Nebraska legislature battles over Medicaid expansion

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April 17th, 2013

Lincoln, NE – Last year’s U.S. Supreme Court decision upholding the Affordable Care Act left it up to the states whether or not to expand Medicaid to cover adults with incomes up to 138 percent of poverty – that’s about $16,000 for a single person, $32,000 for a family of four.

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If states choose to expand coverage, the federal government will pay all the additional costs for three years, declining to 90 percent by 2020. That’s projected to bring about $2.6 billion federal dollars to Nebraska over the next seven years. Sen. Kathy Campbell of Lincoln said the decision the Legislature makes will send one of two messages to Nebraskans:

“Do we say, oh, we don’t think we can cover those of you from that level, to 138% of poverty, even though there is a promise of 100% federal participation?” said Campbell. “The rest of us will just go on. Or do we say, we can make this work. This is our tax dollars with a federal share of 2.3 billion estimate over the years. We can bring those dollars back to Nebraska and serve our people,” said Campbell.

Sen. Bill Kintner of Papillion opposed expansion, predicting the state will eventually have to raise taxes to pay its share:

“And we’re going to the taxpayers,” said Kintner. “And we are going to say, we need more money, we need you to work a couple of extra hours this week to not only pay for your healthcare but the healthcare of others,” said Kintner.

Projections by the Legislature’s fiscal office say expanding Medicaid would actually save Nebraska about $2 million in the next two years, with state costs kicking in after that and rising to about $28 million by 2020. It would provide health insurance coverage to an estimated 54,000 people in the next two years. Sen. Mike Gloor of Grand Island, a former hospital administrator, suggested that might overload an already dysfunctional system:

“We are intending to offer Medicaid coverage to hundreds of thousands more Nebraskans,” Gloor said. “Turning them loose on an industry the gets paid for providing drugs, and procedures, and exams, and institutional care regardless of outcome. Although that is changing, it still hasn’t changed. We are surrendering control of [Nebraska citizen’s] care and tax dollars to a system that does not operate in a manner that any of us would consider a normal business to operate,” said Gloor.

But Sen. Annette Dubas of Fullerton said hospitals she’s checked with say they can handle the increased business.

“I asked them the question about will this overload the system,” said Dubas. “I am being told no. They already believe they are seeing these patients, but at a more costly point in time. Rather than through a clinic early on, either through preventive care or early treatment, they are coming to the hospital or the emergency room that is going to cost so much more and take so much longer for these patients to get better,” Dubas said.

Some senators worried the federal government will not live up to the funding it’s promised. To address that, Campbell offered an amendment requiring lawmakers reconsider the program if the federal cost share drops below 90 percent. But Fremont Sen. Charlie Janssen suggested that wouldn’t work, mentioning supporters of the bill in the legislative balcony:
“There is no sunset clause. Don’t kid yourselves,” said Janssen. “This is a bandaid for Obama care. There will be no sunset. If it passes. . . you think the balcony is full now, wait till you try an repeal it,” said Janssen.

Sen. Sue Crawford of Bellevue said Nebraska has a bad track record of not taking advantage of federal dollars for other education and health programs:

“Leaving this money on the table has not cut federal spending,” said Crawford. “Leaving this money on the table has only shortchanged Nebraskans, exacerbated challenges of covering our at risk populations, such as persons with developmental disabilities and our disabled students. Not passing LB-577 out of a suspicion of the affordable care act, Obama care, or the federal government and leaving 2.6 billion on the table with shortchange Nebraskan,” said Crawford.

Gloor, seen as a key undecided senator, said he’s still skeptical.

“I would love to expand Medicaid, but I am the worst kind of skeptic,” said Gloor. “I am knowledgeable [and] experienced in this area. I will be a hard sell. I will listen but I will be a hard sell,” Gloor said.

Supporters of the bill seem confident they have the 25 votes needed to advance it. Whether or not they have 30 votes to overcome a likely veto by Gov. Dave Heineman is less clear.

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