The latest effort to expand Medicaid to cover more low-income Nebraskans failed in the Legislature Wednesday. And questions were raised about a proposed temporary fix for the state’s prison overcrowding.
The proposed Medicaid expansion would have covered an estimated 54,000 Nebraskans with incomes below 133 percent of the federal poverty line – about $26,000 for a family of three. It would have done so by using federal Medicaid dollars to help pay private insurance premiums for some, and putting others in a Medicaid managed care plan. That plan would have reformed Medicaid by requiring participants to sign up with a primary care physician and a team, known as a patient centered medical home, where available. And it would have provided financial incentives for preventive care, like annual physicals.
Grand Island Sen. Mike Gloor supported the plan, saying Medicaid needs to be reformed. "We’ve got to change the Medicaid system. This is a Nebraska option," he said. "It makes sense for us to move in this direction because if we don’t this year, the next time we revisit this issue, we’ll have to do so using a lot more money that comes from Nebraska taxpayers."
Under the Affordable Care Act, the federal government would pay 100 percent of the cost of Medicaid expansion through 2016, declining to 90 percent by 2020. The Legislature’s fiscal office calculates Medicaid expansion would bring in $2.2 billion from the federal government by the end of the decade, while the state would have to chip in $61 million. A study done for Gov. Dave Heineman’s administration projected higher costs.
Sen. Bill Kintner of Papillion said even providing preventive care for currently uninsured people would cost a lot. "Doctors end up seeing more patients for less money. The patients have an army of do-gooders nosing into their personal lives, searching for disease metrics and risk factors, so they can swoop in and educate them on how to eat properly, how to exercise. And the only people happy about these plans are the major insurers and hospital groups," he said.
Lincoln Sen. Kathy Campbell, the lead sponsor of the proposal to expand Medicaid, said senators decision on how to vote boiled down to a simple question: "Are we going to be there for all Nebraskans, or just for some? Are we going to have people at the door, who need access to health care, and we say ‘I’m sorry, we can’t do that. We may not have a doctor. You’ll have to wait. But I will be taken care of, because I have insurance?’" she asked.
Sen. John Murante of Gretna said opponents of the bill were not uncaring about less fortunate people. But he said they simply were not convinced the Legislature would make things better by enacting the proposal, LB887. "Whether LB887 passes or fails, we’re going to be back here next year with very tragic stories and very sad situations, because that’s the reality of life," Murante said. "While it would be nice to believe that the challenges that life presents can be solved in this (legislative) chamber, I think the reality and history proves that we tend to make problems worse when we get involved."
With opponents promising to talk the bill to death, Campbell moved to cut off debate and take a vote on the bill. That requires two-thirds of the 49-member Legislature, or 33 votes. When the votes were tallied, 27 members – a majority -- voted to cut off debate, with 21 opposed, killing the measure for the year.
Wednesday afternoon, senators debated a proposed stop-gap solution to prison overcrowding. Gov. Heineman wants to move up to 150 inmates from state prisons to county jails. The Appropriations Committee included $5 million for that purpose in the proposed budget, which senators had already given one of three required approvals.
Omaha Sen. Ernie Chambers tried to remove the money. Chambers said county jails, which house people sentenced to less than a year, don’t meet state prison standards for medical treatment and programs for inmates. Sen. Brad Ashford supported Chambers attempt to remove the money from the budget. Ashford said the same money could be spent more effectively to help people leaving prison and make sure they don’t return. For $5 million, Ashford said, the state could run a reentry program giving prisoners approaching the end of their sentence help with job opportunities, housing, and medical treatment. For $1 million, Ashford said, such a program could exceed the results of moving 150 inmates in six months.
Heath Mello, chairman of the Appropriations Committee, opposed removing the county jail money from the budget. Mello said moving 150 inmates could reduce prisons from 156 percent of capacity to less than 150 percent, and possibly head off a lawsuit.
Lincoln Sen. Colby Coash said long term solutions like Ashford has been discussing are important, but not enough. "In the short term, we have a powder keg getting ready to explode in our corrections system because it is too full. The only solutions that have been presented to alleviate the short-term problems are now being challenged," Coash said.
The amendment to remove the $5 million from the budget failed on a vote of 18-22. Senators then gave the budget second round approval on a voice vote.