- Associated Press - Tuesday, January 14, 2014

LINCOLN, Neb. (AP) - Nebraska would use the state Medicaid program and private health insurers to cover tens of thousands of uninsured, low-income residents, including those who have fallen into the so-called “coverage gap,” under a new proposal unveiled Tuesday.

Supporters of expanded Medicaid introduced the “Wellness in Nebraska Act” - dubbed WIN - as they prepared for another attempt to expand coverage under the federal health care law. Opponents in the Legislature blocked an attempt last year to pass a Medicaid expansion bill.

“This is our opportunity to make our state’s health care stronger, to ensure that hard-working Nebraskans are healthier, and to make a smart investment in the state’s economy,” said Sen. Kathy Campbell of Lincoln, the bill’s lead sponsor. “Now is the time to be there for our neighbors, our families, and our state’s future.”

The measure that stalled last year would have insured about 54,000 newly eligible residents - most of them adults, ages 19 through 64, who don’t have children and who make less than 138 percent of the federal poverty level.

Sen. Jeremy Nordquist of Omaha said a failure to act this year would result in Nebraskans paying federal taxes under the Affordable Care Act, with no direct benefit in return.

“I’m certainly convinced that this is the best solution we have right now to create a health care system that is truly a win for all Nebraskans,” he said.

Another key supporter, Sen. Sue Crawford of Bellevue, said the bill seeks to address some of the concerns raised by lawmakers last year and incorporates ideas from other states. Last month, the Legislature’s Health and Human Services Committee reviewed plans that were developed in Arkansas, Iowa, Michigan and Pennsylvania.

“The Wellness in Nebraska Act continues to offer important advantages to the state that we’ve been discussing all along - including saving lives and strengthening economic development,” she said.

Gov. Dave Heineman said in an Associated Press interview earlier this month that expanding Medicaid is still not affordable and would drain state money that might otherwise be spent on education.

The new bill would offer traditional Medicaid coverage to residents who make less than 100 percent of the federal poverty level - $19,530 for a family of three. Participants who make between 50 percent and 100 percent would have to pay as much as 2 percent of their income for premiums, which could be waived if they participate in a wellness program that would initially include a medical checkup and health assessment.

Residents who make between 100 and 133 percent of the federal poverty level would still qualify for subsidies for the federally facilitated marketplace, but the proposal would have Medicaid dollars cover most of what they’re now paying in premiums and copays. Those participants would have to pay up to 2 percent of their incomes.

The proposal is designed to draw more Nebraska residents into doctors’ offices for preventative and routine medical care, Campbell said. It also would have some low-income residents participate in patient-centered medical homes, a new concept focused on preventative care and helping patients tend to themselves.

Residents with employer-sponsored health insurance would be allowed to keep their plans, but Medicaid would cover a worker’s contribution if that employee makes up to 133 percent of the federal poverty limit. Campbell said the provision was added to address some senators’ concerns that the expansion might pull business away from the private market.

The bill also seeks to reduce the “churn” among workers, such as seasonal farm workers and retail employees, whose incomes fluctuate year to year. Those employees often shift between qualifying and not qualifying for Medicaid coverage, which forces them to re-register and increases costs over time.

Nordquist said the measure includes safeguards to reduce emergency room visits. New Medicaid participants would have to schedule an appointment with a primary care physician within 60 days of enrolling, he said, and they would face a copay of up to $75 if they use emergency room care for non-emergency purposes.

The measure would still have the federal government paying 100 percent of the cost until 2016. The federal contribution would then decrease gradually to 90 percent by 2020. Campbell said the legislation includes a requirement that lawmakers re-evaluate the program if federal reimbursement ever drops below 90 percent.


The bill is LB887.

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