Health care, federalism and the states: Nevada's approach to mental health care

According to the Sacramento Bee, in "Vegas mental hospital goofed on patient's discharge to Sacramento, official concedes" and "Is 'Greyhound therapy' the norm in Nevada?" , the Nevada Department of Mental Health's approach to health care for at least 99 patients was to buy them a bus ticket, give them a couple days worth of medication, and send them to California.  It's not known if they sent other patients to other bordering states such as Arizona.

One of the biggest problems I have with regard to the "states right" argument in the context of federalism and the US Constitution is that I believe that we are citizens of the United States first, and citizens of states second, and that the 14th Amendment--equal protection under the law--of the Constitution should mean that citizens are treated the same across the country, not that we are treated differently in fundamental ways depending on the state in which we are in.

There are many problems with what the right calls "Obamacare," although some good things will come out of it.  (My problem with it is that it didn't go far enough.)  But it's troubling that states have the option of opting out of the program, withholding services from their residents who are in fact citizens of the United States ("Only 15 States Opt to Run Obamacare Exchanges" from CNBC).