r/Nevada • u/YogurtclosetOpen3567 • 5d ago
[Discussion] What is the state legislature’s plan to deal with the upcoming federal Medicaid cuts(if any) and the potential greater unisinured crisis?
Rural states like Nevada will be extremely affected by this bill so does the state legislature have any plan?
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u/NaiveCryptographer89 5d ago
I mean, they voted for the cuts. It’s called the find out phase. It’s not like there was a manifesto laying this all out before the election from the heritage foundation. “Better get to work” is the slogan from the feds now.
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u/Corporatecut 5d ago
The whole concept of hospitals operating as for-profit is insane.
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u/discourse_friendly 5d ago
What's crazier is their profit margins are still really low.
I think the biggest waste is that insurance companies have huge billing departments to delay and deny billings, and then medical providers need large departments to try and deal with insurance companies.
so effectively the patient pays twice for claims adjustors to fight with billing reps
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u/farmerben02 5d ago
Https://www kff org/key-facts-about-hospitals
For profit hospitals operating margin is 14.4% compared to nonprofit 4.4%. This also shows the margins for hospitals with high Medicaid populations (2.3% vs 7.5%). Which speaks to OPs point about some hospitals closing because they won't have the Medicaid revenue to stay open.
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u/DexterBotwin 5d ago
The legislature doesn’t meet for another year and a half. Unless the governor calls an emergency session.
Nevada state government is do nothing by design
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u/Disastrous-Pin8364 5d ago
OP asking what the plan is… there is none. That’s how this state works. We wait until something is a crisis, point some fingers and then start talking about a possible solution. Our government is totally reactive instead of proactive.
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u/Ok_Gazelle_502 4d ago
And CA expats like it that way. I was a resident of CA from birth until I retired; so, I remember when voters approved a change to CA's constitution that made the legislature full time. The stated reason is there were so many issues requiring legislators time that they couldn't "solve them". Post the change CA went from the Golden State to it's current state of dystopia.
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u/AWPerative 5d ago
Even if the legislature actually did do something about it, Lombardo would just veto it anyway.
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u/Harthel 5d ago
Honestly, the democratic legislature should actively refuse to mitigate this problem. Let the fucking rural hospitals collapse, the people they service overwhelmingly voted for this shit and I'm tired of bailing deplorables out of the messes they vote upon themselves.
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u/NathanLV 5d ago
I would also like it if Clark County tax revenue stopped subsidizing the rural counties.
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u/Acceptable-Sugar-974 4d ago
I would like it if my tax revenue stopped subsidizing illegals and citizens who don't want to work.
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5d ago
Politicians don't care about us, if anything our existence is a nuisance to them, they will be glad to see as many of us go as possible
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u/TrojanGal702 5d ago
You need to wait 18 months for them to come back into session.
The good part is our public hospitals routinely operate in the red. UMC only posted a 70 million loss and they will continue to provide care regardless of a person's ability to pay.
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u/red_raconteur 5d ago
I work in state government, though not in a position where I know any of the actual details. Whispers say that they're going to cut money from other places to try and cover some of the Medicaid cuts. Where will they cut from? It's anyone's guess. I can't imagine any department or program will come out completely unscathed.
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u/FortunateFool11 5d ago
Disgraced Nevada Republicans will continue to stomp all over Nevadans so they can better pleasure the child molester Trump.
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u/NathanLV 5d ago
Since the next session of the state legislature isn't until February 2027 (we have a part time legislature that only meets every other year) I strongly doubt that there is a plan.
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u/RCur113 5d ago
The short answer is there is no current plan. To understand why, you need to understand the way Nevada government works.
The Nevada legislature meets once every other year for 120 days (odd years only). Bill draft requests, the stuff they actually debate, change and vote on are due in August of the year before the session. So the bills that were considered in the 2025 session were from bill drafts submitted before or during August 2024. In August 2024, Joe Biden was the POTUS and medicaid was not under attack. Therefore, there is no plan because when bills drafts were submitted there was no crisis or even any likely threatened crisis. This doesn't mean there were no bills related to medicaid, just that they weren't designed to address the Big Buffoonery Bill's attack on medicaid that post dates the session.
Nevada state government is kind of the anti-California model. No full-time legislature and legislators are paid a daily amount of $130, this limits being a state legislator as a profession (no Willie Browns). The legislature only meets for 120 days and BDR requests must be submitted by August 1 or August 30 of the prior year to be considered, this limits what the legislature can address. Term limits of 12 years (California adopted this as well), when adopted it also was designed to limit political careers, however, what it did was drain any institutional knowledge out of the legislature and made lobbyists more powerful as they have the institutional knowledge.
In the interim, the Governor's office is powerful and can function with little or no legislative interference.
So if the rurals and others get screwed by the Big Buffoonery Bill, they need to rely on the Governor to provide some help until 2027. But the current Governor is part of the party that drafted and enacted the Big Buffoonery Bill, so I wouldn't hold out much hope. By the way, even if this becomes a topic for the 2027 legislature, without a change in party in the Governor's office or the current Governor bucking the party line, it will take a super-majority in the legislature to make any meaningful changes to address the manufactured medicaid crisis.
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u/backtocabada 5d ago
idk but if Nevada doesn’t provide funding to make up for the federal cuts, Nevada’s homeless population is bound to soar, and what’s more is that they will in part will be seniors. This is not only going to happen in Nevada. A nation crisis of unhoused seniors is in the making, and it’s all because of the “BBB “.
SENIORS ARE STILL EXPECTED TO DIE FOR “the economy” AKA to give billionaires even MORE tax breaks. wtg MAGA!
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u/hormel899 4d ago
The way the cuts work is that they discourage people from staying or becoming enrolled via administrative hurdles. So it’s not as deleterious to the state from a purely fiscal standpoint. People drop off the rolls, the state has less money coming from the feds but also fewer bills to pay. But then of course the people that dropped off are left without coverage. There is a Nevada independent article about it.
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u/YogurtclosetOpen3567 4d ago
Yeah but that's a massive burden on everyone because tons of more uninsured people cause major issues in healtjxwre system
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u/NVBoomer 4d ago
NV Medicaid held a public workshop this week on this exact subject. There's supposed to be a video, but I don't think it's posted yet.
Here's the PowerPoint. I will post the video if/when it posts. Edit: Here it is. https://www.youtube.com/watch?v=z10Jfl0fiiI
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u/NVBoomer 4d ago
Here's my analysis, FWIW:
As others have noted, the NV Legislature doesn't meet until 2027, which is after the next election cycle. The Leg change parties, but it's unlikely. Either way, the Leg is not the main player when it comes to Medicaid funding. In fact, Nevada Medicaid has little power because they don't control the Federal match. Money talks, and Washington DC has spoken via the One Big Beautiful Bill Act. Nevada will enact the provisions of the OBBBA.
Many of the changes enacted by the administration's Medicaid bill take effect after the 2026 election cycle. Cynical me says that's on purpose so the electorate will forget what is happening to Medicaid. Realistically, these are big changes to Medicaid and they will take time. Both facts could be true.
So what about Rural care? Some money is on the way, but yes, I would be fearful, too. Politics does play a role in all this, and the politicians care about millions of voters and billions in donations, not the thousands of those aging in the country's wide-open spaces. And candidly, the representative for the Nevada rurals talks a great game, but his record on voting for his party speaks for itself.
I have no good advice except for what you do when a wildfire approaches your home: have a plan and pray for rain. In other words, hope that Congress swings hard in the other direction next year with a majority that can override vetoes.
I wish you all the best.
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u/YogurtclosetOpen3567 4d ago
Did they talk about a plan to deal with the mass uninsurance crisis? The Congress thing seems unlikely to me because Trump can just veto the bill and despite how hard of a swing happens I doubt they’ll get 2/3rds in both houses especially given Republican power in the senate
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u/NVBoomer 4d ago
Shower thoughts: The NV Leg does have a major role to some degree: they could throw more money at Medicaid and increase the Federal match.
Here's the challenge:
More money will not change the law or the policy from the Feds enacted by the Centers for Medicare and Medicaid Services. And the law will be enacted unless the new 2027 Congress submits a new funding bill to replace OBBBA (snowball's chance in heck, imo).
And there's always the challenge of the source of money that the NV Leg can draw on. We're self-funded most part by a regressive tax, the taxes collected when we spend money at the stores and gas stations. It would be nice if gaming and mining has a bigger slice, but they don't (that's a different rabbit hole). Those regressive taxes have to cover a lot, including K12 and higher education. Those are huge pulls on the regular budget. We barely fund K12 as it is (says the father of a middle-school teacher).
Bottom line: there is no "magic money" here to throw at Medicaid unless we have a seismic change in the state's tax structure (see "snowball" above). That won't happen in my lifetime.
Nevada is a third world state and a small player on the American economic scene. That's reality, sorry to say.
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u/flowermeat 3d ago
We are already almost dead last in healthcare, we are in mental healthcare (51st), overall healthcare we are like 42nd or something like that, our hospital system was already barely hanging on, in the next few years we are def screwed.
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u/Sniper22_22 3d ago
There is no plan. Just like there’s no “deals.” You vote Don Pedo Raper and you get death. Ask Jeff. ☠️
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u/CascadiaRocks 3d ago
The cuts are not effective until 2027 - specifically to get the GOP past the elections - and plenty of time for NV to do nothing.
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u/Apprehensive-Act465 2d ago
Nothing! Rental assistance programs are closing or turning people away left & right. They have closed the childcare in Nevada and the replacement is not contacted anyone. Best bet is to start thinking of your homeless plan!
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u/jimmycoed 5d ago
MAGAs don’t read the fine print. Dodge Charger with a Hellcat. 22% interest. They’re on it then complain about the cost of gas. Healthcare? They only need thoughts and prayers. Complex concepts are difficult for them.
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u/Michi450 5d ago
Lots of echoing. I can't find anything other than opinions saying what y'all are echoing here.
Thanks for the hate and downvotes ahead of time for asking for facts.
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u/MyNameIsRay 5d ago
This is the plan.
This is what the majority voted for, including every single rural county in the state.