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The passage of the Affordable Care Act (ACA) by the federal government requires citizens to have health insurance or be subject to a penalty. As passed, the ACA required states to expand their Medicaid program to include adults between 19-65 years of age with incomes up to 138% of the federal poverty level (FPL). Currently, childless adults that are not disabled or elderly do not qualify for Medicaid. Parents of minor children with incomes above 56% of FPL also do not qualify. Last year, the U.S. Supreme Court upheld the federal law but ruled that the Medicaid expansion portion should be optional for the individual states.
To encourage states to expand their Medicaid program, the federal government has pledged to pay 100% of the expansion costs for the first 3 years, after which the reimbursement level will fall to 90%. Although senators agreed that this appears attractive on the surface, opponents also pointed out that the state must consider the burden that will be placed on taxpayers in future years, both on the state and federal level. The federal government’s budget is far from stable and going further in debt will place greater burdens on our children and grandchildren. As rules and regulations are still being developed, some senators expressed concern that the game plan could change once states have made the commitment to expand. An amendment was offered to address this concern, proposing language to allow the Legislature to reverse the expansion if federal reimbursement is decreased. This may not be a realistic option, as once Medicaid is expanded, it would be virtually impossible to reverse that trend. With the proposed expansion, approximately 1 in 5 Nebraskans would be on Medicaid and 1 in 5 tax dollars would be spent on Medicaid.
Senators discussed LB 577, which proposes to expand Medicaid in Nebraska, over several days this past week. This is probably one of the most important issues facing senators this session. Supporters of Medicaid expansion did not have the 33 votes necessary to cut off debate and vote on the advancement of the bill. Consequently, after more than 10 hours of debate, the Speaker of the Legislature pulled the bill from the agenda. Unless circumstances change and proponents of LB 577 can prove that they have the necessary votes, LB 577 most likely won’t be placed on the agenda again this year.
Senators had general concern for this group of Nebraska citizens that find it difficult to afford health insurance, but our state currently has commitments beyond its resources for other populations that are also in need of state assistance. Nebraska should not promise something that it may not be able to keep.
Medicaid benefits have no premiums or deductibles and minimal cost sharing. Medicaid expansion could cause some low-income workers to drop their job-based health coverage. The law addresses the lack of health insurance, but it will not necessarily result in better health care. Furthermore, studies have shown that Medicaid recipients use the Emergency Room more often than those without insurance, as there are no financial disincentives. Until these habits are changed, which the law does not address, we won’t see the reduction in costs that some are predicting. The shortage of primary care physicians could also result in more visits to the ER.
Considering all the uncertainty surrounding the expansion, enough senators felt that it was in Nebraska’s best interest to wait and see how the ACA plays out before committing our state and its citizens to a program that could be financially unsustainable in the future. I appreciate all the correspondence that I have received on this issue and I value your input.
Please continue to inform me of your thoughts and opinions on the issues that are before the Legislature. I can be reached at District #1, P.O. Box 94604, State Capitol, Lincoln, NE 68509. My telephone number is (402) 471-2733 and my e-mail address is firstname.lastname@example.org.