CARSON CITY, Nev. — From his spacious office in the Silver State’s historic Capitol, Gov. Brian Sandoval keeps one eye focused on Washington, D.C., as he attempts to mitigate the political and economic minefield that has become the implementation of Obamacare.
The first-term Republican governor opposed the Affordable Care Act and joined the lawsuit challenging the legality of President Barack Obama’s landmark health care law. But after the Supreme Court upheld the statute, he moved ahead with the creation of a state health insurance exchange, deciding he would rather have Nevada shape its citizens' access to care under the law rather than have federal bureaucrats do it 3,000 miles away.
But that doesn’t mean Sandoval, who is up for re-election in 2014 and has been mentioned as a GOP vice-presidential candidate, is happy with the law’s implications for Nevada’s arduous recovery from what was arguably an economic depression brought on by the 2008 real estate collapse. Nor is the governor pleased with the Obama administration’s slow and uncertain pace for writing the regulations that will dictate how states are supposed to operate under the new health care regime.
In part one of my broad interview with Sandoval: our discussion about Obamacare and his thoughts on an immigration overhaul. As a Hispanic Republican and a former federal judge who both presided over citizenship ceremonies and prosecuted undocumented immigrants for breaking immigration laws, Sandoval shared his unique perspectives on the matter and the bill that is currently winding its way through the Senate.
Q. Let’s talk about the Affordable Care Act. We know about the old debate, but now there’s the new debate about implementation. Is the implementation process making it harder for Nevada businesses to expand, or for other businesses that want to expand into Nevada, is the uncertainty around the Affordable Care Act making things difficult?A.
Q. Is Washington being responsive? What do implementation issues mean for the Nevada exchange? What has it meant for you?
A. Well, it’s meant that we’ve had to lead. Our Nevada exchange — and I think if you read some of the print on it, or the media — is that it has been a national leader in terms of being a model for other state-run exchanges. And my understanding, anecdotally, is that the [Centers for Medicare and Medicaid Services] has reached out to us in terms of how we are implementing things because we were one of the first ones out and because of that, we’ve had to basically forge our own course, we’re pioneers with regard to that. ... To respond to your question, it’s been frustrating, in terms of trying to get the information so that we can get to decision points and move forward.
Q. Will the Affordable Care Act benefit Nevadans? Or is it that you’d rather the law not exist, but being that it does, you’re going to do the best job you can? How is the statute going to shake out for your average Nevadan who either gets their insurance through their employer or buys a plan on the open market?
A. Stepping back a bit, Nevada was a party to the lawsuit that was in front of the U.S. Supreme Court. As you say, the Supreme Court made its decision, and the  election is what it is and so there isn’t going to be a change and we’re going to push forward. It’s hard to respond specifically to your question because we don’t have the specificity from the federal government. But at the end of the day, obviously I wouldn’t have [chosen to implement the Nevada exchange] if I didn’t think it could be helpful to the people of Nevada.
Q. Republicans keep trying to repeal the law. If after 2016, you ended up with a Republican Senate and a Republican House and a Republican president and they could actually get rid of the law, or most of it, and replace it with the kind of reforms Republicans like, would you rather see that happen?
A. That’s a huge hypothetical. But, yes, certainly, any type of health care reform that can be accomplished. But we’re talking three years down the line. ... But anywhere where we can have reform and save taxpayer money and improve the delivery of care is something I’d obviously be for.
Q. Do you favor the repeal of Obamacare? Or, all things considered, just leave it alone and try to focus on making it work?
A. Well there are a lot of moving parts there, and as I said, I’m a governor that has to govern now with the law as it stands now and that’s how we’re going to proceed, but if there’s a change in the law, we’ll look at it at that time.
A. It is, and I have a special perspective. Before I was in this job, I was a federal judge. One of the best experiences that I had was to be able to preside over the citizenship ceremonies. ... I would have the opportunity to swear in the new citizens. As part of that ceremony, I would have two of them come up and talk about their experiences; and they would talk about how hard they’ve worked to learn the language — to do all the things they had to do to become U.S. citizens, and it made you extremely proud. I also had in front of me on the criminal side, those that had violated the law and I had to sentence them and administer punishment with regard to violating the immigration laws. So, I have that special perspective with regard to immigration reform.
I’ve spoken on several occasions with Sen. [Marco] Rubio [R-Fla.]. I think it is a good bill; I really admire and respect his leadership on this and stepping out. I think it has all the right components to it, to have an immigration policy that Americans can be confident in.
Q. Many conservatives remain skeptical of reform; in particular that legalization will occur immediately without a guarantee that the government will follow through on border enforcement. What is your message to them?
A. I don’t think it’s just the conservatives; I think everybody wants a strong border. I’ve heard Sen. Rubio say on several occasions that that’s a condition precedent in terms of implementing this immigration policy, is ensuring that we have strict border security. ... So, I would tell them that I think they appreciate — ‘they’ being those in Washington — that that’s something that has to be done, because if we’re going to fix this issue, people have to know that the border is going to be secure going forward because we don’t want to repeat all of this several years from now.