Medicaid expansion stalls in Nebraska Legislature

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April 17, 2013 - 5:54pm

A plan to expand Medicaid coverage to more low-income Nebraskans stalled in the Legislature Wednesday, amid philosophical and financial objections that left it unclear whether the issue will be debated again this year.

The proposal would expand Medicaid coverage to cover about 54,000 low-income adults in the next two years. They would be eligible if they made less than about $16,000 for a single person, or $27,000 for a family of three.

Supporting the proposal, Sen. Tanya Cook of Omaha gave several examples of people she said would be eligible, including a 60-year-old woman from Shelton. The woman’s husband retired in 2010, and as a result, she lost her insurance coverage.

The couple couldn’t afford the $650 per month premium that it would cost to cover her, Cook said. Last August, the woman was diagnosed with breast cancer. She was billed $32,000 for the surgery, even after the provider discounted the bill by 60 percent. "She is paying some of the cost by charging it to her credit card," Cook said.

Sen. Ken Schilz of Ogalalla opposed expanding government health coverage. "This is a philosophical question. Who can handle these types of situations better? Is it the private sector, or is it the government?" Schilz asked. "I believe in the people. I believe in the private sector. And I believe that’s the best way to go about it," he said.

Under the Affordable Care Act, the federal government promises to pay the full cost of expanding Medicaid, if states choose to do so, for the next three years. After that, the federal share is supposed to decline gradually before stabilizing at 90 percent by 2020.

Opponents have questioned whether the federal government will live up to its promises, or leave states on the hook for a greater share of the program. To address that, Sen. Galen Hadley of Kearney offered an amendment. Hadley’s amendment would have limited Medicaid expansion to only the next three years, after which lawmakers would have to decide whether or not to extend the program.

Omaha Sen. Steve Lathrop supported Hadley’s approach. "If the predictions of the end of the world come true, if the federal government reduces their commitment, if this doesn’t work, if expanding services to 55,000 people cause a problem, we’ll back it up," Lathrop said. "We’ll just undo what we did. And it will be done before we’re called upon to contribute to the cost."

Schilz questioned if that wouldn’t be worse than not starting the expansion at all. "Is the solution to give a false promise to those that maybe would become eligible under this? And then in three years, when and if the federal government – and I think it’s when, not if – can’t live up to its responsibilities, how do we pull that back? How do we tell those folks ‘Oh, I’m sorry. Yeah, you were covered, but we don’t want to do that anymore?’ Schilz asked "I don’t think it’s smart. And I don’t think it’s moral."

After more than 10 and a half hours of debate over the last two days, Speaker Greg Adams announced that he was pulling the bill off the agenda and moving on to other subjects. Lincoln Sen. Kathy Campbell, chief sponsor of Medicaid expansion, conceded that supporters did not have the 33 votes that would have been needed to cut off debate and take a vote on the bill. Campbell said the issue is complicated, and senators still have a lot of questions – including over a possible alternative being explored in Arkansas, of having the state buy private insurance for people. Critics of that plan say it would be more expensive than expanding Medicaid.

Campbell said she doesn’t know if the Legislature will return to considering her proposal this year. "If I feel any sense of failure here, it’s certainly to the people who would qualify" for expanded Medicaid, she said.

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