LAS VEGAS - Nevada faces a $3 billion budget gap, according to the Nevada Economic Forum, and Governor-elect Sandoval has already said higher taxes are off the table. Health care providers are warning that his stance could be setting the state up for a crisis, in terms of access to health services.

The ten percent cuts Gov. Gibbons already requested from state agencies would cover about $800 million of the budget gap; some worry the cuts could now stretch beyond 30 percent. Laura Coger, the Nevada program manager for Consumer Direct Personal Care, says that would mean drastic changes for the Nevadans her company serves.

"Do we want to go backwards, to a time when people with disabilities sat on the sidewalks with their tin cups and we have to step over them to do business every day? That's not the kind of society most of us want. We want people to be healthy, safe."

One possibility is to reduce state payments to nursing homes by $20 per day. Charles Perry, president of the Nevada Health Care Association, says that amount would put several Nevada nursing homes out of business, and local hospitals would be without what he calls a major relief valve.

"We'd just simply have some facilities that cannot stay in business, and that would create an absolute access-to-care problem for the state. So, you've got people that are in the hospital who can't get out, and you've got people out in the community that need hospital care and can't get into the hospital."

Coger believes if cuts of more than ten percent take place, the physical and mental conditions of her clients with disabilities would quickly deteriorate. If they need hospital and emergency room care, she adds, it will cost the state far more in the long run.

"When we get beyond the 10 percent, we're into unthinkable, and then we get into just dreadful. It would create a Nevada that most of us would not want to live in."

Sandoval says he favors a shared sacrifice approach of budget cuts rather than raising any taxes or fees. He has said Nevada may have to return to 2007 funding levels, but Coger says the no-taxes approach could mean cuts that approach 40 percent. State lawmakers will weigh in on the budget options in the spring.



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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.

The California State Assembly is considering a bill to require schools to have a cardiac arrest response plan. Assembly Bill 2887 would make sure schools update their safety plans to include CPR training and an automatic external defibrillator or AED onsite.

Dr. Stephen Sanko, a professor of clinical emergency medicine at USC, and a founding member of the Cardiac Arrest Survivor Alliance, is a volunteer expert for the American Heart Association. He said having a plan in place is critical.

"The American Heart Association is promoting that schools have a cardiac arrest response plan. A written protocol for what to do in order to decrease the likelihood that if somebody collapses, that they die," he said.

Two years ago, 15-year-old Cash Hennessy collapsed on the football field due to a previously unknown heart defect. Two off-duty medics in the stands gave him CPR. The school brought out its AED - but it was useless, because the batteries were dead.

Hennessy said the experience was traumatic.

"I feel blessed that I had people there for me, that could give me C-P-R. But I think about if those people weren't there and that was another kid, who knows what would have happened? Because there wouldn't have been an AED to save them," he explained.

An AED walks people through the steps to deliver a life-saving shock to a person's heart until an ambulance arrives. Studies show that 70% of kids who suffer sudden cardiac arrest at school recover if an AED is deployed correctly - whereas the survival rate for kids and adults not in the hospital is less than 12%.