Question 4: The quietest constitutional amendment

Voters approved a state constitutional amendment to exempt medical devices from sales tax the first time in 2016. Amendments must be approved twice to take effect, and that seems likely to happen this year. The measure was supported by more than 70 percent of voters two years ago.

That helps explain why Question 4 has received little attention this year. The PAC set up to win the measure’s passage, the “Alliance to Stop Taxes on the Sick and Dying” hasn’t reported raising money since January 2017, and has only spent a little more than $100,000. The PAC had raised about $390,000 for the 2016 campaign, nearly all of it from Bennett Medical Services — a medical equipment supply company based in Reno.

The measure has no financed opposition, and there has been effectively no organized campaign against it.

The Legislative Counsel Bureau’s Fiscal Analysis Division has determined the fiscal cost of the exemption can’t be determined “with any reasonable degree of certainty.”

The Department of Taxation estimates tax revenue from medical equipment sales represents less than one-tenth of 1 percent of the state budget.

Proponents of the initiative contend charging sales tax on durable medical equipment, oxygen delivery equipment, and mobility enhancing equipmentmedical equipment is an undue burden on the most vulnerable Nevadans.

Opponents of the initiative have contended the language of the proposal is vaguely worded, making it difficult to discern exactly what medical equipment will be exempt, and who will really benefit — patients, or the medical device industry. They also argue the exemption will reduce the amount of revenue for the state’s strapped budget.

The ballot measure is not the first attempt to exempt certain medical equipment from taxes. In 2015 Republican Sen. Michael Roberson introduced Senate Bill 334, which would have exempted the sale and use taxes for “ certain durable medical equipment, mobility-enhancing equipment, hearing aid, hearing aid accessories, and ophthalmic or ocular devices” prescribed by a licensed provider of health care.

The legislation passed in the state Senate, with all 21 senators unanimously voting in favor of the bill. However, the legislation never exited the Assembly Ways and Means Committee for a vote.