The GOP primary candidates head to Nevada on Saturday, a state with poor healthcare and few healthcare resources -- also one that has plunged in and begun implementing what it can of the Affordable Care Act, even though many in the state don't agree with the politics of it.

According to the National Conference of State Legislators, only 13 states have established health exchanges so far, as mandated under ACA, with Nevada being one of them. Health exchanges require an entire overhaul of most states’ healthcare IT infrastructures to be able to handle the anticipated increased enrollment in Medicaid beneficiaries, among other things.

[See also: Medicaid enrollment to swell in 2014.]

Interestingly enough, 26 states – including Nevada – have dug in their heals, suing the federal government over the ACA. Yet in the meantime, in 2010 and 2011, Nevada passed a state law to establish an independent state agency to run the Silver State Health Exchange, and it has established a 10-member board to run the exchange, funded by a $1 million ACA federal planning grant and a $4 million federal establishment grant.

According to the Nevada Department of Health and Human Services, while the state of Nevada is joining several other states in challenging the law, Governor Brian Sandoval and the Nevada DHHS believe “it’s prudent to plan appropriately for its implementation and prepare for the many changes that will occur within government and the private insurance markets under the terms of the reform bill.” If nothing changes legally, states are obligated to provide the exchanges by 2014, and there is much work to be done to make that happen.

The GOP primary candidate pool, which started out at nine, has now dropped to four – with Mitt Romney taking 47 percent of the votes; Newt Gingrich, former GOP House speaker 32 percent; and former Pennsylvania Sen. Rick Santorum 13 percent. Although fourth in the running at 7 percent, Rep. Ron Paul (R-TX) claims he’s third when it comes to delegates. “We’ve only gotten started. Now the counting really starts!” he said. “Caucus states lend themselves to people believing and working together.”

After presidential hopeful Paul came in fourth in the Florida primary Jan. 31, he told supporters during his closing speech that he is eager to meet Mitt Romney in the caucus states, one of which is Nevada, on Saturday.

“Something big is happening in this country,” Paul said, speaking of a movement to support his campaign. “The problem is too much government. We need more personal liberty.”

So, how is Paul going to rein in federal spending and reduce the expanded hand of government when it comes to healthcare?

[See also: Federal health reform to force rapid expansion of health IT for states.]

On one of his fan websites, RonPaul.com, Paul claimed, “Obamacare is the worst possible answer. All it does is perpetuate a flawed system by forcing everyone to become a client of insurance companies, even those who don’t want to or need to participate. How could any freedom loving person agree to delegate such criminal acts to the government by supporting a compulsory health insurance system?” Paul asks.

Paul’s views may have some difficulty in Nevada, a state that appears to need the federal help to supply good healthcare to its population. According to a report by the Nevada Vision Stakeholder group, an array of health statistics suggest that Nevada trails most other states in health outcomes and in the healthcare resources it provides.

For several years, Nevada has ranked among the bottom half of states in more than two-thirds of the 18 measures of healthcare quality compiled by the U.S. Department of Health and Human Services, and was most recently ranked among the bottom five states in more than one-third of the indicators, including those related to maternal and child health, timeliness of care, and patient safety, the report says.

Nevadans suffer high rates of homelessness, mental illness, substance abuse and food insecurity. The suicide rate is among the nation’s highest, as are death rates from colorectal cancer and heart disease, conditions that are survivable when diagnosed and treated early. Life expectancy in Nevada is now 76.3 years, the lowest of any state in the West, the report says.

Paul claims his support is growing, “like small brush fires,” wherever people are seeking to reduce the span of the federal government’s power. And where else, but the wild, wild West – historically not a place to submit to Washington easily. Paul reported 5,000 came out to rally with him recently in Colorado.

Sarah Palin recently defended Ron Paul in an interview with Mediaite, saying, “He’s the only one of the GOP candidates “doing something about reining in government growth.”

Following the Florida primary, Santorum also took the opportunity to renew his dedication to his campaign, despite the hits he has taken in the past three primaries. He made specific reference to attacks he will aim at Gingrich and Romney for supporting Obama’s health reform concepts in the past.

In Lehigh Valley’s Morning Call Newspaper on Feb. 2, Santorum said, "Barack Obama, in a debate or in this election, is going to destroy Mitt Romney on the issue of health care."

But the question will be for all of the GOP candidates: How do you campaign against cutting healthcare benefits provided under the health reform law for the sake of defending liberty, when you have people in Nevada dying for lack of healthcare?

It will be interesting to see how the grass-roots support Paul feels he has growing will back him in the Nevada primary on Saturday.

[See also: HIX deadline ‘less than 600 days’.]

Follow Diana Manos on Twitter @DManos_IT_News.