One of four questions before the Supreme Court was whether the requirement that states expand eligibility for the Medicaid program to all persons below age 65 with incomes up to 133 percent of the federal poverty level (FPL)-[$14,856 for an individual/ $30,656 for a family of 4] violates the 10th amendment to the Constitution. The Court found that Medicaid expansion is a valid exercise of Congress's spending power but that Congress cannot require states to accept the expansion (see article below). In other words the expansion becomes a state option. If the state chooses to expand Medicaid, the federal government must provide the promised funding and can enforce the rules for the expansion group. However, Congress cannot "coerce" the states into accepting Medicaid expansion by conditioning the receipt of funding for the current Medicaid program upon acceptance. The battle now shifts to the Governor and the Legislature as to whether Nevada will take advantage of the offered funding. I do not see ACA as coercion, but as a great deal for Nevada. The federal government will pay initially pay 100% of the cost for these newly eligibles (estimates range between 91,000 - 127,000 for SFY’ 2015). In 2016 when the state share will pay 5% which will gradually climb to 10% by 2020. The average benefit would be $3,600 per recipient per month ($350 million - $450 million annually). The only increased costs would be relatively small amounts for administration and to cover enrollment of persons already eligible for the program (the “woodwork”). The much larger influx of federal dollars will not only improve our health but decrease the cost of private insurance to all and boost our economy at a time when we desperately need it. Ironically, if Nevada rejects Medicaid expansion, we will create a two-tiered system of healthcare. Many below 100% of the FPL will remain uninsured with no financial help. Persons with incomes between 100%-400% of FPL will be able to purchase health insurance on our newly created exchange with a subsidy from the federal government. My hope is that we can all work together to make sure that Nevada does not blow this opportunity. GOVERNING The States and Localities Supreme Court Ruling: Uncertain Future for Medicaid Expansion? BY: Dylan Scott | June 28, 2012 One portion of the Supreme Court’s 5-4 decision to effectively uphold the Affordable Care Act (ACA) could have profound implications for the law’s goal of universal health coverage: it appears states could opt out of raising their Medicaid eligibility standards to 133 percent of the federal poverty level in 2014 without losing their existing federal Medicaid funding as a result. The ACA’s Medicaid provision is expected to extend coverage to up to 17 million people within the next decade. But the teeth of the provision, as originally conceived, was that the law gave the U.S. Department of Health and Human Services (HHS) the authority to withhold some or all of a state’s federal Medicaid match (between 50 and 75 percent of each state’s spending for the program) if the state did not adopt the new eligibility standards. Chief Justice John Roberts, writing for the 5-4 majority, declared that the Medicaid eligibility expansion is constitutional, but that it is unconstitutional for HHS to withhold existing federal Medicaid funding for states that don’t comply. That could neuter the Obama administration's ability to enforce the expansion. "Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use,” Roberts wrote. “What Congress is not free to do is to penalize states that choose not to participate in that new program by taking away their existing Medicaid funding." HHS will provide 100 percent of new spending for the newly eligible population, under the ACA, and that match declines to 90 percent by 2020. The expansion is a major part of the law's goal of universal health insurance, covering more than half of the 30 million people expected to receive coverage under the law as a whole. It would appear, however, that states could not participate in the Medicaid expansion without facing any financial penalty. "The ruling, in effect, makes the ACA’s Medicaid expansion optional for states," said Matt Salo, executive director of the National Association of Medicaid Directors. "States will now have to make a series of decisions moving forward. Those include the political, fiscal and policy calculations of whether or not this particular expansion makes sense." The expansion's impact is substantial: some states, such as Nevada and Oregon, would experience up to a 60 percent increase in their Medicaid enrollment under the expansion. California and Texas would add up to 2 million new enrollees, according to the Kaiser Family Foundation. A few states—including Florida, Maine and Texas—have already floated the possibility of opting out of the Medicaid expansion. Applications from Florida and Maine to reduce their enrollment have already been rejected by the Obama administration, which cited the ACA. Given the wording of the Roberts decision, it would seem those states, and others, might now have an opening to pursue that option. On the other hand, eight states have already taken an offer of enhanced funding from HHS to implement the ACA's new eligibility standards early, according to the Kaiser Family Foundation. It seems likely that at least some states will seize the opportunity for federal money to expand their Medicaid coverage. "For many states, it's going to be very difficult for them to leave that money on the table," said Linda Blumberg, health economist and senior fellow at the Urban Institute. "I think is going to be considerable financial pressure, both from providers and the reality of state budgets, to go with this."

SUPRME COURT DECISIONS Our system of government is based upon checks and balances. This week our third branch of government's highest court, the United States Supreme Court, has and will deliver decisions which are landmark. The constitutionality of the Affordable Care Act is set for a decision this week. On Monday, the Supreme Court: Struck down, in a 5-3 vote, the Arizona Immigration law. Iimmigration is a contentious political issue. Governor Sandoval stated that there is no need for an 'immigration law ' in Nevada-- nevertheless immigration law is in need of reform on a federal level. In a "narrowly divided ' 5-4 decision, the Supreme Court reaffirmed the landmark 'Citizens United 2010 decision which allows a " free- speech right of companies and unions to donate unlimited amounts of money for and against candidates with little as to framing transparency". This decision is a blow to campaign finance reform and transparency in campaign finance. In an ideological split decision 5-4 the Supreme Court decision said that federal judges and juries could allow consideration of a juvenile's age when sentences for some of the harshest crimes -- state judges could sentence a juvenile to life without parole, however federal laws cannot automatically impose a life without parole sentence.

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CLARK COUNTY SCHOOL DISTRICT NEWS RELEASE

For Immediate Release	June 8, 2012
Contact Cynthia Sell, (702) 799-5304
CCSD Board of Trustees approves resolution for a capital improvement program request on the November ballot LAS VEGAS – At a special meeting on Friday, June 8, 2012, the Clark County School District (CCSD) Board of Trustees approved a resolution for a question to go before voters in the general election on Tuesday, November 6, for a capital improvement program (CIP) primarily to renovate older schools. The proposal will be for a program of up to six years, projected to raise $669 million for school rehab/modernization, HVAC, electrical, technology and other equipment needs. The funding would come from a $0.212 (twenty-one point two cents) increase in property tax per $100 of assessed valuation that would provide for school needs on a “pay-as-you-go-basis” as funds become available over time, if no further declines occur in local assessed property values. The proposed CIP would take effect July 1, 2013, and CCSD would begin to see revenues from the program in Oct. 2013. The trustees selected the “pay-as-you go” option, which will allow all the funds to go directly to school needs without the issuance of bonds or related debt. The board action comes at a time when school improvement funds are ending from the 1998 bond program, which provided 101 new schools, 19 replacement schools and more than $1.6 billion worth of school improvements. A School Improvement Committee, formed by former Nevada first ladies Sandy Miller, Bonnie Bryan, Dema Guinn and Dawn Gibbons, will lead the efforts to support the capital improvement program.         The list of schools targeted for the CIP, if it is approved, may be viewed at http://ccsd.net/resources/facilities/pdf/proposed-capital-improvement-plan-2012.pdf. If any new or replacement schools become feasible in the CIP, regulations and conditions at that time will determine the locations.
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Office of the Superintendent - Communications Office - 5100 West Sahara Avenue, Las Vegas, NV 89146