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Brian Sandoval, Nevada Governor, Is First Republican To Back Obamacare Medicaid Expansion

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Nevada Gov. Brian Sandoval is the first Republican state leader to embrace a Medicaid expansion under President Barack Obama's health care reform law.

As a result of Sandoval's decision, 78,000 poor Nevadans will gain Medicaid coverage starting in 2014 and the state will save $16 billion because of generous federal funding for the program, Sandoval told the Associated Press in an interview Tuesday. The national health care law seeks to expand Medicaid to anyone who makes up to 133 percent of the federal poverty level, which is $14,856 for a single person this year. The federal government will pay the full cost of enrolling these newly eligible beneficiaries from 2014 to 2016, then gradually dial down its share until it reaches 90 percent in 2022 and beyond.

"All in all, it makes the best sense for the state to opt in," Sandoval told the Associated Press, citing the federal funding, savings on rolling back duplicate programs currently financed by the state and the costs to Nevada health care providers of treating people who lack health insurance.

Sandoval also emphasized that he didn't support the enactment of Obama's health care law, known as the Affordable Care Act, according to the Las Vegas Sun.

"Though I have never liked the Affordable Care Act because of the individual mandate it places on citizens, the increased burden on businesses and concerns about access to health care, the law has been upheld by the Supreme Court," Sandoval said in a written statement. "As such, I am forced to accept it as today’s reality and I have decided to expand Nevada's Medicaid coverage."

When the Supreme Court affirmed the rest of the health care reform law in June, it allowed states to opt out of the Medicaid expansion. So far, nine Republican governors, most recently South Dakota's Dennis Daugaard, have said they won't extend the program to their poor residents. Including Nevada, 15 states and the District of Columbia are now committed to the Medicaid expansion. All of those jurisdictions are run by Democrats except Rhode Island, whose governor, Lincoln Chafee, is an independent.

Governors who oppose the Medicaid expansion and some who haven't declared a position cite costs as a concern. According to an analysis by the Urban Institute and the Henry J. Kaiser Family Foundation, however, if every state expanded Medicaid, total state spending would rise $76 billion between 2013 and 2022, a 2.9 percent increase, while more than 20 million people would gain coverage. The federal government would pay the remainder of the total $1.03 trillion cost of a nationwide Medicaid expansion, according to the study.

Sandoval also is one of just five Republican state officials who plan to adopt another key component of Obamacare's expansion of health coverage to as many as 30 million people. Nevada will create a state-run health insurance exchange under the law. The health insurance exchanges will be online marketplaces where small business and people who don't get health benefits at work can comparison shop for health plans and learn whether they qualify for federal tax credits or Medicaid benefits. Idaho Gov. C.L. "Butch" Otter (R) announced Tuesday that his state would manage its own exchange, joining GOP officials in New Mexico, Iowa and Mississippi.

States have until Friday to inform the Department of Health and Human Services of their plans for the exchanges. States can create their own, partner with the federal government or leave the task to federal authorities. So far, 19 states and the District of Columbia will run exchanges while the federal government will manage exchanges in 21 states, according to the Kaiser Family Foundation. Six states plan to operate exchanges in partnership with the federal government.

Florida, Indiana, Pennsylvania, Utah and Virginia and the only states that haven't announced their intentions. Among those, Virginia and Indiana have indicated they will not build state-run exchanges and Utah Gov. Gary Herbert (R) asked Obama on Tuesday to approve his state's existing health insurance exchange despite its smaller scale.


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