Posts Tagged ‘s’

Heller Says Online Gaming Bill Should Not Be Political Football In Run-up To General Election

By Sean Whaley | 3:33 pm September 25th, 2012

CARSON CITY – U.S. Sen. Dean Heller today said online gaming legislation critical to the future of Nevada’s economy should be removed from the world of politics so partisan fights don’t “poison the water” for the bill’s future in Congress.

Heller, interviewed on the Nevada NewsMakers television program, said the legislation is too important to be subjected to political fights between himself and Senate Majority Leader Harry Reid between now and the Nov. 6 general election.

U.S. Sen. Dean Heller, R-Nev.

Reid earlier this month blamed Heller for failing to line up Republican support in the Senate for the measure.

Heller, R-Nev., is locked in a fierce battle with Rep. Shelley Berkley, D-Nev., to retain his Senate seat.

“So I believe at the end of the day, we’ll have the 10-15 (GOP) votes that we’re going to need in order to get a bill like this passed,” Heller said. “But we don’t need the politics playing in it today. And we don’t need to poison the water on this also.

“Let’s get the politics out of this,” he said. “Let’s put an important issue like Internet poker to the sidelines during this campaign because it isn’t helping the process. And unfortunately in this case, the process is just as important as the bill itself.”

Heller predicted that after the election, he and Reid will again work together on the Internet poker bill.

“The Internet poker bill was never going to pass before the election,” he said. “It’s going to happen. And I’m still committed, as is Sen. Reid, to get a bill passed.

“When this is all said and done, both sides are going to come together and say, ‘OK, let’s do what’s best for Nevada,’ ” Heller said.

Berkley also criticized Heller on the online gaming issue in a statement released earlier this month: “Once again, Senator Dean Heller has failed to deliver for Nevada’s hardworking families who were counting on online poker legislation to boost the state’s struggling economy and to create thousands of good paying jobs.

“Perhaps Senator Heller shouldn’t have spent so much time cozying up to Wall Street special interests by protecting tax breaks for corporations that ship American jobs overseas and more time doing what Nevada families expect of their elected leaders: putting people back to work,” she said.

During the interview, Heller also criticized Berkley for not spending more time in Northern Nevada in her Senate race, including failing to make any recent appearances on the NewsMakers program. Her last appearance was on Feb. 1, 2011.

“Well, as much time as I spend in Southern Nevada I think she should be spending some time up here in Northern Nevada,” he said.

Berkley has made several campaign appearances in Northern and rural Nevada, including stops in Churchill County over the Labor Day weekend. She also attended an event in Reno on Saturday.

When asked about Berkley’s ongoing ethics problems regarding the preservation of a kidney transplant program in Southern Nevada and whether her actions inappropriately benefited her physician husband, Heller did not hesitate to weigh in.

“She was ethically challenged before,” he said. “She was counsel, she was a lawyer, and she told her boss at this point that you’ve got to buy off county commissioners, you’ve got to buy off judges, you’ve got to hire their children into your business in order to get favorable treatment from those judges and from those county commissioners.

“Now she’s in the United States Congress and her activity hasn’t changed,” Heller said.

Heller was referencing a memo written by Berkley to her then Las Vegas Sands Inc. boss Sheldon Adelson that first surfaced in 1998 during her first bid for Congress. The memo has been the subject of a political ad critical of Berkley in her Senate race.

In response to the Crossroads GPS ad, the Berkley campaign told the Las Vegas Review-Journal in August that the episode was old news and has been overshadowed by Berkley winning re-election six times.

“Leave it to George W. Bush’s political director, Karl Rove, to dredge up something from two decades ago that voters made a judgment on during Shelley’s very first campaign for Congress,” campaign spokeswoman Xochitl Hinojosa, told the newspaper.

In the NewsMakers interview, Heller described her activities when working for Adelson as “trying to bribe judges and county commissioners” and the current controversy as “lining her own pockets as a member of the United States Congress.”

Heller was asked why he accepted $10,000 from Republican Sen. David Vitter, R-La., who is on Citizens for Responsibility and Ethics in Washington’s annual list of the “most corrupt members” of Congress as is Berkley with a “dishonorable mention” for a second year in a row.

Heller sidestepped the question, responding by saying, “how hard do you have to work to be on the most corrupt list two years in a row?”

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Audio clips:

Sen. Dean Heller says the Internet poker legislation is too important to be a political football in the November election:

092512Heller1 :24 the bill itself.”

Heller says Berkley’s ethics problems go back many years:

092512Heller2 :22 activity hasn’t changed.”

 

 

Nevada Leads Nation In Size Of Its Budget Gap, National Group Reports

By Sean Whaley | 3:33 pm December 10th, 2010

CARSON CITY – When it comes to the budget problems looming for many states over the next two years, a report released this week by the National Conference of State Legislatures makes one point very clear: Nevada is No. 1, and not in a good way.

The report identifies Nevada as having the largest general fund budget gap of all the states at 32 percent next fiscal year. The report, “State Budget Update, November 2010” shows New Jersey in second place with a 26 percent gap, and North Carolina with a 20.3 percent gap.

The news for fiscal year 2012-13 is even worse, with Nevada first again with a general fund budget gap estimated at 40 percent, followed by New York at 20.4 percent.

The report says 35 states are projecting budget gaps next fiscal year, and 24 states project gaps in 2012-13, due largely to the loss of federal stimulus funds in their current spending plans.

Nevada leads the nation in its unemployment rate and in its home foreclosure rate, factors which have helped create the budget gap.

“And while state revenues are starting to pick up, the growth is unlikely to be sufficient to replace expiring American Recovery and Reinvestment Act (ARRA) funds or cover projected increases in program areas such as Medicaid and K-12 education,” the report says.

States will face a $37.9 billion loss in federal funds next fiscal year, which begins July 1, 2011, compared to the current year, according to the Federal Funds Information for States. This is expected to make big holes in state budgets, what many state officials call the “ARRA cliff effect.”

Nevada is expected to lose about $600 million in federal stimulus funds that helped balance the current budget.

“State legislators are being realistic about the budget situations facing their states,” said William Pound, executive director of the National Conference of State Legislatures. “But how they balance their budgets could be filled with as many twists and turns as the latest Harry Potter movie.”

Nevada’s public school enrollments are expected to be nearly flat in the next two years, but the state’s Medicaid caseload is growing dramatically. General fund support for Nevada’s Medicaid program could increase by as much as 50 percent to $1.25 billion in the two-year budget that will be approved by the 2011 Legislature compared to the current budget.

Nevada is projected to have about $5.3 billion in general fund revenues to spend over the next two years, well below the current biennium. Gov.-elect Brian Sandoval said the revenue estimate means state agencies will have to cut about $1.2 billion from their two-year budgets.

Some Nevada lawmakers have called for tax increases as part of the solution for the general fund budget hole, but Sandoval has rejected any such suggestions.

Nevada’s budget problems are being made worse not only with the loss of federal stimulus funds, but because a collection of tax hikes approved by the Legislature in 2009 will expire on June 30 next year.

There was some good economic news for Nevada this week. The October gaming revenue report shows Nevada casinos took in nearly $889 million from gamblers for an 11 percent increase over October 2010. For the fiscal year to date, revenues are up 4.4 percent.

The NCSL budget gap estimates for Nevada were made before the state’s Economic Forum made its revenue projections on Dec. 1.

NCSL is a bipartisan organization that serves the legislators and staff of the states, commonwealths and territories. It provides research, technical assistance and opportunities for policymakers to exchange ideas on pressing state issues.

Nevada Medicaid Program Continues To Grow, Adding To State Budget Challenges

By Sean Whaley | 10:15 am December 9th, 2010

CARSON CITY – Despite the need for drastic spending reductions to balance Nevada’s budget, the government program that provides health care to the poor continues to expand, consuming a growing share of the state’s scarce state revenues.

Medicaid, the cost of which is shared by both the federal government and the state, could require about $1.25 billion in state general fund support in the upcoming two-year budget. That’s a spike up from the $835 million approved by the 2009 Legislature for the current spending plan.

The increase is due both to an ever rising caseload and the loss of federal stimulus funds that paid for a greater share of the Medicaid budget in the current biennium.

Unlike many other state-funded programs, the state must provide Medicaid coverage to those who qualify. Higher education funding can be cut and prison populations can be managed with early parole or alternative sentencing. While the state must also fund the public education system, enrollments are expected to be nearly flat because of the current economic situation in Nevada.

Medicaid has expanded significantly in the current economic slowdown, however, as more people lose jobs and become eligible for the government funded health care coverage. As a result, the program is consuming a larger piece of a shrinking budget pie.

The increasing cost of the Medicaid program can be seen in the caseload. The number of Nevadans receiving assistance totaled nearly 276,000 as of October. The caseload is expected to hit 311,416 by the end of the next biennium on June 30, 2013.

“That’s significant growth,” said Charles Duarte, administrator of the Division of Health Care Financing and Policy, which oversees Nevada’s Medicaid program.

In December of 2000, Nevada had a Medicaid caseload of 116,000, according to the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. In December of 2009 that figure had more than doubled to just over 238,000.

The foundation reported recently that from December 2008 to December 2009, Medicaid enrollment increased by 8.4 percent nationally. In Nevada, that number was 22.4 percent, the biggest increase reported by any state.

Gov.-elect Brian Sandoval, who will take office in January, recently traveled to Washington DC to discuss Nevada’s growing Medicaid costs with U.S. Sen. Harry Reid, D-Nev. Sandoval intends to balance Nevada’s two-year general fund budget without a tax increase, which could mean even greater reductions to the Medicaid budget than are already under consideration by the agency.

Duarte said that despite the increasing caseload, the agency is looking at reducing the cost of the program in the next two-year budget. Options are limited, however, since Medicaid is an entitlement program and people who are eligible must be served. The cuts are even tougher because of reductions already made over the past two plus years, he said.

Two general approaches to cost cutting are reducing or eliminating some services to recipients and reducing payments to the various medical providers who treat Medicaid recipients, Duarte said.

Nevada’s Medicaid program does offer some optional programs which can be cut to the adult population, he said. Under consideration are cuts to personal care services, which involve helping adults with daily activities at home, eye glasses and dentures.

“Final decisions aren’t made on a lot of this,” Duarte said.

There are other optional programs that could potentially be cut, including pharmacy coverage for adults, but such reductions could result in serious adverse consequences, he said. Cutting prescriptions could result in increased hospitalization, Duarte said.

Pharmacy coverage is a big factor in the Medicaid program, costing Nevada $81 million total in fiscal year 2008, according to the Department of Health and Human Services.

There are also potential legal challenges to program cuts if they could lead to people ending up in institutional care, Duarte said.

“We fully understand the effects on lives,” he said. “But we’re looking at a cash issue.”

Any budget cuts could also have an effect on the state’s employment situation, since Medicaid pays for many programs such as those that employ thousands of home health care aides, Duarte said. Most of Nevada’s Medicaid program is spent directly on care provided by private sector health care professionals, he said.

“It affects their revenues and the ability of those providers to pay people,” he said. “We’re a fairly big chunk of the health economy.”

Cutting rates paid to health care providers has its own set of issues, Duarte said.

Decisions at the 9th U.S. Circuit Court of Appeals, mostly involving challenges to reductions in California, could make such reductions difficult if they are challenged in court, he said.

“So there is a host of legal restrictions, dealing with the courts, judicial actions, as well as federal regulatory actions, that really restrict our ability to manage the budget in a crisis,” he said.

State Sen. Sheila Leslie, D-Reno, said there are no realistic options available to policy makers to cut Medicaid.

Nevada has one of the stingiest Medicaid programs in the country, and other states that are cutting Medicaid are making reductions to services that Nevada never offered to begin with, she said.

Cutting personal care services that keep Medicaid recipients in their homes will just shift costs to more expensive nursing home care, Leslie said.

“Any of the optional Medicaid programs that we have, if you eliminate them, there is a corresponding cost in another area that exceeds the cost of providing that optional service,” she said.

And the state has already made some payment reductions to health care providers, Leslie said. Further reductions could reduce access to care for Medicaid recipients as providers drop out, Leslie said.

About the only option is to seek more funding from Congress, unless there is an appetite to drop out of Medicaid entirely as outgoing Gov. Jim Gibbons suggested at one point earlier this year, she said.

Other states have also entertained the idea.

“It’s a very difficult problem,” Leslie said.

State Sen. Joe Hardy, R-Boulder City, said the reality is there will be painful cuts to education, Medicaid and other programs in the upcoming session because there just isn’t going to be enough revenue to continue to pay for all existing services.

But the problem with cutting state dollars to Medicaid is that the federal match is lost as well, so it costs the state as much as $2 or more in Medicaid funding to save $1 in state general fund support, he said.

The key to reducing Nevada’s funding for Medicaid is to create jobs and get people back to work, Hardy said.

“The most important thing we can do to decrease Medicaid expenses is get people back to work,” he said. “If we get people back to work, if our focus is on jobs in the private sector, where the jobs produce instead of use, anything we do that gets people to work will help us with our Medicaid budget.”

Several states have a program where employers can hire the unemployed and use the individual’s jobless benefits as part of the worker’s salary, Hardy said. It is an incentive for businesses to hire workers.

The last time Nevada’s Medicaid population declined was in the boom years of 2005 and 2006. Nevada now leads the nation in unemployment.

Heading off potential cuts to Medicaid reimbursement rates will be the top goal of the Nevada Health Care Association in the upcoming session of the Legislature, the group’s president said this week.

Charles Perry, president and chief government affairs liaison for the non-profit group, said the association will play a defensive position in the 2011 session in an effort to ensure adequate Medicaid funding to the nearly 50 non-profit and for-profit assisted living and nursing facilities that care for over 6,000 elderly and disabled individuals statewide.

Perry said the association was able in the 2010 special session in February to head off a proposed $10 per day per patient reduction in Medicaid reimbursements after it was shown the state would only save $3.60 because of the sizeable federal matching share of the program.

There has been discussion of a $20 per day per Medicaid patient reduction in the 2011-13 budget, he said.

Such a reduction would lead to some facilities having to close, Perry said.

“And it would also have a very detrimental effect on the issue of access to care,” he said.

According to a recent study published by the Mercatus Center at George Mason University and authored by University of Kentucky economics professor John Garen, a big part of the increased cost of Medicaid is the conscious decisions by many states to greatly expand who is eligible for the program.

According to research done by Matthew Mitchell, a research fellow with the Mercatus Center’s State and Local Policy Project, since 2001, 24 states have expanded their eligibility. In some of these cases, the expansion more than doubled the number of possible participants for the program.

Duarte said Nevada has not expanded its eligibility in any significant way so this expansion is not a factor driving the state’s Medicaid costs.

On a per recipient basis, Nevada’s costs are about in the middle of all states because the Medicaid population is smaller and there are fewer healthy people in the program, he said. Nevada is also a high health care cost state.

But on a per capita basis, Nevada historically has spent the least of any state on Medicaid, Duarte said.

“We run a fairly modest program from an eligibility standpoint,” he said.

Nevada has likely seen an increase in the percentage of people covered by Medicaid because of the economic downturn, Duarte said. Nevada is probably at about 10 or 11 percent now, but nationally the rate is higher at 14 percent to 15 percent, he said.

Audio clips:

Chuck Duarte, who oversees the Nevada Medicaid program, says caseload growth and the loss of federal funding is driving costs higher:

120810Duarte1 :07 issues for us.”

Duarte says the state is limited in its ability to reduce Medicaid spending in a crisis:

120810Duarte2 :18 in a crisis.”

State Sen. Sheila Leslie says Nevada’s Medicaid program is already stingy.

120810Leslie1 :12 to begin with.”

Leslie says cutting optional services just transfers the cost elsewhere:

120810Leslie2 :12 that optional service.”

State Sen. Joe Hardy says the key to reducing Medicaid spending is to create private sector jobs:

120810Hardy :26 our Medicaid budget.”

Health Care Association President Charles Perry says Medicaid reimbursement reductions could close some facilities:

120810Perry :17 access to care.”