Nevada Question 4, Medical Equipment Sales Tax Exemption Amendment (2018)

Elections in Nevada, 2018

* General election: Nov. 6
* Voter registration deadline: Oct. 9 (mail), Oct. 16 (in-person), or Oct. 18 (online)
* Early voting: Oct. 20 - Nov. 2
* Absentee voting deadline: Nov. 6

* Online registration: Yes
* Same-day registration: No
* Voter ID: No
* Poll times: 7:00 a.m. to 7:00 p.m.

* * *

On the ballot: U.S. Senate • U.S. House • Governor • Lt. Gov • Attorney General • Secretary of State • State executive offices • State Senate • State Assembly • Supreme court • Local judges • State ballot measures • Local ballot measures • School boards • Municipal • Democratic primaries • Republican primaries

Nevada Question 4

Election date
November 6, 2018
Topic
Taxes and Healthcare
Status
a Approved
Type
Constitutional amendment| Origin
Citizens

* * *

List of Nevada measuresNevada Question 1Nevada Question 2Nevada Question 3Nevada Question 4Nevada Question 5Nevada Question 6Submit

* * *

Nevada Question 4, the Medical Equipment Sales Tax Exemption Initiative, was on the ballot in Nevada as an initiated constitutional amendment on November 6, 2018. The measure was approved.

| A "yes" vote supported this amendment to require the state legislature to exempt from sales and use tax durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment prescribed for human use by a licensed health care provider.

|

| A "no" vote opposed this amendment to require the legislature to exempt certain types of medical equipment from the sales and use tax.[1]

|

In Nevada, initiated constitutional amendments need to be approved in two even-numbered election years. As the measure was approved in 2016, Question 4 needed to be approved again in 2018 to amend the Nevada Constitution.

## Contents

* 1 Election results
* 2 Overview
* 2.1 Initiative design
* 2.2 Sales tax on medical equipment in Nevada
* 3 Text of measure
* 3.1 Ballot title
* 3.2 Ballot summary
* 3.3 Constitutional changes
* 3.4 Readability score
* 4 Support
* 4.1 Supporters
* 4.2 Arguments
* 5 Opposition
* 5.1 Opponents
* 5.2 Arguments
* 6 Campaign finance
* 7 Background
* 7.1 Sales tax in Nevada
* 7.2 Medical equipment exemptions
* 7.3 Question 13
* 7.4 Legislature
* 8 Path to the ballot
* 9 See also
* 10 External links
* 11 Recent news
* 12 Footnotes

## Election results[edit]

Nevada Question 4

Result | Votes | Percentage

Yes

| 637,140 | 67.38%
No | 308,517 | 32.62%

Results are officially certified.
Source

## Overview[edit]

### Initiative design[edit]

Question 4 required the Nevada State Legislature to exempt from sales and use tax durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment prescribed for human use by a licensed health care provider. Examples of durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment included oxygen tanks and concentrators, ventilators, CPAP machines, nebulizers, drug infusion devises, feeding pumps, infant apnea monitors, hospital beds, bath and shower aids, wheelchairs, walkers, canes, and crutches.[2]

### Sales tax on medical equipment in Nevada[edit]

As of 2018, the state sales tax in Nevada was 6.85 percent. In 1996, Nevadans passed Question 13, which exempted from sales and uses taxes certain medical supplies. The supplies exempted included “orthotic appliances, ambulatory casts, other supports, splints, bandages, pads, compresses and dressings.” Some other states in the intermountain west and southwest, including Arizona, California, Colorado, Texas, and Utah provide exemptions similar to the ones in the proposed amendment.

## Text of measure[edit]

### Ballot title[edit]

The question on the ballot was as follows:[3]

“  | Shall Article 10 of the Nevada Constitution be amended to require the Legislature to provide by

law for the exemption of durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment prescribed for use by a licensed health care provider from any tax upon the sale, storage, use, or consumption of tangible personal property?[4]

| ”

|
|

### Ballot summary[edit]

The ballot explanation was as follows:[3]

| “  |

EXPLANATION—This ballot measure proposes to amend the Nevada Constitution to require the Legislature to pass a law that allows for the exemption of durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment prescribed for human use by a licensed health care provider acting within his or her scope of practice from any tax on the sale, storage, use, or consumption of tangible personal property. The proposed amendment does not create an exemption of durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment from these taxes, but rather requires the Legislature to establish by law for such an exemption. Pursuant to Article 19, Section 2, of the Nevada Constitution, approval of this measure is required at two consecutive general elections before taking effect.

A “Yes” vote would amend Article 10 of the Nevada Constitution so that the Legislature would be required to pass a law exempting durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment prescribed for human use by a licensed health care provider from taxation related to the sale, storage, use, or consumption of the equipment.

A “No” vote would retain the provisions of Article 10 of the Nevada Constitution in their current form. These provisions do not require the Legislature to pass a law exempting durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment prescribed for human use by a licensed health care provider from taxation related to the sale, storage, use, or consumption of the equipment.

DIGEST—Article 10 of the Nevada Constitution contains provisions relating to taxation. Approval of this question would add a new section to Article 10 of the Nevada Constitution to require the Legislature to pass a law that allows for the exemption of durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment prescribed for human use by a licensed health care provider acting within his or her scope of practice from any tax on the sale, storage, use, or consumption of tangible personal property. This tax exemption would decrease public revenue as this equipment is currently subject to sales and use tax.[4]

| ”

|
|

### Constitutional changes[edit]

See also: Article 10, Nevada Constitution

The measure added a Section 7 to Article 10 of the Constitution of Nevada:[1]

Section 7. The legislature shall provide by law for the exemption of durable medical equipment, oxygen delivery equipment and mobility enhancing equipment prescribed for human use by a licensed provider of health care acting within his or her scope of practice from any tax upon the sale, storage, use or consumption of tangible personal property.[4]

### Readability score[edit]

See also: Ballot measure readability scores, 2018
Using the Flesch-Kincaid Grade Level (FKGL and Flesch Reading Ease (FRE) formulas, Ballotpedia scored the readability of the ballot title and summary for this measure. Readability scores are designed to indicate the reading difficulty of text. The Flesch-Kincaid formulas account for the number of words, syllables, and sentences in a text; they do not account for the difficulty of the ideas in the text. The secretary of state[5] wrote the ballot language for this measure.

The FKGL for the ballot title is grade level 13, and the FRE is 27. The word count for the ballot title is 53, and the estimated reading time is 14 seconds. The FKGL for the ballot summary is grade level 11, and the FRE is 36. The word count for the ballot summary is 340, and the estimated reading time is 1 minute and 30 seconds.

In 2018, for the 167 statewide measures on the ballot, the average ballot title or question was written at a level appropriate for those with between 19 and 20 years of U.S. formal education (graduate school-level of education), according to the FKGL formula. Read Ballotpedia's entire 2018 ballot language readability report here.

## Support[edit]

Yes on 4, also known as the Alliance to Stop Taxes on the Sick and Dying, led the campaign in support of Question 4 in 2016.[6] The committee was terminated after the election. Douglas Bennett, owner of Bennett Medical Services, filed the initiative.[7]

### Supporters[edit]

* Elko City Council[8]

### Arguments[edit]

Josh Hicks and Doug Bennett of the Alliance to Stop Taxes on the Sick and Dying PAC, along with Dr. Joseph Kenneth Romeo, wrote the argument in support of the measure found in the state's voter guide. Their argument was as follows:[1]

A YES vote on Question 4 helps sick, injured, and dying patients and their families. It stops the Department of Taxation from imposing unnecessary sales taxes on medical equipment prescribed by physicians, such as wheelchairs, infant apnea monitors, and oxygen delivery devices. It will bring Nevada in line with the vast majority of states which do not tax this type of equipment for home use.

A YES vote would relieve the sales tax burden on medical equipment used by patients who require oxygen devices to live, such as those with cancer, asthma, and cardiac disease; babies who need protection from Sudden Infant Death Syndrome; children with cystic fibrosis on home ventilators; and hospice patients in their last weeks of life. Current Nevada law already exempts medicine and prosthetics because we have recognized how vital this relief is for our most vulnerable populations. Question 4 simply seeks to extend this protection to critical medical equipment.

For insured Nevadans, this tax is contributing to the increasing copays, deductibles, and premium costs that are crippling family finances across the state. For uninsured Nevadans the impact is even worse: Sales tax on medical equipment can reach thousands of dollars for severely disabled patients, and it forces people to forego essential equipment prescribed by their doctors because they simply cannot afford to pay.

Fortunately, while this would have a significant impact on the patients and their families, there would be very little impact to state tax revenue. The Department of Taxation, itself, has estimated that a tax exemption on this medical equipment represents approximately 0.025% of the annual state budget.

Almost all people will need some sort of medical equipment in their lifetimes. Voting YES on Question 4 is the compassionate, and eventually prudent, thing to do. ...

|

## Opposition[edit]

### Opponents[edit]

* Controller Ron Knecht (R)[9]

### Arguments[edit]

Controller Ron Knecht (R) said that while the amendment's goals were a good idea, he did not support inserting the amendment into the state constitution. He said:[10]

“  | While this may be a good idea, it raises many questions in context of the various things the state does and does not tax. But even if one concludes as a matter of sound tax policy that these items should be tax-exempt, the legislature already has the power to exempt them now. Once again, enshrining these provisions in the constitution would prevent timely reform of any parts of the proposal that may be found to merit change or repeal later.[4] | ”

|
|

## Campaign finance[edit]

Total campaign contributions:

Support: | $0.00
Opposition: | $0.00

See also: Campaign finance requirements for Nevada ballot measures

There was one political action committee, Alliance to Stop Taxes on the Sick and Dying, registered to support the measure. While the committee supported Question 4 in 2016, the committee was registered as inactive in January 2018.[11] In 2016, the committee had raised $388,226 and spent $218,957.

No political action committees registered to oppose the ballot measure.[12]

## Background[edit]

### Sales tax in Nevada[edit]

As of 2018, the state sales tax in Nevada was 6.85 percent. Counties of Nevada were also permitted to enact an additional sales tax. The highest sales tax was in Washoe County, where the county levied a 1.415 percent tax in addition to the state's 6.85 percent tax for a total of 8.265 percent. Eureka County, Esmeralda County, Humboldt County, and Mineral County did not levy an additional county sales tax. The average local sales tax was 1.13 percent, making the average combined state-county sales tax 7.98 percent.[13]

### Medical equipment exemptions[edit]

Some other states in the intermountain west and southwest provided exemptions similar to the ones in the proposed amendment. As of 2016, Arizona, California, Colorado, Texas, and Utah provided tax exemptions for durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment. New Mexico provided tax exemptions for prosthetics, oxygen delivery equipment, and vision and hearing aids.[14]

### Question 13[edit]

See also: Nevada Sales and Use Tax Medical Supply Exemption, Question 13 (1996)

In 1996, Nevadans passed Question 13, which exempted from sales and uses taxes certain medical supplies. Over two-thirds voted in favor of the legislative referral. The supplies exempted included “orthotic appliances, ambulatory casts, other supports, splints, bandages, pads, compresses and dressings.”

The Nevada Association of Medical Products Suppliers cited Question 13’s success in 1996 as evidence that voters will approve Question 4. The group noted, "Our example is the Prosthetics and Orthotics ballot measure in the 1990s that passed by an overwhelming 80 percent. Obviously, the voting public does not want sick and injured patients paying sales and use tax for their prescribed medical equipment.”[15]

### Legislature[edit]

In 2015, Sen. Michael Roberson (R-20) introduced Senate Bill 334, which would have exempted from sales and use taxes “durable medical equipment, mobility-enhancing equipment, hearing aids, hearing aid accessories, and ophthalmic or ocular devices.”[16] He explained his reason for introducing the bill, saying, "People using such medical devices have had to change their lifestyles. It can be costly, and typically insurance companies do not cover the sales tax on the medical equipment. Not everyone has the money or insurance to afford these basic, necessary devices, let alone the sales tax.”[17]

The legislation passed in the Nevada Senate on April 21, 2015, with all 21 senators voting “yea.” However, SB 334 never exited the Assembly Ways and Means Committee for a vote.

Doug Bennett, the developer of the amendment, cited the legislature's failure to pass the bill as one factor motivating the initiative.[18]

## Path to the ballot[edit]

See also: Nevada signature requirements

As an initiated constitutional amendment, this measure was put on the ballot directly after signatures were collected, submitted, and verified by the Nevada secretary of state.

The following was the timeline of events:

* The Nevada Secretary of State received the petition on September 9, 2015.[2]
* A total of 55,234 valid signatures were required for qualification purposes.
* Supporters had until June 21, 2016, to collect the required signatures.
* Supporters submitted signatures on June 21, 2016, to the secretary of state's office.[19]
* On July 12, 2016, the Nevada Secretary of State certified the measure for the ballot.[7]
* On November 8, 2016, Nevada voters approved this measure as Question 4, thereby automatically pushing it onto the 2018 ballot since initiated constitutional amendments require voter approval at two general elections.

Cost of signature collection:
Sponsors of the measure hired Bennett Medical Services[20] to collect signatures for the petition to qualify this measure for the ballot. A total of $110,125.00 was spent to collect the 55,234 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $1.99.

## See also[edit]

2018 measures

* 2018 ballot measures
* Taxes on the ballot
* 2018 legislative sessions

Nevada

* Nevada ballot measures
* Nevada ballot measure laws

News and analysis

* Ballot measure lawsuits
* Ballot measure readability
* Ballot measure polls

|
|

## External links[edit]

* Petition for the Medical Patient Tax Relief Act

## Recent news[edit]

The link below is to the most recent stories in a Google news search for the terms Nevada 2018 Medical Equipment Sales Tax Initiative. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

Nevada Question 4, Medical Equipment Sales Tax Exemption Amendment (2018) - Google News

## Footnotes[edit]

1. ↑ 1.0 1.1 1.2 State of Nevada, "Statewide Ballot Questions," accessed September 4, 2016
2. ↑ 2.0 2.1 Nevada Secretary of State, "Initiative Petition," accessed September 22, 2016
3. ↑ 3.0 3.1 State of Nevada, "2018 Ballot Questions," accessed September 21, 2018
4. ↑ 4.0 4.1 4.2 4.3 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source. Cite error: Invalid `<ref>` tag; name "quotedisclaimer" defined multiple times with different content Cite error: Invalid `<ref>` tag; name "quotedisclaimer" defined multiple times with different content
5. ↑ The secretary of state writes the ballot language in consultation with the attorney general.
6. ↑ Yes on 4, "Homepage," accessed September 22, 2016
7. ↑ 7.0 7.1 Las Vegas Review-Journal, "3 new petitions approved for Nov. 8 ballot in Nevada," July 12, 2016
8. ↑ Elko Daily, “City supports two state ballot questions,” October 13, 2016
9. ↑ Elko Daily Free Press, "Commentary: Three state ballot measures we oppose," October 27, 2016
10. ↑ Elko Daily Free Press, "Commentary: Three state ballot measures we oppose," October 27, 2016
11. ↑ Nevada Secretary of State, "Alliance to Stop Taxes on the Sick and Dying," accessed February 5, 2018
12. ↑ Nevada Secretary of State "AURORA Campaign Finance Database," accessed February 5, 2018
13. ↑ Nevada Department of Taxation, "Sales and Use Tax Publications," accessed February 9, 2018
14. ↑ Guinn Center for Policy Priorities, “Fact Sheet: Medical Patient Tax Relief Act,” accessed September 22, 2016
15. ↑ Senior Spectrum Newspaper, “Durable Medical Equipment, Oxygen Providers,” December 2015
16. ↑ Nevada Legislature, “Senate Bill 334,” accessed September 22, 2016
17. ↑ Nevada Legislature, “Minutes of the Senate Committee on Revenue and Economic Development,” March 31, 2015
18. ↑ Nevada Appeal, "Backers of proposed Nevada ballot measures submit signatures," June 22, 2016
19. ↑ Daily Journal, "Three groups proposing Nevada ballot measures have submitted signatures that could qualify them for the November election," June 21, 2016
20. ↑ Bennett Medical Services provided in-kind signature gathering.

v • e

2018 ballot measures

I&R States|

• Alaska • Arizona • Arkansas • California • Colorado • Florida • Idaho • Maine • Maryland • Massachusetts • Michigan • Missouri • Montana • Nebraska • Nevada • New Mexico • North Dakota • Ohio • Oklahoma • Oregon • South Dakota • Utah • Washington

Non I&R States|

• Alabama • Connecticut • Georgia • Hawaii • Indiana • Kentucky • Louisiana • New Hampshire • New Jersey • North Carolina • Rhode Island • South Carolina • Virginia • West Virginia • Wisconsin

Political topics|

• Abortion‎ • Administration of government‎ • Bond issues‎ • Business regulation‎ • Campaign finance‎ • Civil and criminal trials‎ • Civil rights‎ • Civil service‎ • Constitutional conventions‎ • Constitutional language‎ • County and municipal governance‎ • Definition of a corporation‎ • Direct democracy measures‎ • Education‎ • Elections and campaigns‎ • Energy‎ • Environment‎ • Federal constitutional issues‎ • Forests and parks‎ • Gambling‎ • Government accountability‎ • Healthcare‎ • Housing‎ • Hunting and fishing‎ • Labor and unions‎ • Law enforcement‎ • LGBT issues‎ • Marijuana‎ • Natural resources‎ • Pension‎ • Property‎ • Redistricting measures‎ • State and local government budgets, spending and finance‎ • State executive official measures‎ • State judiciary‎ • State legislatures measures‎ • Statehood‎ • Suffrage‎ • Supermajority requirements‎ • Taxes‎ • Term limits‎ • Tobacco‎ • Tort law‎ • Transportation‎ • Veterans‎ • Water‎ • Welfare‎

Other|

Scorecard • Petition drive deadlines and requirements • Polls • Lawsuits • Readability analysis • Signature costs • Cost per required signatures analysis • Campaign finance • Media editorial endorsements • Voter guides • Potential measures • Ballot Measure Monthly • Changes in 2018 to laws governing the initiative process • Not on the ballot • Filed initiatives

v • e

State of Nevada
Carson City (capital)

|

Elections |

What's on my ballot? | Elections in 2024 | How to vote | How to run for office | Ballot measures

Government |

Who represents me? | U.S. President | U.S. Congress | Federal courts | State executives | State legislature | State and local courts | Counties | Cities | School districts | Public policy