A Penny Saved Is a Billion Lost—

If You Ask a Politician

Congressional Republicans have turned their attention to Medicaid, and naturally, the folks in Nevada’s halls of power are wringing their hands and predicting doom. State officials warn that if the federal government stops doling out matching funds for low-income folks, the Silver State stands to lose a whopping $1.9 billion over the next two years—which, by politician math, means we might as well start digging mass graves now.

The expansion–originally dreamed up during President Obama’s administration, has since wrapped its comforting arms around 800,000 Nevadans—roughly one in four residents—and now, like any government giveaway, it has become something between a birthright and a sacred cow. State Senate Majority Leader Nicole Cannizzaro all but sounded the bugle for the death of public services, warning that if the feds tighten their purse strings, the state budget will have to follow suit, and dear reader, that is the one thing a politician loathes above all else.

But let’s not get carried away. These so-called cuts are not cuts at all. The Trump administration is simply shaking the dust and varmints out of the federal wallet, hoping to trim some of the waste fattening up on Medicaid dollars since the program’s expansion. It’s a bit like discovering your horse eats twice as much as it works—at some point, you have to ask whether you’re running a ranch or a charity for lazy livestock.

The House budget could lead to $880 billion in reductions, which Representative Steven Horsford says is a tragedy since his grandmother once faced trouble due to Medicaid cuts. An honest man might ask if it’s good governance to run the country based on one man’s grandmother, but honesty and Congress have rarely been seen in the same room together.

As it stands, the federal government currently covers 90 percent of Medicaid costs for the expansion population. A new plan would dial that back to around 60 percent—leaving Nevada with a tab of $6.7 billion over nine years. It’s the sort of arithmetic that sends state lawmakers into a cold sweat and suggests they might have to make tough choices instead of merely blaming Washington.

The Affordable Care Act allowed Nevada a chance to expand Medicaid, and for a while, the uninsured rate tumbled from 22 percent to 12 percent. But as anyone with a lick of sense knows, free things don’t stay free forever.

With budget hawks in Congress sharpening their knives and Nevada officials clutching their socks, the only certainty is that before the dust settles, there’ll be enough grandstanding to make the Fourth of July parade look humble.