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One of the items that will appear on your ballot next month is a measure for Medicaid expansion. This ballot measure is the result of a successful citizen led initiative by Insure the Good Life, which collected more than 104,000 signatures for its petition drive. So, the time has come for us to ask: Is Medicaid expansion really good for Nebraska? Medicaid expansion won’t be good for Nebraska and today I would like to explain why that is the case.
The Medicaid expansion measure on your ballot would extend coverage out to those living at 138 percent of the federal poverty level, which amounts to an estimated 90,000 Nebraskans. While this sounds quite nice and compassionate, it would actually have the opposite effect on our State’s poorest citizens. Allow me to explain.
Under our current system with the Obamacare Marketplace those living at 138 percent of the federal poverty rate qualify for free healthcare plans or healthcare plans with $0 premiums. These are private healthcare plans which provide easy access to doctors, hospitals, healthcare clinics, and pharmacies. However, Medicaid expansion would force these same individuals into Heritage Health, which is our State’s Medicaid program. Under Heritage Health doctors, hospitals, healthcare clinics, and pharmacies become difficult to find. For instance, some of our Medicaid patients under Heritage Health have had to drive to Lincoln or Omaha just to find the services they need.
After an additional 90,000 patients get added into Heritage Health, benefits would necessarily be reduced for everyone in the Medicaid system. The reason is that Nebraska has no way to pay for the extra costs associated with Medicaid expansion. In order to keep benefits at their current levels, the Nebraska State Legislature would be forced to either raise taxes or to make huge cuts in its biennial budget or both. You might as well kiss any hopes of ever getting property tax relief good-bye!
Medicaid expansion always turns out to be more expensive than originally projected. The original cost for Medicaid expansion in Nebraska was projected to be $45 million per year, but that cost is more realistically projected to be $90 million. States that implement Medicaid expansion always find out that it is more expensive than originally forecasted. For example, in Iowa the per-member Medicaid costs have nearly tripled. Last year, for instance, Iowa’s per member cost rose 4.4 percent compared to the 1.5 percent for the previous six years. Iowa’s Medicaid expansion bill went into effect in 2015.
Medicaid expansion is unsustainable. While individual states provide 10 percent of the funding, the federal government is expected to provide the other 90 percent. Because our national debt already exceeds $21.5 trillion, it is safe to say that the federal government cannot afford to pay for Nebraska’s Medicaid expansion. For this reason, Governor Ricketts has expressed doubt that the federal government would be able to pay their portion of the costs. In fact, there is nothing preventing the federal government from shirking its responsibility to our State.
The success of a social welfare program like Medicaid should never be measured by how many people we can put onto it, but by how many people we can get off of it. For this reason, Louisiana Congressman Steve Scalise recently said, “…Medicaid is one of the most failed forms of healthcare,” and Ronald Reagan said during his 1980 presidential campaign, “I happen to believe that the best social program is a job.”