Editor: Janine Hansen

November 2017, In the Year of Our Lord                    

Volume 43, Number 10

Happy Thanksgiving !


 Important Health Care/Illegal Alien Issue for Campaigns 2018

Lawmakers plans will bankrupt hospitals

AJR14 is an important campaign issue for 2018. The Legislature will vote on AJR14, which passed in the 2017 session, again in the 2019 session because it is a Constitutional Amendment. It is important to defeat it at the Legislature because big money will be used to pass it in 2020 when it goes to a vote of the people at the general election. AJR14 will bankrupt hospitals, limit access to medical care for Nevadans while insuring illegals have health care.

AJR14 Makes Emergency Medical Care to All Persons in this State a Constitutional Right

(Of course, including Illegal Aliens)

 Federal and state laws already require hospitals to provide emergency medical care regardless of the ability of the person to pay and regardless of whether the person has health insurance.  This federal law has caused a crisis in California where “a large percentage of hospitals are losing money; hundreds of medical clinics have closed or gone bankrupt…while at least 84 hospitals have closed in the last dozen years, many due to overuse of emergency rooms and illegal aliens unpaid medical bills…estimating that illegal aliens utilize hospital emergency rooms at more than twice the rate of overall U.S. population: 29 percent versus 4 percent, and the Pew Hispanic Center estimates that about 59 percent of illegal aliens have no health insurance. Even using conservative figures, it is estimated that in 2010 illegal aliens accounted for approximately $1.25 billion in unpaid medical care at California hospitals.” http://www.capsweb.org/pop-facts/how-pop-affects-you/healthcare

 Under the Constitution, health care is not a right; it is a good—like an education or a gym membership. You work hard, you decide what good to purchase. If government gives you the good that does not magically transform it into a right.” Judge Andrew P. Napolitano analyst Fox News.

 If government can give you something then they can take it away. Consider the cost. Hospitals, like those in California, will close their doors, unable to cover their costs or make a profit. 

 Existing state law requires a hospital in Nevada to provide emergency services and care to patients, regardless of their financial status. State law further makes it a crime for a hospital to 1) refuse to treat a patient in need of emergency care, 2) transfer a patient to another hospital, 3) order testing from another hospital if the hospital where the patient is can provide the tests. In addition, state law requires major hospitals to reduce the total billed charges by at least 30 percent for patients who do not have insurance.

 The real reason Democrat lawmakers want AJR14 is not because free emergency medical care is not already available and mandated by the government, they want, through AJR14, to impose socialist price controls. As I testified in the State Senate, “The real impact of AJR14 will be to impose price controls on hospitals, which do not work. Price controls make goods and services less available.” That means medical services, especially emergency services, will be less available for Nevadans. 

AJR14 Section 17 subsection 2 provides, that “All persons in this State have the right to receive medically necessary emergency services at a reasonable cost whether or not that person has insurance ...” and the amount cannot be “greater than 150 percent of the lowest rate which the hospital…accepts from a federal public insurer (Medicare, Medicaid) for the treatment, service or medication…” 

 This sounds reasonable doesn’t it? Until you understand that Medicare pays only about 80% of actual costs and Medicaid pays much less at 52% of actual costs. Medicare is available at age 65. Medicaid is government welfare healthcare paid for by taxpayers.

 According to the Center for Immigration Studies 62% of households headed by illegal immigrants used one or more welfare programs (like Medicaid)…and there is a child present in 86% of illegal immigrant households using welfare, and this is the primary way that these household access government programs.” http://cis.org/Welfare-Use-Legal-Illegal-Immigrant-Households

 The low reimbursement rate for Medicaid is especially significant when you consider the testimony before the State Senate of Todd Sklamberg, Chief Executive Officer of Sunrise Hospital in Las Vegas. “We are the State’s largest Medicaid provider with 42 percent of our inpatients and 57 percent of our emergency room patients covered by Medicaid. That is over 95,000 emergency room patients covered by Medicaid. We commit to serving this population when we get reimbursed slightly more than half of our costs.” Last year they served 167,000 patients in their emergency center which is the largest emergency room in the State.

 [Sunrise Hospital} “provides all of the pediatric heart care for children and are the only accredited rehabilitation program. We operate the largest and most comprehensive adult cardiac program in the state.  Providing these programs and access to care requires investment and the ability to recruit and retain the best physicians, nurses and staff.  Bringing new technology to the State would stop. It will lead to an exodus of physicians and will significantly impact our ability to bring physicians or expertise to Nevada. I along with my colleagues would be forced to continue to close programs, eliminate high-cost procedures and drugs. This is not a threat but a reality. In fact, Sunrise Hospital closed our infusion center two months ago…This was not due to volume, as our volumes remains at record levels, but as a result of the underfunding of Medicaid reimbursements and continued growth of uncompensated Medicaid care.” He also makes the statement that Nevada is 51 out of 50 states in the number of physicians per capita.

 Matthew Walker, Chief Executive Officer of William Bee Ririe Hospital in Ely stated in testimony on AJR14 before the Assembly Committee, “We struggle to sustain financial viability in rural, underserved areas such as Ely, and if this legislation passes as is, William Bee Ririe Hospital will cease to exist. This means that the nearest health care would be over 200 miles away. This means that traumas, pregnancies, strokes, heart attacks, and psychiatric patients will all have a four-hour drive to the nearest treatment center. Imagine the effect this will have on morbidity and mortality rates in rural Nevada. My argument is not about profits; it is about being there for patients as a critical access hospital.”

 Chris Ferrari stated in testimony before the Senate, “Dignity Health-St. Rose Dominicans is a not-for-profit health hospital provider founded 70 years ago. We came to Henderson, and our nonprofit status allows us to turn excess dollars into community benefit. Las year, St. Rose provided $113 Million in public health programs in southern Nevada for those most in need. The forecasted budget impact to our three primary hospitals with the passing of AJR14 is $100 Million per year.

 Erik Olsen, Vice President and Chief Executive Officer of Renown Regional Medical Center in Reno, testified before the Assembly. Renown is a not-for-profit hospital. “We operate the region’s only trauma center and dedicated children’s hospital –which includes a pediatric emergency room that operates 24 hours a day 7 days a week and sees more than 23,000 annual visits. Two-thirds of our pediatric patients are Medicaid or self-pay patients (no-insurance)…We accommodated nearly 100,000 emergency room visits last year. Nearly 50 percent of patients were Medicaid or self-pay. In many cases, these are the only safety net services available to these most vulnerable Nevadans.”

 “For the most recent reporting period, Renown provided $78 Million in community benefits; $65 Million of which was related to uncompensated care.”

 There are many problems with AJR14 that we do not have space to explore here. There are 32 pages of testimony from the hearing in the Assembly and 40 pages of testimony from the State Senate plus exhibits.  Excerpts from my testimony in the Assembly are as follows:

 “If the government can mandate something, they will by law or natural consequences—limit access to the market. We know that this is what has happened with Medicare. Many physicians do not accept Medicare patients because the reimbursement rate is not great enough. Many of my friends, and some of my family, do not have Medicare Part B because doing so would limit what health care choices they can make. If a doctor accepts Medicare, you cannot, as the patient, pay more than Medicare will pay to receive a treatment or service that you want. Therefore, access is already limited because of current laws that mandate certain kinds of health care.

 “This is what happened in California. Their system of hospitals and health care is under siege. A large percentage of California hospitals are losing money. Hundreds of medical clinics have closed or gone bankrupt while most others are in financial trouble. Some 84 hospitals in California have closed in the last dozen years, many due to overuse of emergency rooms by illegal aliens, unpaid medical bills, and by others without insurance.

 “A couple of years ago, I was in a situation where I was without health insurance, and I ended up in the hospital with a ruptured appendix. I was ultimately able to negotiate with the hospital in Elko for a 70 percent reduction in cost so I was able to pay my bill. My bill was over $25,000 for the hospital stay alone, not to mention everything else.

 “In California, it is estimated that illegal aliens utilize hospital emergency rooms at more than twice the rate of the overall United States population.” (At this point the Latina Chairwoman stopped me saying, “I do not appreciate choosing immigration as a focal point.”)

 Continuing I said, “I am sorry, but it is a great cost. One of the things pushing our hospitals out of business is unpaid emergency visits. That is obvious—and we already know who is responsible—but this is the problem we have. If we impose unreasonable limits on hospitals, hospitals will go out of business, and they will not even be able to serve those who have insurance. They will not be able to serve Medicare or Medicaid (patients). They will not even be able to serve people--like me--who do not have insurance. It is very important that we are reasonable in what we mandate because mandates limit the access we have, either by law or natural consequences. If you think you are going to fix access by mandating it, this will create a huge problem.”

 What is driving the cost of health care to go up?  The answer includes uncompensated care including, unreimbursed portions of Medicare, Medicaid and care for those who have no insurance including Illegal Aliens. Those who pay for health insurance and who pay their hospital bills are subsidizing the hospital care for those who don’t, and we must make up the difference.  Socialism, welfare and open borders are real problems contributing to the high cost of hospital care.

 This is a critical issue facing our state and should be a very important issue in the 2018 campaigns for Governor, Lt. Governor, Attorney General, State Senate and Assembly and County Commissioners.

“Every working American owes $1.5 Million.”

British Prime Minister, Disraeli stated: “There are Lies, Damned Lies and Statistics.”

        The statistics we are fed by the federal government are “damned lies.” The real stats are very different than the rosy picture painted by the Feds. This information is from Egon von Greyrez’s article “Every working American owes $1.5 Million.” Below are some truthful statistics regarding the U.S. economy.

       The Labour Participation rate is down from 67% in 1999 to 62% currently. The problem with US labor statistics is that they conveniently disregard the 95.4 million people, a record level, who are able to work but are not working. The total US labor force which is capable of working is 256 million. Of those, 161 million are actually working or actively looking for a job. This means that the 95.4 million, many of which have given up looking for a job, represent 36% of the all those capable of working. So with fewer people working and with average workers’ real pay having declined since 1975, it is hard to accept that people in the US are feeling so optimistic. US workers real earnings are down 46% since 1973.

      ... the official unemployment figures are  4% when according to proper analysis by John Williams of Shadowstatistics, unemployment is 22%.

      Every working American owes $1.5 million.  The US working population of 154 million have the responsibility for the US total debt which currently is $70 trillion. That excludes unfunded liabilities of anywhere from $120 trillion to $200 trillion which also must be funded.

       But if we just take the $70 trillion debt, that amounts to $454,000 of debt for each person working. Adding the unfunded liabilities, we are looking at anywhere between $1.2 and $1.7 million debt per US working citizen. Since the average US person is one wage check from bankruptcy, he is hardly in a position to pay anywhere from $454,000 to $1.7 million on an average gross wage of less than $50,000. If every working American paid used his gross wage to pay off this debt, it would take over 50 years to pay off including interest and inflation. But the average American couldn’t even afford to allocate 10% of his wage to repay the debt and liabilities. Thus Americans couldn’t even afford a 500 year repayment plan. https://goldswitzerland.com/every-working-american-owes-1-5-million/

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