Critics say plan to expand Medicaid to noncitizens could overstrain providers

Jannelle Calderon
Jannelle Calderon
Health CareLegislature

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State Sen. Fabian Doñate (D-Las Vegas) presented his highly anticipated bill looking to expand Medicaid to Nevada’s undocumented population Tuesday afternoon in a hearing that lasted nearly four hours. 

But the measure, SB419, met resistance from Senate Republicans who criticized the bill for the costs it would present to the state, security concerns and fears that an influx of new Medicaid users would overwhelm a health care system that is already struggling to meet demand.

“We have a lack of providers throughout this state. Our providers are burned out from COVID,” said state Sen. Jeff Stone (R-Henderson). “So why aren't we boosting our investment in Medicaid so that we can pay the doctors more and we can pay the hospitals more so that we don't have them on the brink of subsidizing and possibly closing their doors, especially in some of the rural counties?”

During the hearing, Doñate pushed back against those worries, saying that the measure would save money in the long run, given that the health care system is already bearing the brunt of care costs for residents who are underinsured or uninsured.

“The direct effect of expanding coverage can lead to better indirect effects of how that actually reduces costs over the long term,” Doñate said, citing Colorado’s experience expanding Medicaid to undocumented people. “I don't think it's easy to say, ‘Well, if there's going to be an enrollment of folks, there could be an increased cost of utilization.’ The utilization already exists. We're already paying for it.”

According to a presentation before the hearing by Patrick Kelly, president and CEO of the Nevada Hospital Association, Nevada’s 19 largest hospitals have about $1.26 billion in unreimbursed care each year from patients unable to pay their medical bills — including those under Medicaid and Medicare, and those who are uninsured, underinsured or undocumented. 

A 2019 Guinn Center report on uninsured populations in Nevada found that an estimated 210,000 Nevada residents (about 7 percent of the state population) were “unauthorized immigrants” or undocumented in 2017. It’s estimated that between 94,500 and 109,000 of them do not have health insurance and would qualify for Medicaid, and Doñate said that figure “continues to increase.” 

Sen. Robin Titus (R-Wellington) argued that not being able to access health care can affect anybody as provider shortages often mean long wait times to see a doctor even with insurance. 

“Access to care, or lack thereof, is not limited to any person, no matter how much you make, no matter what your insurance is, no matter where you're from, whether you're documented or not,” Titus said, noting that some of her constituents “can't get into care now. And you're asking us to now dilute that [care] so your constituents can get in and see a provider.”

Kelly said that individuals who are under Medicare and Medicaid, or are underinsured, uninsured or undocumented represent about 75 percent of the care provided by the state’s 19 acute care hospitals. He added that 13 percent of Nevadans are uninsured, and 83 percent of those uninsured people are eligible for Medicaid but do not take advantage of it.

Several of the doctors who presented alongside Doñate said that this group of underinsured or uninsured people tend to not receive primary care, therefore ending up in the emergency room with a worsened ailment.

“Primary care is life. It can mean the life of your family, it can mean the life of multiple families,” said Dr. Jose Cucalón Calderón, a pediatrics professor at UNR. “And access for everybody is something necessary, not only for all the right reasons. It's going to be cost effective.” 

Aside from the ambitious proposal to expand Medicaid coverage to undocumented people, the 56-page bill, also known as the Health Opportunities, Planning, and Expansion (HOPE) Act, has other key goals, Doñate said, including creating a way for Nevadans to access their health records directly from their provider anywhere and at any time.

The bill also proposes offering health care groups the ability to apply for tax incentives when they build facilities and hire doctors to attract more companies to the state.

During the bill’s first hearing, dozens of people lined up to testify in support and opposition. 

Joy Trushenski, a community member and former candidate for the Carson City school board, said she opposes AB419 because it is “unsustainable” as it would give taxpayer-funded Medicaid to people who are undocumented and “giving them free stuff will only encourage more illegals coming over our unsecured borders.”

Others in support of the bill argued that undocumented people work, pay taxes and contribute to their community, and they should receive some health insurance benefits. 

According to the IRS, people required to file taxes who do not have a Social Security number and are not eligible to obtain one, such as nonresidents, can request an Individual Taxpayer Identification Number (ITIN) to be able to file.   

Among the supporters were Annette Logan-Parker, founder and CEO of childhood cancer treatment center Cure 4 The Kids Foundation; Todd Sklamberg, CEO of Sunrise Hospital in Las Vegas; and Dr. John Hardwick, who works in the emergency room at Renown Health in Reno, among others. 

Asked about the bill's prospects, a spokesperson for Gov. Joe Lombardo has said on multiple occasions that the office is monitoring "all bills as they work through the legislative process and engage when we feel necessary." During the hearing, Doñate said the bill has been shared with the governor's office as well as Republican leadership.

Updated on March 30, 2023 at 9:45 a.m. to include comment from the governor's office.


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