that not only would Medicaid expansion save Nevadans money (a constant concern) while providing health-care coverage to people who have none (a humane concern). It would also be good for the economy. Simply, the federal government would send hundreds of millions of dollars to Nevada. Lang told the Las Vegas Sun that Medicaid expansion could translate into as many as 40,000 jobs in Southern Nevada.

And it’s not as if Nevada has maxed out its taxing capacity. As one of only three states with no form of tax on business income or profits, Nevada could raise the money to pay its share of the cost of expansion — which is miniscule compared to the money the feds would send to the state — with no discernible impact whatsoever on the bottom lines of Walmart, Wells Fargo, R&R Partners and the rest of the deep-pocketed companies that pay no significant taxes around here.

Sandoval is reportedly not an idiot, so presumably he knows all this. But he is also a politician and committed to the inane “no new taxes” gibberish that is far more cherished by the Republican base than practical policy reflecting a thoughtful consideration of facts. So that’s his excuse.

But what of Conklin, Denis and, sigh, Mastroluca? Are they economically ignorant, or just too cowardly to buck politically fashionable anti-government claptrap?

Democrats are notorious for lacking confidence in their own ability to make an argument, so they routinely let arrogant right-wingers frame the narrative, especially with respect to economics.

But if the weight of logic is going to prevail on Sandoval so he can do the right thing for his state and its people and back Medicaid expansion, he’ll need some political cover. Specifically, he’s going to need a public that understands the practical benefits of the policy. And that’s going to be hard to come by if wimbley-wombly Democratic leaders don’t get their heads out of their asses and into the game.

HUGH JACKSON blogs at The Las Vegas Gleaner ( and contributes to KSNV Channel 3.