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We’re about to learn if Sandoval is sweet on SprinkleCare

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Nevada Gov. Brian Sandoval has two days left to decide whether to sign or veto the state's Medicaid buy-in bill. That proposal, which we've covered previously here at Vox, would make Nevada the first state to allow any resident to buy into its public insurance plan.

The bill passed the Nevada legislature last Friday. Sandoval, a Republican, now has until Friday at midnight to make up his mind, a spokesperson from his office told me. The governor spoke with a local reporter Tuesday, defending the bill against characterizations of "socialized medicine" but not offering a clear stance on the proposal:

I've been doing a deep dive in terms of the policy. I'm keenly aware that the repeal of the Affordable Care Act is pending in front of the US Senate, that's something I'm looking at in terms of what this bill will do. That bill is not — I think it's giving the impression that it's free medicine, socialized medicine, which it is not. It is providing people with at least an opportunity to at least buy into at 100 percent cost into the Medicaid system, and if I do decide to sign it, then it is subject to waivers by the CMS. Those are all things, all the different issues I'm thinking about, but I think it's important to be able to tell people what it is and what it isn't. It's an interesting concept, one that I'm taking my time to make sure that I've answered all my questions before I decide to take action on it.

Nevada State Assembly member Mike Sprinkle, who sponsored the bill, says he hasn't had any discussions with the governor since legislation passed the state Senate two weeks ago.

"It's not typical for somebody who isn't the head of the majority to have direct conversations with the governor and to lobby on bills," he says. "It would be slightly inappropriate. He's got the information. His staff was part of my working group on the bill. They know exactly what we're doing and what our goal is."

Seasoned Nevada politics observers, meanwhile, seem torn about what the governor will do. Jon Ralston at the Nevada Independent said on Twitter he "smells a veto."

Steve Sebelius, a columnist for the Las Vegas Review Journal, seemed more optimistic. He read the Sandoval statement as the governor "trying to get to yes."

Sprinkle has been in touch with Sen. Catherine Cortez Masto about federal waivers. If Sandoval does sign the Medicaid buy-in bill, it would still need approval from the Trump administration. States generally need waivers when they want to make big changes to their Medicaid programs.

Sprinkle says he spoke with staff in the office of Cortez Masto, a Democrat from Nevada, who offered the help with that process should the bill become law.

"They indicated that they would be quite interested in assisting us in getting the waivers," he says.

A spokesperson for Sen. Cortez Masto confirmed the conversation and the offer to help.

What does Mike Sprinkle think of the name SprinkleCare? I mentioned in my last story that given the assembly member's last name, some have begun to call the Medicaid buy-in plan SprinkleCare. The moniker appears to have stuck — showing up in news headlines and as a Twitter hashtag. I asked Sprinkle how he felt about the name.

"I think it's kind of funny," he said, laughing. "I'm mostly ambivalent about what people call it. In the bill, it's the Nevada Care Plan. If people want to give it a new name, I find that funny."

Chart of the Day

Changes in total and healthcare employment due to the American Health Care Act 2018-2025 The Commonwealth Fund

The Republican health care bill would cause the economy to lose 924,000 jobs over the next decade. Analysts from the Commonwealth Fund and George Washington University estimate that the steep cuts to health care spending would mean fewer jobs. Three-quarters of the lost jobs would be in the health care sector.

Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

Today's top news

  • “Cruz’s fragile alliance with GOP leaders now pivotal in health-care push”: “The Republican attempt to reshape the nation’s health-care system has grown increasingly dependent this week on the fragile alliance between Senate GOP leaders and a man they have clashed bitterly with for years: Sen. Ted Cruz (R-Tex.).” —Sean Sullivan and Kelsey Snell, Washington Post
  • “Trump Says Market Is Failing, but One Insurer Bets Big on Obamacare”: “The Obamacare insurance markets aren’t as shaky as President Trump seems to believe. On Tuesday, the insurer Centene announced plans to expand aggressively into the state marketplaces established under the Affordable Care Act. Centene said it intended to sell individual policies for the first time in Nevada, Missouri and Kansas, and to grow its presence in six other states, including Ohio and Florida.” —Margot Sanger-Katz and Reed Abelson, New York Times
  • “Administration Weighs How to Stabilize Exchanges Amid Insurer Uncertainty”: “The focus on stabilizing the Affordable Care Act’s individual marketplace comes even as Senate Republicans are struggling to reach consensus on a bill that would overhaul major parts of the ACA. As lawmakers and the federal government struggle with what to do, a key deadline is looming: Insurers in most states must file their requested 2018 premium rates next week.” —Mary Ellen McIntire, Morning Consult
  • “Michigan health director Nick Lyon, 4 others charged with involuntary manslaughter over Flint water”: “Attorney General Bill Schuette charged two high-ranking state health officials today in the fourth round of criminal charges in the Flint drinking water crisis. He also said he will be adding new, serious felony charges against four defendants who were charged earlier in the investigation.” —Paul Egan and Elisha Anderson, Detroit Free Press

Analysis and longer reads

  • “Descent Into Secrecy: Senate Health Talks Speak To Steady Retreat From Transparency”: “The extreme secrecy is a situation without precedent, at least in creating health law. Still, it’s not hard to see how we got here — and there is plenty of bipartisan blame to go around.” —Julie Rovner, Kaiser Health News
  • “How California made Obamacare work”: “While several states are fretting over potential health insurer shortages and lofty rate hikes for 2018 individual coverage, California's exchange seems to be a shining example of an insurance exchange gone right. Medicaid expansion, cost-sharing subsidies and a big marketing budget are keys to the state's success.” —Shelby Livingston, Modern Healthcare
  • “Hospitals Are Dramatically Overpaying for Their Technology”: “Health care is woefully underengineered. Too often, clinicians mold their work processes around the demands of multiple devices and health IT systems, yet those technologies don’t work together to serve their needs and the needs of patients. Using systems engineering, we can integrate technologies and build hospitals and clinics that ensure consistently safe, high-quality, and efficient care.” —Peter Pronovost, Sezin Palmer and Alan Ravitz, Harvard Business Review

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