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But keeping some of the taxes in the Senate bill risks alienating conservatives. On Tuesday, 45 conservative groups and activists sent a letter to Republican Senator Orrin Hatch of Utah, the chairman of the Senate Committee on Finance, urging the Senate to repeal all Obamacare taxes. One cornerstone tax that could remain is the net investment income tax, which imposes a 3. The taxes most likely to be abolished directly impact consumers and the health industry, including a tax on health insurance premiums, the so-called Cadillac tax on high-cost employer-provided insurance and the medical device tax.

Another proposal being floated is to keep all the taxes from the Affordable Care Act, often called Obamacare, but to scale them back. A group of 13 Republican senators led by Majority Leader Mitch McConnell has not completed a full draft of the bill, but is sending pieces to the nonpartisan Congressional Budget Office to assess the impact of various provisions. Spokesmen for McConnell and Cruz declined to comment. A spokesman for Lee said he wants Republicans to abolish every tax that was included in a Obamacare repeal bill that Obama vetoed.

Since Obamacare became law in , Republicans have campaigned on repealing the program that extended insurance coverage to 20 million additional Americans through both subsidized private insurance and an expansion of Medicaid. President Donald Trump promised to eliminate the law on his first day in office, but Republicans, who control the White House, the House of Representatives and the Senate, have struggled to coalesce around a single plan.

House of Representatives last month.

50 Vetoes: How States Can Stop the Obama Health Care Law | Cato Institute

You are now logged in. Forgot your password? On Friday, Nevada Gov.

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Brian Sandoval vetoed a bill that would have made Nevada the first state in the nation to have a "Medicaid-for-all" health insurance option, striking the latest blow against Democrat-led efforts to expand government-run health care plans at the state level. The bill in Nevada—semi-seriously referred to as "Sprinklecare" after chief sponsor, state Assemblyman Mike Sprinkle D-Sparks —would have allowed residents who were otherwise ineligible for Medicaid the joint federal-state program is open only to low income residents and their dependents to purchase "Medicaid-like" plans offered by the state.

What President Obama Didn't Tell You About Obamacare

Even though the bill cleared both chambers of the Nevada legislation, there were many unanswered questions, including what those plans would have covered, how much they would have cost a not insignificant question since Nevadans making more than the Medicaid threshold would have had to purchase those plans without the assistance of federal subsidies , and how many people would have taken advantage of the new system.

It was the lack of detail—the final bill was a mere four pages long, perhaps a record for brevity in health care policy—that Sandoval said forced him to veto it. Despite the vote, he praised the bill's supporters for their "creativity" and acknowledged that some of the ideas offered by Sprinkle "may play a critical role in future healthcare policy.

Sprinkle said in a statement that he will reintroduce the bill next year.

'Promise Kept': The Senate Finally Votes to Repeal Obamacare

There's good reason to believe that we might not have to wait that long to see another, similar propose pop-up somewhere else. For supporters of government-run health care, Medicaid-for-all has several advantages over the types of single-payer systems that have been proposed in California and New York and previously passed in Vermont. Unlike those plans, which would sweep aside all private insurance in favor of government-run insurance, Nevada's proposal would have offered the Nevada Care Plan alongside private offerings on the state's Obamacare exchange.

The idea was to give an additional option to Nevadans who might earn too much to qualify for Medicaid but who otherwise might not be able to afford private insurance. With the Congressional Budget Office estimating that some 26 million Americans might lose their health insurance if the Republicans' healthcare bill becomes law, Sprinkle positioned his bill as a state-level alternative for those who could lose coverage, if and when Congress acts.


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The lack of specificity in Sprinkle's bill meant there were widespread fears of unintended consequences. Health care providers worried about reimbursement rates—a longstanding fight between providers and Medicaid—and warned that Nevadans who already have private health insurance could jump to the new public option if it was more generous, the Los Angeles Times reported.

In his veto message , Sandoval pointed out, correctly, that merely providing more coverage for people is not the same as giving them more health care. He also worried about disruptions to the state's current insurance market and the potential to drive doctors out of the state, again a consequence of Medicaid's lower than average reimbursement rate.


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  8. The bill also lacked a clear analysis of how many people would sign up for the new state-run insurance option and how much the state would have to pay for offering it. Those projections can be wrong, but signing the bill without knowing those details would have been foolish. Michael Schaus, communications director for the free market Nevada Policy Research Institute, said the veto is a welcome sign and called the Medicaid-for-all plan "an inferior government program" that wasn't a real solution for health care.

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    It's actually quite the opposite. As I've written before, progressives face many hurdles before being able to implement a single-payer system —or even a less expensive and less disruptive Medicaid-for-all system—anywhere beyond the bluest of states. Implementing a system that works and can be funded over the long-term is yet an even larger challenge. Still, there is something worth noting about the effort. Republicans spent most of the past decade out of power in Washington, D. They used that influence to block some aspects of Obamacare from taking root—most notably the expansion of Medicaid—but generally failed to do much in the way of crafting their own health policy ideas.