The Nebraska Legislature opened a crucial debate on expanding Medicaid Tuesday, with senators projecting health care benefits pitted against those concerned about costs.
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. 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 percent of poverty, even though there is the offer of 100 percent federal participation. The rest of us will just go on.’ Or do we say ‘We can make this work?’ These are 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," Campbell said.
Sen. Bill Kintner of Papillion opposed expansion, predicting the state will eventually have to raise taxes to pay its share. "We’re going to have to go to the taxpayers and say ‘We need you to pay more money. We need you to work a couple of extra hours this week to not only pay for your healthcare, but to pay for the healthcare of others,’" he said.
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 tens of thousands more Nebraskans, turning them loose in an industry that gets paid for providing drugs, and procedures, and exams, and institutional care, regardless of outcomes. Although that’s changing, it’s still not changed," Gloor said.
"We’re surrendering control of their care and we are surrendering our tax dollars, too, into a system that doesn’t operate in the manner any of us would consider (how) a normal, reasonable business would operate," Gloor continued.
But Sen. Annette Dubas of Fullerton said hospitals she’s checked with say they can handle the increased business. "I asked them about ‘will this overload the system?’ I’m being told ‘no,’ she said. "They already believe they’re seeing these people, but at a more costly point in time. Rather than going into a clinic early on, either through preventive care or early treatment, they’re coming to the hospital. They’re coming to the emergency room where it’s going to cost so much more, and take so much longer for these patients to get better."
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. "This is a band aid on Obamacare. It will not be sunset. If it passes today, you think the balcony’s full now? Wait ‘til you try to repeal it," he told fellow senators.
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. Leaving this money on the table has only shortchanged Nebraskans and exacerbated our challenges in covering our vulnerable populations such as persons with developmental disabilities and our special needs students," she said.
"Not passing LB577 out of a suspicion of the Affordable Care Act or Obamacare or the federal government and leaving $2.3 billion on the table will shortchange Nebraska," Crawford continued.
Gloor, seen as a key undecided senator, said he is still skeptical. "I would love to expand Medicaid. But I am the worst kind of skeptic. I am knowledgeable, I’m 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.