When the Nebraska Legislature reconvenes next month, senators are expected to introduce a new proposal to expand Medicaid, with a bigger role for insurance companies. Supporters hope that will attract enough support to ensure health coverage for up to 50,000 more people. But opponents still say expanding Medicaid hurts taxpayers.
One person following the debate is Randi Devorss of Lincoln. As a 19-year-old, first-year student at Southeast Community College, aiming for a career as a clinical psychologist, Devorss is already juggling some adult responsibilities. “I’m working 22 hours a week…and I work on the weekends. That way I can go to school,” Devorss said.
Until this month, Devorss was included in the Medicaid coverage of her mother, who’s disabled. But she lost that when she turned 19. Now, she has no health insurance. “I’m trying to be proactive. I’m trying to get a health care plan but there’s really nothing out there that’s in my price range,” she said.
Federal subsidies under the Affordable Care Act are supposed to help people buy health insurance. But they’re geared for people at or above the federal poverty line – about $12,000 for a single person. For people with even lower incomes, like Devorss, the Act expanded Medicaid. But the U.S. Supreme Court made that optional for each state, and opponents in the Legislature blocked expansion in Nebraska last year.
Devorss said if that continues, she will have to change her plans to be able to afford health coverage. “If there is no expansion of Medicaid, there is no assistance to me, I am going to have to not attend school full time. I’ll have to go part-time so I can get another job to help pay for those expenses,” she said.
Sen. Jeremy Nordquist of Omaha, who supports expanding Medicaid, said Devorss’ situation is hardly unique. “There’s 50,000 stories probably like hers. Most of these people are working low-wage jobs. Many of them are young college students who are working part-time jobs and whose parents don’t have coverage for them,” Nordquist said.
Instead of trying again for a simple expansion of Medicaid, Nordquist said he, Sen. Kathy Campbell of Lincoln, and other supporters will try something new next year. “Sen. Campbell and myself and other supporters will sign onto a bill and have a new bill proposed this year that will be something like Iowa or Arkansas – some mix of public insurance and private insurance,” Nordquist said. “It’s likely we’ll include some form of cost co-payment or cost sharing of some nature. That’s some options that we’re still looking at and talking about to make sure that everyone has some skin in the game.”
Iowa’s plan puts people making up to the federal poverty line on a state-run plan. For people making more than that, it uses federal money to pay private insurance premiums via the new health care exchange. It was just approved by federal officials on Tuesday, although they rejected a proposed fee for low income people. Arkansas' plan also uses Medicaid money to pay private insurance premiums.
Sen. Beau McCoy of Omaha, who led a filibuster against expanding Medicaid last year, said he still thinks it is the wrong way to go.
“Other states may make their own decisions about it. But the Supreme Court – the U.S. Supreme Court’s been very clear that Medicaid expansion under Obamacare is optional for states and up to us as individual states whether or not we do it and whether or not we expand it,” McCoy said. “We’ve got to be very careful that we go about doing the best job possible not only that we make to make it possible for health care to be provided to our citizens across the state but that we are responsible and protect the taxpayers of Nebraska.”
Supporters’ plans to change their proposal aren’t enough to sway another leading opponent, Gov. Dave Heineman. Asked if adopting a plan like Iowa’s or Arkansas’ would change the governor’s opposition, spokeswoman Jen Rae Wang said, “These are still just forms of Medicaid expansion, which is unaffordable and unsustainable.”
Both Heineman and McCoy said even the 10 percent share state taxpayers would ultimately have to pay would cost hundreds of millions of dollars that should fund schools and other obligations.
Nordquist said it’s foolish for the state not to take billions of federal dollars to fund health care for low income Nebraskans.
Devorss hopes Nordquist and Medicaid supporters will prevail. “I want to go to college. I want to go to school. I want to get things done and be an active citizen and have my own practice and do things like that. And ideally, I would not want to push school off, plain and simple,” Devorss said.
She and other Nebraska taxpayers -- for and against Medicaid expansion -- will be watching closely to see what lawmakers decide after they reconvene next month.