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With less than ten days left in this legislative session, the Legislature is in the midst of many controversial issues. The budget bills were given final approval this past week. If the Governor uses his authority to line-item veto funding from various programs in the budget bills, the Legislature will have the chance to decide whether to override the items vetoed by the Governor.
LB 916, which would eliminate the integrated practice agreements (IPA) for nurse practitioners, was given first-round approval this past week. In its place, a nurse practitioner would submit evidence of completion of 2,000 hours of practice or a “transition-to-practice agreement”, which requires a nurse practitioner and the supervising provider to practice collaboratively within the framework of their respective scopes of practice. I designated LB 916 as my priority bill because it enhances access to care for all Nebraskans.
Current law requires a nurse practitioner to sign an IPA agreement with a collaborating physician. However, the IPA is not working as intended. Oftentimes, nurse practitioners in rural areas of the state have difficulty securing an IPA. In some cases, physicians may charge a fee to sign the agreement, even though the nurse practitioner may never meet or speak to the physician. The difficulty in finding physicians willing to sign an IPA and the desire to practice independently has prompted nurse practitioners to move to other states. Eighteen other states allow nurse practitioners to practice without an IPA.
For over 30 years, nurse practitioners have provided high-quality, cost-effective care. Nurse practitioners currently diagnose, prescribe, and treat without supervision. Removal of the IPA will not change this, as it is currently within the nurse practitioner’s scope of practice. Collaboration is crucial to successful healthcare and it will continue to exist between nurse practitioners and other health care professionals.
Forty-eight states allow bond financing for road construction. LB 1092 would add Nebraska to the list of states allowed to borrow money to build roads. Committee amendments reduced the amount of bonding authority given to the State Highway Commission from $400 million to $200 million and specified that the interest rate could be no greater than 5%.
Proponents stressed the importance of transportation infrastructure to our state and emphasized that the ability to issue bonds will accelerate the construction of our high priority road projects. Opponents argued that it tied the hands of future legislators and pointed out that Nebraska is top-ranked for their management of finances by a well-known financial magazine, primarily due to our practice to “pay as you go” for roads projects. After eight hours of debate, the motion to invoke cloture and allow for a vote on the advancement of a bill was successful and the bill advanced to the second stage of debate on a 32-14-3 vote.
The Legislature also gave first-round approval to two bills that would increase alternatives to incarceration for nonviolent offenders in an effort to relieve prison overcrowding and avoid the necessity of building another prison. The legislation also works towards better preparing inmates for a successful re-entry into society. As amended, LB 907 would provide funding for vocational and life skills programs within prisons, would expand a successful alternative to prison program for drug offenders, and would expand services for mentally ill inmates and those newly released. The bill also creates a prison reform task force to work with the Council of State Governments, who has successfully helped other states with prison reform. Finally, it would appropriate funding to UNO to continue their work with CSG. LB 999 would appropriate funding to study the feasibility of adding more behavioral health treatment beds.
If you would like to inform me of your opinions on legislation during the final two weeks of this legislative session, 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 email address is email@example.com.
The Governor gave his final State of the State address to the Legislature this past week. He began his speech on the topic of health care, referring to the many problems with the federal Affordable Care Act. The Governor said that the new federal health care law will cost the State of Nebraska more than $200 million in state general funds over the next six years. He is still strongly against the expansion of Medicaid, which was originally part of the federal plan, but due to a lawsuit became voluntary for states.
Senator Kathy Campbell, the chair of the Health and Human Services Committee, introduced LB 887, the Wellness in Nebraska Act. It is her second attempt to expand Medicaid in Nebraska, proposing to offer Medicaid coverage to adults age 19-64 with incomes up to 100% of the federal poverty level, while those with incomes above 50% of the federal poverty level would have to contribute 2% of their income. For these newly eligible with incomes between 100% and 138% of the federal poverty level, insurance would be purchased through the marketplace, with the enrollees paying 2% of their income and Medicaid paying the remainder. The plan would have to be approved by the federal government.
Although the federal government has agreed to pay 100% of the costs for the first three years of the expansion, dropping to 90% after that, the Governor fears that the state’s share could jeopardize funding for other important programs in Nebraska, such as K-12 education and higher education. He also questioned whether the federal government will keep their promised commitment.
The Governor also addressed crime and punishment. He recommended legislation that will make violent criminals earn their “good time”, instead of automatically receiving it. Currently, Nebraska’s prisons are at approximately 150% of capacity. Some senators expressed concern that this change could enhance the overcrowding problem, while not addressing the underlying problem, of lack of services to prepare the inmate to live in the community. The Governor offered some suggestions for short-term prison capacity issues, but recommended further study for long-term changes.
Senator Brad Ashford, the chair of the Judiciary Committee, introduced LB 907. This bill incorporates the concept of “supervised release”, which has been shown to result in lower rates of recidivism than if inmates are released without supervision. The use of structured monitoring is intended to help inmates adjust to life outside of prison. Each inmate would undergo a comprehensive risk and needs assessment prior to release.
The Governor stressed that the biggest and most important issue facing the state is high taxes. He indicated his support for the Nebraska Farm Bureau’s proposal to lower agricultural land valuations from 75% to 65%. Last year, I introduced LB 101 which proposed this same concept for school taxation purposes. The Governor also recommended a decrease in the top individual income tax rate.
Governor Heineman suggested that the state could offer up to $500 million in tax relief over the next three years, considering our strong cash reserve and our growing economy – if we strictly limit spending. Senators, remembering how a strong cash reserve helped carry our state through the last recession, may be reluctant to spend down the cash reserve too far.
If you have any comments on the Governor’s speech or on other legislation that has been introduced, I encourage you to contact me. I can be reached at District #1, P.O. Box 94604, State Capitol, Lincoln, NE 68509. My e-mail address is firstname.lastname@example.org and my telephone number is (402) 471-2733.