Medicaid Expansion Unlikely in Nebraska

Details: 03 May 2013

An early March installment of this column described Legislative Bill 577 in these either-or terms: a cost-effective, human-needs policy opportunity not to be squandered; or a cost-prohibitive financial obligation not be undertaken.

The legislation is more complex than those alternatives, but nonetheless it is safe to say that as of April 17 the latter "not" has prevailed over the former. On that date, after more than 10 hours of floor debate over two days, legislators moved on to other matters, leaving LB 577 without a meaningful vote and with an uncertain future, at best.

Medicaid is a federal-state partnership that provides insurance-type coverage of health care expenses for certain groups of citizens who meet means-tested eligibility requirements. Expanded eligibility is related to the federal Affordable Care Act (ACA). Expansion was originally mandated by the ACA, but the U.S. Supreme Court ruled it had to be optional for the states, not mandatory, notwithstanding the fact that expansion was a key component of a multi-faceted health-care-access plan under ACA.

LB 577 would have Nebraska exercise the option. Per the ACA, it would direct and authorize the state Department of Health and Human Services to expand eligibility for Medicaid to all adults, ages 19 to 64, with annual incomes less than 138 percent of the Federal Poverty Level, approximately $15,850. It would make available to the newly eligible a benchmark plan of health care benefits, including behavioral health services.

A key element of the option is that the federal government is statutorily committed to pay 100 percent of the costs of expanded coverage in each of calendar years 2014, 2015 and 2016. Then the federal share drops incrementally over the next three years until it reaches 90 percent for 2020 and thereafter.

The debate on LB 577 was interesting at times, but hardly inspiring. For opponents of the measure, such as Senators Beau McCoy from Omaha, Bill Kintner and Jim Smith from Papillion, Ken Schilz from Ogallala, Lydia Brasch from Bancroft and Charlie Janssen from Fremont, assertions of too much cost risk were a big part of attacking the bill, including whether the federal government can be trusted to fulfill its commitment to pay as federally legislated. Another part was challenging the nature and extent of government’s responsibility to provide health care for the poor.

Senator Mike Gloor from Grand Island, perhaps the key legislator on the outcome of these issues given his veteran membership on the Health and Human Services Committee, his role as chairman of the Banking, Commerce and Insurance Committee, and his past professional experience as a hospital administrator, described himself as skeptical, and aggressively expressed doubt about the capacity and willingness of health-care providers to meet the needs of a significantly increased number of Medicaid insured. From his perspective, which seems cynical as well as skeptical, apparently it’s still better that impoverished adults seek health care through hospital emergency rooms, or not at all.

From the perspective of meeting needs and increasing access to adequate health care for impoverished citizens, it must have been frustrating for proponents of the bill, such as Senators Kathy Campbell, Danielle Conrad and Kate Bolz from Lincoln, Annette Dubas from Fullerton and Jeremy Nordquist, Steve Lathrop, Tanya Cook and Bob Krist from Omaha, to listen to views proclaiming much compassion and concern for the poor, but strident opposition to using Medicaid to expand access to adequate health care, and offering nary an alternative for accomplishing what’s right, just and necessary. From the perspective of most opponents, the ongoing default alternative is apparently just fine: having hospitals pass on uninsured emergency-room costs to premium payers or otherwise provide "charity care" by incurring bad debt.

There was some allusion to a non-Medicaid idea that has surfaced in Arkansas, but the feasibility and legitimacy of the idea are far from certain at this point.

Opposition to LB 577 was aggressively presented, but opposition might not have been the Legislature’s majority position. That was never determined, even after the lengthy debate. The bill never had a meaningful vote. Opponents were willing to keep up the talking; proponents realized that 33 votes, the number needed to invoke cloture to stop the filibuster, were unattainable. So rather than try and fail, they yielded to the Speaker, who decided it was time to move on to other matters.

While not entirely out of the question, it appears unlikely that LB 577 will return to the agenda this year. As it stands, the bill would carry over to 2014. Perhaps by then, more will be known about Medicaid expansion in states that have viewed it as an opportunity not to be squandered and a renewed effort in Nebraska will be deemed worthwhile, the loss of a year of federal funding notwithstanding.

And finally…. It appears likely that LB 44 will be passed overwhelmingly by the Legislature. As amended by compromise, it will establish a 40-year minimum sentencing option (parole petition eligibility after 20) for anyone convicted of a Class IA felony committed while under the age of 19. Under current Nebraska law, the only sentencing option in such circumstances is life imprisonment without parole and that singular option is unconstitutional.