Nevada is no one's idea of a liberal stronghold. Gallup polling places it squarely in the ideological middle of the country, with 36 percent of residents identifying as conservatives and only 23 percent copping to liberalism. It's known for ranchers, Mormons, and live-and-let-live attitudes toward gambling and sex work. In other words, it's one of the last places you'd expect big government to flourish.
Yet progressive healthcare reforms are blossoming here. Nevada just passed a law pushing for greater transparency from pharmaceutical companies. The state's legislature voted for a plan that would have allowed anyone to buy in to Medicaid—though Governor Brian Sandoval ended up vetoing that bill on Friday, calling it "undeveloped." Sandoval was one of three Republican governors who signed onto a letter urging Congress to preserve the benefits of the Affordable Care Act. Even Republican senator Dean Heller, who is up for reelection in 2018, said that any ACA repeal bill should protect people with preexisting conditions.
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Why is all this happening in Nevada? For the answer, look to Claudia Ramos, who's been cleaning rooms at the Paris Hotel & Casino on the Las Vegas Strip for the past 12 years. During the 2016 election, Ramos took a leave of absence from her job to join fellow members of the Culinary Workers Union Local 226 in knocking on doors and making phone calls. In particular, she said, she talked with Spanish-speaking Nevadans who might not otherwise have gotten much information about the local races.
"We talked about why the union's involved with politicians and why we support the Democratic Party," she said. "We try to involve them because it's important they understand, in our language, what's going on."
Hillary Clinton narrowly won the state with about 48 percent of the vote, and the Culinary Union—the largest union in the state, with 57,000 members—was widely credited with helping to turn both houses of the Nevada Legislature blue. Now workers like Ramos, in alliance with other progressive groups in the state, are pushing to turn those political victories into concrete policy.
Their big victory this year so far was the passage of the diabetes drug transparency law, which Sandoval signed on June 15 at a Culinary Union event. The law requires pharmaceutical companies to disclose information on how much they spend marketing insulin drugs, as well as the cost of actually producing the drugs. It also requires that pharmacy benefits managers, companies that help determine what insurers pay for the drugs, act in the insurers' best interests.
Pharmaceutical industry groups fought hard against the law, and opponents continue to say it could have unintended consequences. Michael Schaus, communications director for the conservative Nevada Policy Research Institute, said he believes it won't bring down insulin prices.
"I think, unfortunately, it's going to do kind of the opposite," he said. "Any time you start to track somebody's profits, it's going to discourage people from coming into the market. The way to do that is to make the market more inviting to people… not pile on more regulations."
But Culinary Union spokeswoman Bethany Khan said the union believes that the law could help curb what she calls price gouging. The prices of some major insulin drugs in real dollars have risen by 450 percent over the past two decades.
"Patients don't know what's going to happen, or why it's happening," Khan said.
The original version of the diabetes bill, which ended up passing in a different form, was introduced by freshman state senator Yvanna Cancela, the union's former political director. The union put its organizing clout behind it, helping families dealing with diabetes tell their stories to lawmakers and the public.
Ramos said she and her fellow union members worked to help pass the law because almost all of them know people with diabetes who are struggling with the cost of drugs.
"Sometimes they have to go out from the city to buy medicine because it's cheaper in Mexico," she said. "Because here it's very expensive."
The Culinary Union has also been working on the broader question of insurance coverage through the Progressive Leadership Alliance of Nevada (PLAN), an umbrella group that includes a number of unions as well as environmental and civil rights groups and chapters of Planned Parenthood and the ACLU.
Amanda Khan, PLAN's economic justice organizer (and, as it happens, Bethany Khan's sister), said the group has been holding events nearly every day around healthcare issues, flooding politicians' phone lines, sending letters, and sharing families' stories through social media.
"It's very aggressive," she said. "We've definitely stepped it up. We're essentially in panic mode."
At the state level, the Culinary Union's success in electing Democratic legislators helped get a bill through both houses that would have allowed anyone to by in to Medicaid. Some liberal national media outlets hailed the concept as a radical idea that could bring relatively low-cost Medicaid coverage to many more people. Sandoval vetoed the bill Friday, arguing that it needs more study, but the bill's sponsor said he'll bring it up again in the next legislative session.
For now, PLAN is focusing on pushing Senator Heller to oppose big rollbacks of ACA provisions—particularly those affecting Medicaid. Heller is often identified as the most vulnerable Republican senator in the 2018 elections, which Khan said could create some leverage. Heller has said he wants to soften existing Republican proposals by extending the timeline for phasing out the ACA's Medicaid expansion, but seems likely to be on board with the general idea of the Republican benefit rollback.
Khan said PLAN has responded by hounding Heller, inviting him to town hall meetings and getting hundreds of constituents to show up even if he doesn't, and seeking him out wherever he goes in the state.
"Constituents have stories that need to be heard," she said. "We are literally going to meet him at the airport. It's like, 'You can't get off the plane without seeing us.'"
Schaus said conservative groups like his are pushing Heller in the opposite direction, seeking to reduce the role of government in the healthcare system. But he said the Culinary Union and its allies are putting up a strong fight on the other side.
"They've been probably one of the strongest political unions in the United States," he said. "Their fingerprints seem to be all over this campaign against ACA repeal."
Bethany Khan said the Culinary Union is turning its resources toward the national healthcare battle. Republicans in the Senate hope to vote on their bill—which has not been completed or released to the public—by the end of June.
"We're pivoting to phone banking—thousands of phone calls to ask the senator to protect Nevadans," she said. "We'll also be canvassing, talking to immigrants, making sure we're getting the word out on this really important vote that's happening."
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