Doctors, hospitals, and advocates for the poor urged Nebraska lawmakers to expand Medicaid in a public hearing Thursday. But questions were raised about the practical effects, and some taxpayer advocates were opposed.
Currently, Medicaid covers mostly the aged, blind, disabled people and children of poor families. But if the state opts to expand it, as allowed under the federal Affordable Care Act, estimates are an additional 54,000 newly eligible Nebraskans would be covered. Those are people with incomes up to 138 percent of the federal poverty line, or with incomes of less than about $16,000 for a single person, or $27,000 for a family of three.
Tens of thousands more people who currently have expensive insurance coverage with few benefits could also switch to Medicaid. Advocates of expanding coverage say covering more people will improve overall health. Pediatrician Stacie Bleicher was among those supporting the proposal. She gave an example of what happens when children have good coverrage, but their parents do not.
"The other day I had a couple of kids in with pneumonia. The mother was in the room just hacking up a storm and had been sick longer than the children had been. And I said, ‘So when are you going to go to the doctor? Because if I get your children well, you’re going to give this right back to them, because I suspect you have the same problem,’"Bleicher related.
Bleicher said the woman replied "Oh, my deductible’s too high. I can’t afford to do that."
"That’s not good either. The parents need to be healthy and covered."
Sen. Mike Gloor of Grand Island said Medicaid currently pays doctors at a low rate, leading some not to accept Medicaid patients. Gloor asked Rowen Zetterman of the Nebraska Medical Association if the proposed expansion was setting up a bad formula. "It’s current reimbursement rates plus an increased population seeking, using Medicaid services, doesn’t necessarily equal those folks being able to get in and see providers. That’s my concern," Gloor said.
Zetterman said it would take only about 25 providers to handle 50,000 new patients, since the typical family physician cares for about 2,000 people in his or her practice.
Omaha Sen. Jeremy Nordquist, a cosponsor of the bill, said the federal government will pay to raise Medicaid payments to the higher Medicare rates for primary physicians for two years. After that, he said, the state anticipates paying an additional $1.5 million a year to keep the rates up.
Still, advocates say, expansion will pay for itself. They say by providing coverage, it will keep people who can’t afford it from waiting until they need expensive expensive emergency room care, and having those costs passed on to people with insurance.
By late afternoon, supporters of the bill were still testifying. But in an interview with NET News, Mike Groene of the Western Nebraska Taxpayers Association previewed some of the reasons why he opposes the bill. "This is basically picking up people who in my opinion I don’t want to pay for their health care. I can’t afford to. As a taxpayer, our burden is too high already," Groene said.
"We’re talking about people with chronic diseases, with gunshot wounds, with knife wounds, with alcoholism. We’re talking about people who I don’t want to pay for," he added.
Groene was asked about the argument that he’s already paying through higher insurance premiums to cover the cost of people without insurance premiums. He said he would rather do that than contribute through his taxes to the mindset that everything is free in this country.