Sandoval's embrace of Obamacare could hurt his national prospects. GOP governor 'all in' on ACA

In a Republican party that’s gone all out against Obamacare, Nevada Gov. Brian Sandoval went all in.

Sandoval is the only Republican governor whose state is both running its own health insurance exchange this year and expanding its Medicaid program under the health law. He’s arguably doing more to put the Democrats’ signature law into place than any other Republican.


But in fully implementing Obamacare, Sandoval faces a double-edged sword: He’s helping bring health care coverage to a state with the second highest uninsured rate in the country, while he may be hurting his national ambitions because he’s not actively blocking the president’s law.

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Sandoval has always maintained that he dislikes the health law and he’d like to see it repealed. But as long as it’s the law of the land, he says it is his job to make it work for the people of his state.

“I opposed the Affordable Care Act from its inception,” he wrote in an email. But he’s a former federal judge and in his view, once the Supreme Court upheld the legislation, “the Affordable Care Act became the law of the land.”

Even after sticking his neck out on Obamacare — which few others in his party would consider amid fear of a conservative backlash — Sandoval is overwhelmingly popular in Nevada. State lawmakers backed his Obamacare approach on a bipartisan basis, and he’s cruising toward reelection next year with no formidable opponent in sight.

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“Sandoval’s approval numbers are stratospheric, so it’s a very small group of folks who are concerned about it,” said Jon Ralston, the state’s leading political analyst. The objections came from those on the far right who “seized on that because they don’t believe Sandoval is conservative enough.”

On health care, Democrats laud him too.

“I don’t know what the politics are from his standpoint but I think it’s the right decision,” said Democratic Rep. Dina Titus, whose Nevada district has one of the highest uninsured rates in the country. “People are signing up, fortunately, in Nevada and the website is working pretty well. We’ve been very aggressive.”

Politically, it helps that Nevada is a “purple” swing state with the second highest uninsured rate in the country and especially high uninsured rates among Hispanics, a key constituency that Republicans hope to attract. That makes it easier for the Republican governor to carry out President Barack Obama’s law.

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But Sandoval, 50, is also seen as a GOP up-and-comer, and Obamacare implementation could crimp any national ambitions if the health law remains as unpopular with Republicans as it is today. There’s a hint of early 2016 vice presidential buzz around Sandoval, and Obamacare implementation could be a big negative.

“I don’t think most Americans know that he’s one of the only Republican governors to implement,” the law, said Republican strategist Ron Bonjean. Bonjean noted that Sandoval has been more vocal with his opposition recently, “and it seems like he’s really going exactly where his constituents want him to be.” He’s trying to “thread the needle,” implementing in his state, while being clear about his record of opposing the law.

Nevada was one of the states that went to the Supreme Court in an unsuccessful bid to have the Affordable Care Act struck down. Sandoval says he still wants the law to be “dramatically changed or repealed.”

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He’s ratcheted up his objections in recent weeks as Nevadans were among the millions of consumers who got cancellation notices from their insurance companies. “The fact is the president misled the American people when he promised they could keep their insurance if they liked it,” he said in the email.

Still, Sandoval has made decisions all along that differed from most Republican governors, who kept spurning much of a state role even after the Supreme Court ruling and Obama’s reelection.

States were supposed to run their own insurance exchanges but most GOP governors refused, forcing the feds to take on the job. Nevada is the only GOP-governed state running an exchange, although New Mexico Gov. Susana Martinez and Idaho’s Butch Otter are partnering with the feds this year and plan to run their own next year.

And once the Supreme Court made Obamacare’s Medicaid expansion optional at the state level, GOP governors split. Some high-profile ones like Rick Perry of Texas and Bobby Jindal of Louisiana have resisted. But at least eight Republican governors have also expanded Medicaid, including New Jersey’s Chris Christie, Arizona’s Jan Brewer, Michigan’s Rick Snyder and Ohio’s John Kasich.

Recently, Nevada rejected the White House’s administrative “fix” that allowed the states to let insurers extend policies that would have been canceled next year because they don’t meet Obamacare standards. The insurance department said it couldn’t do that, and Sandoval said “the only way to fix the problems resulting from Obamacare is for Congress to change the law itself.”

Sandoval’s overall approach to carrying out the law harkens back to his earlier career. He was a U.S. district court judge in Nevada for four years before becoming governor. Earlier, he was the state’s attorney general.

“Especially when the Supreme Court engaged, it was at that moment — him being a man of the bench and a former attorney general — [Sandoval said] this is the law of the land and so we chose to go our separate way, which I think was wise,” said Nevada Lt. Gov. Brian Krolicki, also a Republican.

“You have to deal with how the table has been set and I call that leadership,” Krolicki added, noting that Sandoval had taken heat for some of his decisions.

Both Sandoval and Krolicki argued that running an exchange in the state ensures that Nevada — not Washington —will make key decisions that affect Nevadans.

“The various changes and federal mandates included in this law compelled us to make decisions for the state to best navigate the shortcomings and failures of this law,” Sandoval said.

Like other states, the Nevada exchange got off to a slow start but has since found its footing. As of Nov. 30, 4,834 residents had selected health plans through the exchange, according to the exchange.

But the state has a large pool of people eligible for coverage.Twenty-two percent of residents are uninsured, the second highest rate after Texas, according to the Kaiser Foundation. More than 36 percent of the state’s Hispanic population is uninsured — one of the highest rates among states with significant Hispanic populations. And getting them covered could help Republicans make inroads with that constituency.

Obamacare implementation so far has flown pretty far under the radar in Nevada, said Bob List, a former Republican governor of the state. Numerous polls and reports have found similar confusion and apprehension across the country.

“Everywhere I go I hear that ‘the president said I could keep my plan’ and ‘I know it’s going to cost a lot of money,’ And ‘I wish they’d repeal it,’” List said. “That’s the general attitude of the people of Nevada and I think that uncertainty about the consequences applies to the governor’s and legislature’s approach as well.”

List says Nevada’s high unemployment rate and steep Medicaid bills are taking a toll — two factors that he suspects went into Sandoval’s decisions.

“Our state’s been through a tremendous crunch and the cost of Medicaid in particular has just spiked,” he said. “So I think he’s looking to try to protect the taxpayers in Nevada.”