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A third attempt in as many years on expanding Medicaid was considered last week. LB 472, introduced by Sen. Kathy Campbell and prioritized by the Health and Human Services Committee would help redesign our Medicaid program, creating a Nebraska-specific plan for better, cost-effective care, and would close the coverage gap, providing health insurance to working Nebraskans with low incomes that cannot afford it under the current system.
LB 472 creates a Medicaid Redesign Task Force, composed of members of the Legislative and the Executive branches, which will review the Medicaid program and provide recommendations to improve quality, innovate, and save costs. Closing the coverage gap would bring $2.2 billion back to our state to utilize for redesigning Medicaid and health care innovation. The bill would allow the Department of Health and Human Services to work with the federal government to create a coverage plan unique to Nebraska, with some individuals getting coverage in the private marketplace, and others getting coverage under Medicaid.
The bill is intended to provide Medicaid coverage to a newly eligible population of adults ages 19-65 with income below 133% of the federal poverty level. Senator Campbell handed out to each of us information on how many uninsured people there were in our legislative districts. Legislative District 34 has 1274 individuals that fall into that category.
LB 472 would allow approximately 54,000 Nebraskans to access health care on the private insurance market with costs covered by Medicaid with a 100% federal match from now through 2016. Later 95% will be covered in 2017, 94% in 2018, 93% in 2019, and 90% thereafter. At least $2.2 billion in funds would be returned to Nebraska’s economy through these funds between now and 2020. It projects that there will also be cost savings in other areas of the state budget to help offset any costs to the state, including savings from corrections, the state disability program, drug assistance programs, and behavioral health.
LB 472 sets out a framework to redesign Medicaid and close the coverage gap, and provides the Governor and the Department of Health and Human Services broad latitude to design and implement a plan for Nebraska. It also leaves us with many unknowns and very few details on how this would be implemented. It reminds me of the Affordable Care Act in that we should pass this and then find out what is in it.
The bill requires most enrollees to contribute up to 2% of their income to the cost of insurance, unless they engage in wellness activities. Individuals that use the Emergency Room for a non-emergency will also face a co-pay of up to $50. LB 472 allows Nebraskans to have coverage for important preventive care like health screenings, which is vital to keeping health costs down. It also emphasizes wellness activities, like yearly exams, physicals or screenings that can lead to early detection of conditions in need of treatment. If individuals engage in wellness activities, they will be exempt from the 2% income contribution.
The bill would encourage and explore several different innovative approaches that could improve the overall health of Nebraskans and our health care system, and it would use federal dollars to do so.
LB 472 would pilot the use of patient-centered medical homes, health homes, accountable care organizations, and value-based payments. These approaches would help ensure people manage their health conditions, coordinate medical care, and stay healthy.
Supporters of this measure say that a lack of mental health services and substance abuse treatment is a primary cause of reoffending and recidivism and a return to jail or prison. LB 472 could help keep nearly 400 people from returning to prison in one year; could result in gross savings to the state’s correctional budget of nearly $11 million in one year; and could save additional state and county dollars that have already been invested or will be invested in corrections reform.
Opponents, including Governor Ricketts, say expanding Medicaid would be a risky proposition for taxpayers, not only because of the expense, but also because “we cannot trust the federal government’s long-term financial commitment to state programs.” With the federal government showing $18+ trillion of debt that sooner or later will need to be addressed I truly believe that states will be left funding more and more of the program. When looking at the number of individuals that could qualify for this program the number used is 54,000. A study conducted by two University of Nebraska at Kearney professors predicted the number possibly qualifying as 79,500. These numbers could increase dramatically if this program encourages small business owners to drop coverage for employees and pushes them into Medicaid coverage. The system is broken and this does nothing to hold down health care costs. We cannot fix the system by throwing more money at the problem whether it is federal or state dollars.
Supporters say we are leaving federal dollars on the table and we should take them and inject that money into the economy and create jobs. I will say that we cannot create good jobs with tax money that should not have been taken from us in the first place.
Someone needs to say no and with the federal government unable to stop spending that leaves it to us to say no. We should be encouraging businesses to maintain coverage and keep some responsibility of living a healthy lifestyle with the individual.
After four hours of debate it was evident that supporters of LB 472 could not maintain a filibuster and so on a vote of 28-16 the bill was bracketed (or postponed) until the last day of the session, which means it is dead for the rest of this session. However, it leaves it available to return to next session with time to work on changes during the summer. I am unsure if there is a solution to this issue.