State official: 10 percent of Nevadans will remain uninsured under health care reform

CARSON CITY – Even with the advent of health care reform, the director of the state agency that will implement parts of the Affordable Care Act said on Wednesday that 10 percent of the state population, or more than 313,000 residents, will remain uninsured in 2020.

Mike Willden, director of the state Department of Health and Human Services, told a legislative committee that the law sometimes called “Obamacare” will not cover undocumented residents and that some people simply will pay penalties rather than enroll in available programs.

Willden also told the Legislature’s Committee on Health Care that he does not yet know what it will cost the state if Nevada decides to expand its Medicaid program in 2014, when the federal law goes into effect.

Under the Supreme Court’s June decision, states have the option to offer this free health care program to citizens earning less than 138 percent of poverty-level incomes, slightly more than $15,000 for an individual.

Gov. Brian Sandoval has not decided whether he will back the expansion.

Now a single, childless Nevada resident cannot apply for Medicaid. About 71,000 residents have incomes that would make them eligible for Medicaid if it is expanded.

According to Willden’s figures, 21.3 percent of Nevadans, 581,485 people, now are uninsured. If the Affordable Care Act were fully implemented, that number would drop to 10 percent, 313,246, in 2020.

If the state decided against expanding the Medicaid program, then the uninsured rate in 2020 would be 11.4 percent. Besides using Medicaid, the Affordable Care Act calls for creating insurance exchanges to help the working poor find affordable health insurance.

Willden said the figures he used are estimates, made by actuaries and through talks with officials in Massachusetts, which implemented its own health care program under then-Gov. Mitt Romney.

While Willden said he does not know yet the extra costs the state would absorb, an advocate for the poor said the amount would be about $30 million a year.

Jon Sasser, a lobbyist for the Legal Aid Society of Southern Nevada and other groups, said it would be foolhardy for Nevada to refuse to expand the program to cover more poor people.

The state would receive about $300 million a year in federal funds if it expands, and that money would go toward hiring more people for medical care jobs.

“It is a real good deal for our state,” Sasser said. “It would help our economy and our citizens. Don’t get lost in the weeds. Look what our citizens get.”

Members of the committee said little as Willden went into detail about how the Affordable Care Act would work in Nevada.

“They are going to get health care somewhere, and it is going to be a big cost,” said Sen. Valarie Wiener, D-Las Vegas, when Willden mentioned that more than 300,000 people would remain uninsured.

According to the U.S. Department of Homeland Security, Nevada had 183,000 undocumented residents last year.

Willden said reports stating that the federal government will pay 100 percent of all Medicaid expansion costs for the first three years of the program are not entirely correct. Even with the new program, he noted, states must cover
50 percent of the administrative costs.

Also, the Affordable Care Act provides a 36 percent increase to primary care physicians who accept Medicaid participants in the first two years of the program.

After that, states must decide whether they want to continue that increase.

Starting in 2020, the federal government is supposed to cover 90 percent of the costs of the health care program.

Contact Capital Bureau Chief Ed Vogel at evogel@reviewjournal.com or 775-687-3900.