Nebraska again rejects Medicaid expansion

For the fourth year in a row, Nebraska lawmakers have rejected the idea of expanding Medicaid to provide health coverage for more low-income residents.

Near the beginning of Tuesday’s debate, Sen. Kathy Campbell acknowledged the obvious with a quote from Yogi Berra: "It’s like déjà vu all over again."

And yet, this year’s proposal was different. It would still have used federal money offered under the Affordable Care Act, also known as Obamacare, to pay most of the cost of providing health insurance for an estimated 97,000 Nebraskans. But it would have done so, in most cases, by using that money to buy private insurance, instead of enrolling people in Medicaid. And it would have discontinued the program after three years if the Legislature and governor did not reaffirm it.

Campbell noted that 32 other states have already decided to expand Medicaid. "We have brought forward the most conservative plan in this country. We have tried to address questions, concerns and suggestions. Potentially 97,000 Nebraskans are waiting for our answer," she said.

Sen. Bill Kintner of Papillion credited opponents like himself with changing the proposal. "The fact that we defeated Medicaid expansion in the past is why we have this right here, that they are calling the ‘most conservative’ approach to Medicaid expansion. Think about this: What they tried to impose upon the state was flat-out Obamacaid, and you can call it nothing else," Kintner said.

Opponents have continued to question whether the federal government would live up to its commitment to pay 90 percent of the program’s cost. That led Sen. Adam Morfeld, an expansion supporter, to suggest they were using a double standard. "The arguments that many have made against Medicaid expansion include that we cannot trust the federal government to fulfill their obligation; the funding stream is not guaranteed beyond several years; and government spending is out of control," Morfeld said. "I look forward to the day that many of us make the same arguments against other federal programs for roads, farms, Medicare, and economic development. I have yet to hear them and I doubt I ever will."

Sen. Beau McCoy, arguing against the bill, said state’s 10 percent cost share should be spent on other issues. "Robust, healthy, adequate and growing funding for K-12, higher education, roads and tax cuts are a higher priority than the expansion of Medicaid in my mind," McCoy said.

Sen. Ken Schilz, referring to the waning time left in the legislative session, urged lawmakers not to use the minimum of six hours of debate that would be required before trying to break a filibuster and vote on the bill itself. "On a lot of these issues, especially one that we’ve been over before and talked about before – Medicaid expansion, other issues, big issues like that – we should take a test vote up front. And find out if we are close or not. Because there’s no reason to take these things six hours if we don’t need to," Schilz said.

Sen. Dave Bloomfield offered just such a test vote, moving to "bracket" the bill – postponing any further debate this session. Senators voted 28-20 to do just that, effectively killing the bill for this year.

Afterwards. Gov. Pete Ricketts released a statement praising lawmakers’ decision, saying the program would have been unsustainable and would have exposed the state budget and Nebraska taxpayers to great risk.

For her part, Campbell predicted Nebraska would eventually join the other states in approving Medicaid expansion under the Affordable Care Act. "I think over time that many components of the ACA will stay in place, and eventually, all states will opt into Medicaid expansion. Just as when we first had Medicaid itself, the states had to vote to participate and finally all 50 did," she said.

Congress approved Medicaid in 1965. The last state to join the program was Arizona, whose program started in 1982 – 17 years later.