Sam Morris / Las Vegas Sun
Wednesday, Dec. 12, 2012 | 12:08 p.m.
Gov. Brian Sandoval made ambitious promises not to raise taxes while expanding state health insurance for the poor, preventing cuts to state agencies and actually increasing money for K-12 schools, in a wide-ranging interview with the Las Vegas Sun editorial board Wednesday.
A day after he announced that he would expand Medicaid, the first Republican governor in the nation to do so, Sandoval cast the decision in a pragmatic light - a chief executive doing what he has to do to make sure the state functions.
“It’s no secret that I was opposed to the Affordable Care Act,” he said, singling out the mandate for individuals to buy health care as well as the potential cost to the state. He then pointed to spreadsheets, showing that the state would save $17 million over the next two years by expanding Medicaid to 78,000 additional Nevadans, largely because of mental health patients in state programs will now be eligible for Medicaid instead.
“It was very clear to me it was more prudent to opt in than not opt in,” he said.
He sidestepped questions about the human aspect and whether the state had a role to play in decreasing the percentage of Nevadans without health insurance, which is currently at 22 percent, one of the highest in the nation.
He said he wasn’t weighing this as an ideological consideration.
“I look at it this way,” he said. “The Congress passed the Affordable Care Act. I don’t really get into the theoretical piece of it. I get into the reality piece of it.”
With the Medicaid expansion and the Affordable Care Act implementation, the state’s rate of uninsured is expected to drop to 10.5 percent in two years.
The move will save money in the short-term, but will begin costing the state as soon as 2018 when the federal government starts shifting some costs to the states.
On top of it, Sandoval said he’d reduce the state’s payroll tax, though he didn’t say by how much. He also will ask the Nevada Legislature to begin charging Medicaid patients a co-payment for health care visits.
“It’s a co-pay. It’s going to be a small one,” he said. “But I believe that is the appropriate way to go on this.”
Sandoval faces a tight budget for next session. But even so, he promised to increase funding for K-12 schools.
“It’s not only how much you spend, but how you spend it,” he said. “It will be a combination of meaningful reforms and targeting the funding where you need it.”
He said reforms would include further changes to teacher tenure, adopting a common core curriculum and moving toward a different standardized test for graduation.
But on one of the major complaints of Nevada’s political establishment, that the state’s tax structure is broken and unstable, Sandoval took a cautious approach.
Sandoval said the state’s tax system is working well.
“We’re doing what I hoped we would do, which is growing our way out of it,” he said. “Our tax system is working. A part of eating it is working.”
Sandoval stopped short of explaining how all of his promises will pencil out to meet the constitutional requirement of a balanced budget. But he said it will be apparent when he releases his budget on Jan. 16.