$12 billion: That seems like a large sum of money. Yet look at all the programs stuffed in Governor Brian Sandoval’s (R) proposed health care budget. Medicaid. Mental health services. Nevada Check-up. The list goes on.
Is his budget stretched too thin? And how can President Donald Trump and Congress make it worse? Let’s take a closer look at how much we truly value health care in Nevada.

Last month, I asked two leading State Senators about how the Nevada Legislature was approaching the host of new federal challenges to the state budget. This week, I spoke with Senate Finance Committee Chair Joyce Woodhouse (D-Henderson) again to check in on how the budget is coming together.
Once again, the Affordable Care Act (ACA) looms large. President Donald Trump and U.S. House Speaker Paul Ryan (R-Wisconsin) are pushing their “repeal and replace” bill that risks decimating Medicaid and various other health care programs administered by states, but powered by federal ACA funds. Woodhouse stated that Nevada’s resistance remains bipartisan and strong.

Photo by Andrew Davey

“I applaud Governor Sandoval and the Legislature standing together in saying Nevadans’ health care must not be disrupted.” – Senator Joyce Woodhouse

So did U.S. Rep. Jacky Rosen (D-Henderson) during a press call with various Southern Nevada health care leaders last week. “We reduced our uninsured rate by 50%. We do not want to drop that.” Brian Brannman, Dignity Health’s Senior Vice President of Operations, agreed. He referred to Medicaid expansion as a “godsend” that resulted in lower costs and greater access to health care. He worried about the effects of undoing Medicaid expansion.

“Removing that safeguard will put people right back on the street.” – Brian Brannman, Dignity Health

Although Brannman did not address this directly, his comments alluded to another ongoing problem in Nevada: mental health care. The ACA has also ensured more funding for mental health, something that’s come in quite handy here in Nevada.
In 2013, the State of Nevada came under fire for the Las Vegas Rawson-Neal Psychiatric Hospital’s practice of patient dumping. That later revealed a much larger system-wide failure to care for Nevadans with mental illness. In 2015, Governor Sandoval and the Legislature agreed to take a major step to fix this by boosting mental health funding. But this year, Governor Sandoval has proposed a mental health budget that undoes much of what was done in 2015.
“That could be devastating. […] We can not cut mental health.” Woodhouse stated she’s not the only legislator who has deep concerns over Governor Sandoval’s proposed mental health cuts. She also explained how these cuts could be even more severe than they appear at first glance. The Nevada Department of Health and Human Services has suggested community health care providers can step up as the state steps back. But if Congress decides to cut ACA mental health care budgets, those community providers will likely be in no position to make up for state budget cuts.

“Governor Sandoval stepped forward [in 2015]. We can not roll back services on these people. They’re the most vulnerable.” – Senator Joyce Woodhouse

Rep. Rosen agreed, along with Bill Welch from the Nevada Hospital Association. He noted how Nevada had the nation’s highest uninsured rate before the ACA. Now, some 401,000 Nevadans have insurance via Medicaid or Nevada Health Link. He described his fellow health care industry professionals’ fears of uninsured Nevadans crowding emergency rooms for everything from severe mental illness to minor issues that otherwise should not be treated in the ER. Welch specifically stated his fear of Clark County being unable to pick up the tab for services that Trump and Ryan have singled out for severe cuts in their American Health Care Act ACA repeal bill.
Sandoval’s administration has already signaled state cuts in advance of potential federal cuts. ACA repeal, especially the way Trump and Ryan seem to want to do it, could result in a painful domino effect of budget cuts that lead to people being denied life-saving care.

Photo by Andrew Davey

“We save lives that way. We save money that way. We improve the quality of life by keeping people healthy.” – Rep. Jacky Rosen

“We need to have a heart when making these important decisions.” That’s how Rosen concluded her press call last week. State Senator Woodhouse agreed, though she also noted the Legislature’s requirement to “base our decisions on what is reality” as the June 6 sine die deadline edges closer… And the specter of ACA repeal and/or severe cuts to ACA federal funds loom.