Gov. Brian Sandoval, a staunch opponent of the Affordable Health Care for America Act, said on Thursday that if the measure's expanded Medicaid options are indeed optional, Nevada may not opt in.
"The Supreme Court's decision indicates states will have an option to expand Medicaid, but additional guidance is needed in order to understand the penalties for not expanding the Medicaid program," Sandoval said in a statement on the ruling.
"Given what we know today, the governor does not intend to automatically accept the Medicaid expansion," the statement said. "These serious budgetary implications, including the impact on education spending, require further analysis - not just of the next biennial budget but of the long-term costs."
The Supreme Court ruling, issued Thursday, made clear that while the expansion of Medicaid can proceed, the federal government can't threaten to pull existing Medicaid funding from states that refuse to participate in the extended services. That, in effect, makes the health care act's expanded requirements an option like others within Medicaid, giving the states the freedom to decide whether they wish to participate in order to get the added funding.
Nevada participates in only a few of the optional Medicaid programs.
Sandoval's office said the state Health and Human Services Department expects an additional 49,000 Nevadans to enroll in Medicaid as a result of the mandate to have insurance. Those are individuals not currently in the program even though eligible. Sandoval said that would cost the state about $60 million over the next biennium.
An additional 20,000 un-insured children will probably join the Nevada Children's Health Insurance Program, adding another $11 million to state costs for the next budget cycle, he said. That program pro
Sandoval said other expansions to Medicaid could add some 72,000 more to the rolls and, although the federal government covers them for the first two years, the state would be responsible for its share in the future - nearly half the total cost of those added recipients.
Sandoval said that although he respects the court's decision, he believes that Congress should reform the law to "ease the serious burdens it places on the states and the nation's businesses."
Sandoval didn't initiate Nevada's participation in a lawsuit by 26 states challenging the constitutionality of the health care act, but he made it clear when he took office that he supported that lawsuit. As a former federal judge, he said, he believed that parts of the law - including its cornerstone, the individual mandate - were unconstitutional.
Nevada's participation in the suit was initiated by then-Gov. Jim Gibbons who, after state Attorney General Catherine Cortez Masto declined to so do, raised private money and volunteer legal representation to join the suit.