Committee advances Medicaid expansion; Keystone controversy continues

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February 24, 2014 - 5:35pm

Sen. Mike Gloor (Photo by Fred Knapp, NET News)

A Nebraska legislative committee tweaked a Medicaid expansion proposal Monday and sent it on for all senators to debate. Sniping continued over the future of the Keystone XL pipeline, which may be decided soon. And senators moved toward making more mental health care available in rural areas.
Changes to the Medicaid proposal focus on the issues of cost and quality of care. This year’s original proposal would expand the existing Medicaid managed care system for people with incomes up to the federal poverty line – about $20,000 for a family of three. From there to 133 percent of poverty – about $26,000 – it would use federal Medicaid funds to subsidize the purchase of private insurance policies on the federal health care exchange. Gov. Dave Heineman’s administration opposed the plan, citing a consultants’ study that said the plan would be more even more expensive than a straightforward expansion of Medicaid.
A Health and Human Services Committee amendment adopted Monday would require an actuarial study. If the study shows the new plan with private insurance would cost more, participants would go into Medicaid managed care instead. The amendment also discusses creating a position to oversee Medicaid costs and quality. 
Committee Chairwoman Sen. Kathy Campbell says the legislation, dubbed the “Wellness in Nebraska” act, is moving in the right direction. “What Wellness in Nebraska does is say ‘Okay, we’re going to use the Medicaid expansion dollars, but we’re going to use them to transform our health care system.’ And to be able to use that money to demonstrate what does work with populations. What is cost effective. What is efficient,” she said.

Among those supporting the revised proposal was Grand Island Sen. Mike Gloor. Gloor has opposed the proposal until now, citing concerns about simply dumping more money and patients into an already overloaded health care system. But Monday, he praised the bill’s emphasis on getting people into so-called patient centered medical homes. That’s a health care system in which patients establish relationships with a team directed by a doctor that’s supposed to coordinate care in a more cost-effective manner.
Gloor said that would help make Nebraska’s system better, regardless of what happens at the federal level. “Even if the Affordable Care Act goes away, in another two, three or five years, whatever the case may be, what we’ll  be left with is some transformational change in health care that will serve us well in the future regardless of what the health care system looks like. And I remain hopeful maybe we’ll move to a market-driven system,” he said.
On the other hand, Omaha Sen. Bob Krist, who supported Medicaid expansion last year, declined to support it Monday, abstaining on the vote to advance it from committee. Krist said he changed his mind after President Barack Obama started granting exceptions to the health care law, and because it became clear to him the Heineman administration would not cooperate in implementing it. But he said he could change again. “We’re going to talk about it on the floor and we’re going to have to understand or we’re going to have to come to consensus that this is possible, the executive branch is going to work with us, then my vote may change. But right now, it’s just not, it’s not there,” he said.
Last year, Medicaid expansion was blocked by a legislative filibuster. If that tactic is used again this year, it would take somewhere around three to five senators changing their mind to overcome it.
Meanwhile, controversy continues over the future of the proposed Keystone XL oil pipeline. Gov. Heineman said President Obama was asked about Keystone at a White House meeting with about 40 governors Monday. Heineman and Oklahoma Gov. Mary Fallin say Obama told governors he expects a decision "in the next couple of months," but didn't offer a specific timetable.
The statement came as arguments continued over the significance of  last week’s court decision invalidating Nebraska’s pipeline siting law. Monday, pipeline company TransCanada said because Attorney General Jon Bruning has appealed, the approval of its proposed route remains in effect, and should not stop the State Department from approving the pipeline. But David Domina, the lawyer who got the law overturned, accused TransCanada of ignoring Nebraska’s court system. Domina said the project remains in limbo until the Nebraska Supreme Court rules and the federal government acts.
Also Monday, the Legislature gave first-round approval to a proposal aimed at improving mental health services in rural areas. The bill by Lincoln Sen. Amanda McGill would fund five doctoral-level psychological internships, increasing to 10 within three years. It’s projected to cost about $600,000 for the first two years. Senators advanced the proposal on a 31-0 vote.

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