Proposed Medicaid expansion bill back again

For the third year in a row, Nebraska legislators will consider a bill to expand Medicaid coverage for low-income state residents.

Legislative Bill 472 was introduced by Lincoln Sen. Kathy Campbell last month. The bill was assigned to the Health and Human Services Committee, which will conduct a hearing on the legislation this week.

Following the hearing, the committee can vote to send to the bill to the full Legislature – with or without amendments – indefinitely postpone the bill or take no action.

Mandatory Medicaid expansion was initially part of the Affordable Care Act but was struck down as unconstitutional by the U.S. Supreme Court.

Without the expansion, thousands of Nebraskans are stuck in a coverage gap – earning too much to qualify for Medicaid but not enough to qualify for federal marketplace insurance subsidies.

According to the Nebraska Hospital Association, 54,000 state residents earn less than 100 percent of the federal poverty level – disqualifying them from marketplace subsidies – while also having a child and making more than 50 percent of the FPL, disqualifying them from Medicaid. Childless adults are currently ineligible for Medicaid.

LB 472 would close that gap and also create a Medicaid Redesign Task Force to facilitate the coordination of the various agencies that currently provide services. Residents earning 100-133 percent of the FPL ($11,670-15,521) would receive insurance premium assistance, and those making 50-100 percent of the FPL ($5,835-11,670) would qualify for Medicaid.

Individuals enrolled in the expanded Medicaid would be required to contribute 2 percent of their income to the cost of their insurance unless they participated in qualifying preventive care wellness activities the previous year. A $50 co-pay would also be assessed to enrollees improperly using an emergency room.

In response to the Supreme Court’s ruling, and to encourage states to expand Medicaid, the federal government has offered to pay the full cost of expansion until 2016, after which time the amount would be pared down incrementally until 2020, when the federal government would cover 90 percent of the costs.

Campbell estimates Medicaid expansion would bring the state $1.8 billion in federal funds from now through 2020.

Twenty-eight states and Washington, D.C., have already opted for some form of Medicaid expansion.

In the past two Nebraska Legislature sessions, similar bills have been defeated. Last year, Medicaid expansion was defeated 27-21 in a cloture vote. In 2013, an expansion attempt ended after proponents were unable to secure enough votes to end a filibuster.

Campbell said while it’s too early to predict what will happen to the bill this year, there are 18 new senators in the Legislature.

“I will be spending time talking to those people,” she said. “I think it takes time to give people some information and background.”

In a statement, Americans for Prosperity-Nebraska State Director Matt Litt said his organization is opposed to LB 472.

“For three years now, Sen. Campbell has sought to implement the Medicaid expansion provision of Obamacare in Nebraska without Success,” Litt said. “The latest iteration, LB 472, should likewise meet a similar fate. Nebraskans simply cannot afford President Barack Obama’s expensive and burdensome government programs.”

According to a report released by Washington, D.C. based-Families USA, a nonprofit and nonpartisan organization that works toward ensuring affordable health care for Americans, the majority of Nebraskans who would benefit from expanded Medicaid are employed.

Campbell said providing insurance coverage for those currently not covered is important to ensure a healthy workforce in the state.

“Many people currently not covered are considered the working poor with not enough income to afford insurance,” she said. “They either go to the emergency room, which is the most expensive way, or they wait a very long time.”

Medicaid expansion would directly benefit them.

“To some extent, we’re trying to create a healthy workforce,” she said. “We want those people to be healthy – part of what we need for economic development.”

LB 472 would strengthen the economy and the health of Nebraskans, she added.

“All around, it makes sense,” the senator said.