Initiative 427 will appear on your ballot as the latest attempt to expand Medicaid coverage under Obamacare. Medicaid expansion has unsuccessfully come before the Unicameral numerous times, and the pros and cons your Nebraska senators have considered in previous years are relevant to Initiative 427. Like most issues, Medicaid expansion is not black and white. As your representatives in the Nebraska Unicameral, we feel obligated to share our concerns and urge you to consider the consequences Medicaid expansion would have on our state.

Expanding Medicaid through Initiative 427 would hurt our most vulnerable Nebraskans by removing the focus of Medicaid benefits from people with disabilities, children, and pregnant women and placing the focus on working-age adults without disabilities or children. The costs of expansion would make property tax relief nearly impossible, leave the state’s reserve funds at a dangerously low level, and put funding at risk for K-12 education, the University of Nebraska, roads, and current Medicaid recipients.

Obamacare (the Affordable Care Act) requires the federal government to reimburse states for only a portion of Medicaid expansion costs. Initiative 427 would require the state to fund the remaining expansion expenses – a price tag projected to cost Nebraska taxpayers $33 million in 2019-20 and up to $768 million over the next decade according to Nebraska’s Legislative Fiscal Office and Department of Health and Human Services. Actual costs have far exceeded projections in nearly every state that has opted to expand Medicaid under Obamacare. For example, in the first year Iowa expanded Medicaid, actual costs totaled nearly $150 million more than expected.

In a study published this month, Nebraska was ranked number one nationally for financial wellbeing. We have accomplished this by using taxpayer dollars cautiously and keeping unpredictable financial obligations out of our state budget. Unlike Washington, we balance our state budget each year and remain debt free. Medicaid expansion would create an unpredictable financial obligation on Nebraska, as seen in other states, which could throw our balanced budget into jeopardy. If Initiative 427 passes, Nebraskans could be forced to choose between increasing taxes or cutting funds to existing programs, such as K-12 education, roads, or current Medicaid benefits. Tax increases would create an overwhelming financial hardship for most Nebraskans, and cutting funds to existing programs is an equally unappealing option.

As Nebraskans, we have always prided ourselves in looking out for our friends and neighbors who are in need. Our current Medicaid program provides health care benefits to people with disabilities, children, and pregnant women. We are one of the few states to offer all federally optional Medicaid services (such as prescription drugs, mental health services, and care for the developmentally disabled) in addition to federally required services. Although the federal government would fund a limited portion of Medicaid expansion, none of these funds can be used to support benefits for current Medicaid recipients. As a result, some states have been forced to cut optional Medicaid services to their most vulnerable citizens – a reality Nebraska would also likely face.

Current Nebraska Medicaid recipients are at risk of losing benefits for dental services, prescription drugs, treatment for specific diseases (such as breast and cervical cancer), vision care, mental health, speech and occupational therapy, and many more. Initiative 427 would put the needs of working-age adults without disabilities over the needs of our friends and neighbors with disabilities, children, and pregnant women who truly cannot afford to lose these essential services Nebraska provides.

Medicaid expansion would place a significant burden on Nebraska taxpayers that could hurt Nebraska’s most vulnerable citizens. Before you cast your vote on Initiative 427, we urge you to consider the impacts Medicaid expansion would have on your neighbors, your family, your business, and your budget.

Senator Joni Albrecht; District 17 – Chair, Business & Labor Committee

Senator Lydia Brasch; District 16 – Chair, Agriculture Committee

Senator Curt Friesen; District 34 – Chair, Transportation & Telecommunications Committee

Speaker Jim Scheer; District 19 – Speaker of the Legislature

Senator Bruce Bostelman; District 23

Senator Tom Brewer; District 43

Senator Rob Clements; District 2

Senator Steve Erdman; District 47

Senator Steve Halloran; District 33

Senator Lou Ann Linehan; District 39

Senator John Lowe; District 37