Medicaid expansion argued again; $8.6 billion preliminary budget released

Feb. 25, 2015, 5:48 a.m. ·

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Nebraska Capitol from the west (Photo by Fred Knapp, NET News)

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Supporters renewed their push to provide health coverage for more low-income Nebraskans through Medicaid, and a preliminary plan for state spending of nearly $9 billion dollars was presented to senators Wednesday in the Legislature.


It’s the third year in a row advocates have tried to take advantage of the federal dollars being offered to expand Medicaid. Among those testifying in support of the proposal, LB472, was Shelly Sedlak of Seward. Sedlak said she’d worked until she had a stroke, and now can’t afford treatments that could help her. "If LB472 was passed, I could afford an MRI and the physical therapy that would help me improve to the point that I may able to be go back to work some day and live a more normal life," she said.

Sen. Merv Riepe of Ralston questioned whether there are enough physicians willing to take care of the estimated 54,000 more Nebraskans who would be insured through Medicaid if the bill passes. "In the real world, many of these physicians will not take Medicaid patients at Medicaid reimbursement beyond 10 percent of their practice. I know firsthand from running a pediatric group, we had patients from Lincoln that had to drive to Omaha to see a pediatrician because …Medicaid would not be accepted. So unless you’re going to mandate that all these providers must participate, you’re going to have a hard time."

Dr. Amanda McKinney, an obstetrician/gynecologist from Beatrice, supported the bill on behalf of the Nebraska Medical Association. "There have been many statements made by current lawmakers opposed to this expansion claiming that many providers don’t accept Medicaid patients because of low reimbursements. While there may be some physicians declining to see Medicaid patients, most do accept these patients, particularly providers in rural areas of the state. Currently almost 30 percent of the patients I see in my clinic are covered by Medicaid.

Doug Kagan of Nebraska Taxpayers for Freedom said that group opposes the proposal, which seeks to take advantage of one portion of the Affordable Care Act, or Obamacare. "We think there is a need for medical health care for the uninsured individuals but we do not believe that any kind of attachment to Obamacare is the way to go because of the nonsuccess of Obamacare so far," he said. "What we’re promoting is what we think is better alternatives, like health savings accounts. We believe that employers can pool together to get cheaper insurance for their employees -- even private individuals if the law was changed so they could pool together to get better insurance."

Courtney Miller of the Department of Health and Human Services also opposed the proposal on behalf of the administration of Gov. Pete Ricketts.

As of last month, 29 states have opted to expand Medicaid, according to the Kaiser Family Foundation. Under the Affordable Care Act, the federal government pays 100 percent of the added cost initially, declining to 90 percent by 2020. Supporters of expansion say it’s foolish not to take the federal dollars; opponents say the state’s eventual ten percent share would divert money from other needs like schools and roads. The Health and Human Services Committee took no immediate action on the proposal.

Also on Wednesday, senators were given copies of the Appropriations Committee’s preliminary budget. It calls for state spending of about $8.6 billion over the next two years. Sen. Heath Mello, the committee chairman, calls it a "responsible fiscal foundation" for further discussion, and said it amounts to an increase of about 3.2 percent a year. Gov. Pete Ricketts budget proposal called for an increase of 3 percent a year, or about $32 million less spending. The committee says the main differences are from updated estimates of school aid and child care payments, and funding for juvenile justice bills passed last year. Mello says the Department of Health and Human Services requested more money to cover child welfare costs this year. But says he wants to know if those needs, which could be more than $15 million, will continue in the future. "That’s the concern that I have in the sense of not wanting to see foster parents and foster children be put in an unfortunate political situation of whether or not there’s enough funding to pay foster parents their payments and/or to provide the state-required services that we give foster youth that become wards of the state," Mello said.

Mello said the state should make sure the system works in the long run. "I don’t want to see us have to continue to do emergency funding bills for such a vital service that the state provides to those vulnerable children and those vulnerable families," he declared.

The proposed budget would allow hiring 8 more chemical dependency counselors/mental health practitioners and one psychologist for the state’s troubled prison system. That would be an increase over the current total of 81, and would increase the existing 3.5 million expenditure by another $1.2 million. The committee will now hold public hearings for each agency before making its final budget recommendation to the Legislature in late April.