- Associated Press - Wednesday, January 29, 2014

LINCOLN, Neb. (AP) - A new bill to expand Medicaid drew support Wednesday from Nebraska health care providers and advocates for the poor but faced opposition from conservative taxpayer groups and Gov. Dave Heineman’s administration.

Supporters packed a legislative hearing at the Capitol and spoke for more than three hours in favor of the proposal, an optional piece of the federal health care law. A similar measure was blocked last year by opponents in the Legislature, and Heineman remains opposed to the measure.

Sen. Kathy Campbell of Lincoln said the bill would give working, low-income Nebraskans better access to quality health care. The federal government has promised to pay at least 90 percent of the costs for newly eligible residents. The new bill, the “Wellness in Nebraska Act,” borrows from plans backed by Republicans in Iowa, Arkansas, Michigan and other states.

“This is an opportunity to make our state’s health care stronger, to make sure they’re healthier, and to make smart investments in our economy,” Campbell said. “I believe (the bill) sets in place a way that we can work on effective, quality health care for all Nebraskans in the future.”

Dr. Kevin Nohner of the Nebraska Medical Association said the bill would help alleviate health care inequalities in Nebraska that make it too expensive for low-income workers to buy coverage.

“It’s been asked whether this bill is better than last year,” Nohner said. “You’d have to ask the patients who didn’t get health care last year.”

Lancaster County Commissioner Deb Schorr said the bill would reduce health care costs for Nebraska’s 93 county governments, which are required by law to pay for care for low-income residents. Lancaster County pays $2.1 million a year in general medical assistance and $700,000 for community mental health services, she said.

“We cannot afford to miss this once-in-a-lifetime opportunity,” Schorr said.

Sharon Lind, the CEO of Ogallala Community Hospital, said the Medicaid expansion would help rural hospitals not affiliated with larger chains. She said other forms of federal funding for those hospitals have diminished due to Medicare cuts and part of the federal health care law.

“There are many critical access hospitals that are concerned about their viability in the future,” she said.

The bill drew opposition from the Departments of Insurance and Health and Human Services, both under Heineman’s administration.

Department of Health and Human Services CEO Kerry Winterer said the bill would increase the cost of the state’s current Medicaid program, which covers an average of 241,000 individuals a month at a yearly cost of $1.8 billion. Winterer said the expansion bill would cover an additional 113,400 residents in Nebraska through fiscal 2020, with a cost of $3.3 billion in state and federal dollars.

The bill also drew opposition from the Platte Institute, a Nebraska think tank that advocates for free markets and small government, and the Nebraska chapter of Americans for Prosperity, the group funded by conservative billionaire brothers Charles and David Koch. And lawmakers who opposed the bill last year promised Wednesday to fight it once again.

“This bill would grow the state government by adding yet another entitlement program and a new layer of bureaucracy to our current health care system,” said Omaha Sen. Beau McCoy, a Republican candidate for governor. “This bill does nothing to protect hard-working Nebraska taxpayers from the tens of millions of dollars the state will be stuck paying under the best of scenarios.”

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.

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 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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