CARSON CITY — Nevada's Republican governor has detailed to top White House staffers his concerns with a Republican bill to remake federal health care, including some scenarios that would pose major state budget shortfalls that the administration had not yet identified.
Gov. Brian Sandoval said Wednesday that he was grateful for separate phone calls with U.S. Health and Human Services Secretary Tom Price and White House deputy Rick Dearborn. But his discussions with those officials Tuesday did not allay Sandoval's trepidation of the proposal to rework and eventually cut back government-subsidized health care that roughly 1 in 4 Nevadans currently rely on.
"I don't know if I'd say we're becoming more comfortable; I'm appreciative of the fact that they're reaching out to us and really seeking specifics in terms of what the consequences would be to our state," Sandoval said. "In fact, there were a couple things we brought up that no other governors had brought up before — that was their exact words, so I was really proud of that."
Price held conference calls with governors across the country to promise them greater flexibility in planning Medicaid services and for the federal government to expeditiously consider any changes, Sandoval and his Chief of Staff Mike Willden said.
Dearborn personally called Sandoval about the GOP bill, saying "We hope you can be supportive, governor. What are your concerns?" according to Willden.
Sandoval said he told both Price and Dearborn that his primary concern remains protecting more than 300,000 Nevadans who gained coverage after he expanded Medicaid.
In states like Nevada that opted to expand Medicaid, the Republican proposal introduced in Congress last week would increase from 10 percent to 35 percent the share of Medicaid costs the state must contribute for every patient who enrolls after 2020.
Willden said Nevada sees roughly 25 percent of Medicaid participants mistakenly leave the system every year and later get back on, often due to paperwork delays or because they moved.
Not accounting for that turnover would speed up higher costs.
"I think that was a new piece of information to the White House that may not have been contemplated," Willden said.
Another provision of the House bill would base future Medicaid funding on states' 2016 patient statistics, which Sandoval said could drop Nevada's federal aid by as much as $300 million annually in coming years.
The proposed recalculation also does not consider the amount of health costs that are incurred in one pay period but filed or paid later, Willden said, putting states at risk of overrunning their federal allotments or inhibiting coverage options if cuts are drastic.
"This also seemed new to them," Willden said of Dearborn and other White House officials on that call.
Sandoval also told Dearborn he's worried there could be a lengthy wait list for parents to seek alternative federal assistance to insure children who would lose Medicaid coverage under the GOP proposal.
Preliminary estimates show 35,000 to 50,000 Nevada kids could be kicked off of Medicaid, Willden said. Their families would likely try to enroll them in a different government-subsidized program, Nevada Check Up, which Willden said currently covers 23,000 children at most.
"Can you double or triple the program and still have enough headroom to cover all those kids?" Willden said.
Additionally, proposed cuts to federal grants for preventative care — ranging from behavioral analysis to reducing obesity — would eliminate about $3 million for those services in Nevada, Willden said.
Sandoval spent at least 30 minutes on the phone with Dearborn and a few members of each of their staffs, including Willden.
The Nevada Department of Health and Human Services is studying the GOP proposal and exact effects it would have on the state. The governor will present and speak to that analysis when it's complete, expected later this week.
"We believe there's room for improvement in the Medicaid program and health care in general, but we don't want to do that by simply shifting the burden and costs to the states," Willden said. "This is a large change just like the Affordable Care Act was a large change; there are a lot of moving parts that states are trying to get a handle on."