LAS VEGAS — Voters in Nevada fret about the economy. Many are disquieted by the war. They worry about taxes, the federal threat of a nuclear waste site in their midst, immigration and gun rights.
Multimedia Isaac Brekken for The New York Times "Is that the kind of life we fought for?" ANTHONY DiMARIA, a former marine who says the V.A. will no longer provide care  Isaac Brekken for The New York Times "There are millions of people who can’t get coverage." TERRENCE M. JACKSON, a lawyer who pays $15,000 a year for his daughter’s health insurance  Isaac Brekken for The New York Times "It’s the pits. Don’t ever get old." CAROL WILKEN, with her husband, Jim, at a Las Vegas retirement community | But with the Nevada caucuses coming Saturday, little seems to concern people here as much as health care. The state has an unusually high number of people with no insurance, doctors are hard to come by, Medicaid reimbursements are low and health care safety nets are eroding. “I used to be able to go to the V.A. and they’d take care of us,” said Anthony DiMaria, 84, who served in the Marine Corps. “Now they send you a letter saying you have what they call ‘means,’ and they aren’t going to take you in anymore. Is that the kind of life we fought for?” Just as the presidential nominating contests in other states have been defined in part by national issues with local poignancy — immigration in Iowa, unemployment in Michigan — Nevada’s caucuses could turn on how well the candidates address the United States’ growing health care crisis. Older voters — and the children who help care for them — worry about Medicare benefits, young people in jobs without coverage say they cannot afford to pay for their own and most everyone knows or has cared for someone with too little insurance. In interviews with 30 registered voters around this city — in a retirement community, a middle-class neighborhood and downtown on the steps of a courthouse — almost half said that health care was the most compelling and worrisome problem the candidates needed to solve. “I have a daughter who had a major car accident three years ago and she can’t get health insurance,” said Terrence M. Jackson, 61, a lawyer. “I pay $15,000 a year for her medical coverage. And there are millions of people who can’t get coverage.” Among Democrats — whose caucuses are the main event on Saturday because Republican candidates have largely sidestepped the state — voters were particularly outspoken in identifying health care over the mortgage foreclosure crisis, the national economy or the war in Iraq as their principal concern. “We had to go to one of those plans that are Medicare-driven and they tell you what you’re going to do and not going to do,” said Carol Wilken, 62, who said at a retirement community here that the candidates’ health care plans would drive her vote. “It’s the pits. Don’t ever get old.” While insurance difficulties plague nearly every state, Nevada has come to its problems in some unique ways. The fastest-growing state for most of the last two decades, it has a largely mobile employee base — particularly in Las Vegas — with residents who move from job to job, often never gaining insurance. The state’s large Hispanic population — which tends to lead the numbers of uninsured — further contributes to the high numbers. Finding doctors who will accept Medicaid is difficult in the state, especially in rural areas, and the state’s income eligibility requirements are high and the paperwork required to enroll is excessive and inaccessible compared with other states, health care experts say. A recent poll of 500 likely Democratic voters in Nevada found health care to be “the single most important issue in determining” a presidential vote among 20 percent of those polled. Only the economy, with 21 percent, was mentioned by more respondents. (The poll, conducted by Research 2000 for The Reno Gazette-Journal, has a margin of sampling error of plus or minus four percentage points.) The percentage of people without insurance in Nevada is among the highest in the nation, significantly higher than in Iowa, New Hampshire or Michigan — the states that have already voted. According to the Census Bureau, an average of 18.3 percent of Nevadans did not have health insurance from 2004 to 2006, compared with 9.3 percent in Iowa. The Democratic and Republican candidates concur that affordable health care eludes many Americans, but they are deeply divided on how to remedy the problem and insure the 47 million people without health insurance. The Democrats, whose plans would cost $65 billion to $100 billion annually, believe that the federal government should play a role, in part through the elimination of the Bush administration’s tax cuts for the wealthy. Senator Hillary Rodham Clinton of New York and John Edwards, the former North Carolina senator, say they would require all Americans to get coverage and would provide subsidies to that end, while Senator Barack Obama of Illinois would require only children to have coverage. Mr. Obama’s plan would require employers to provide coverage or contribute to a new public program. They have all mulled expanding the Federal Employees Health Benefits Program. Republicans prefer plans that rely on the marketplace over government, and they generally eschew mandated coverage. Rudolph W. Giuliani, the former mayor of New York City, has called for a voluntary move from the employer-based system to one granting tax benefits to those who buy their own insurance. Mitt Romney, who signed a universal coverage plan into law when he was governor of Massachusetts, would give states the flexibility to come up with their own answers, with federal assistance. Senator John McCain of Arizona is focused on containing health care spending, and has said that essentially high-cost diseases, like diabetes and heart disease, should get more attention. Mr. McCain proposes that hospital and doctor compensation be linked to performance measures. Among the voters interviewed here, few were particularly informed about what any of the candidates have proposed. While no candidate was overwhelmingly supported by those interviewed, Mrs. Clinton’s association with health care registered with some voters. “I know it was a major issue when she was a first lady,” said Jeffrey Eskin, 55. “And my feeling is that it was started and not completed.” The issue cuts both ways for Mrs. Clinton, whose health care plan in the Clinton administration failed spectacularly. “I think with Senator Clinton, she’s trying to bring in a socialistic health care system which would probably bankrupt the country,” said Marlene Lansdell, a registered nurse and a Democrat. “Health care is my No. 1 issue, but they are going to make changes that are going to be extremely costly and the taxpayer will foot the bill. I don’t want a free-for-all.” So for the next few days, most everyone here seems to be listening intently — and hoping for inspiration. Cheryl Reber, who at 26 was recently removed from her parent’s coverage, has no insurance in her job as a legal secretary, but says she tries not to think about that. “I haven’t had to face any health care problems yet,” Ms. Reber said, adding that the possibility haunts her. “I don’t want to go as far as Canada, but we need something more affordable.” |
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