LINCOLN (AP) — Nebraska lawmakers began a heated debate Tuesday on a proposal to expand Medicaid to more low-income adults as part of the federal health care law.
The bill’s sponsor, Sen. Kathy Campbell of Lincoln, introduced the measure with added cost safeguards in an attempt to garner support from lawmakers, who are worried about the state’s future financial burden.
Campbell said there’s a tremendous cost to not expanding Medicaid benefits to the people who need health care the most. She said that too many working poor Nebraskans go without health insurance because they make too much to qualify for Medicaid, but earn too little to afford insurance premiums.
“What will it cost if we don’t expand Medicaid?” Campbell asked. “All of us are paying that cost. Some of those costs are financial, some of those costs are as a society and some of the highest costs are borne by the individuals themselves.”
Lawmakers voted 30-12 to support the sunset provision that would require lawmakers to reevaluate Medicaid expansion when the federal government reduces or drops funding below 90 percent. Campbell offered another amendment that would require Nebraska lawmakers to approve, amend or repeal Medicaid expansion in 2020. Senators have not voted on that amendment yet.
“Not once in the ensuing years has the federal government failed to keep its pledge of support for Nebraska medical needs,” Campbell said.
Conservatives spoke out against the bill and amendments, voicing skepticism about whether expanding Medicaid is sustainable down the road.
Sen. Beau McCoy of Omaha quickly filed a motion to reconsider the vote lawmakers took on the sunset provision amendment. He said lawmakers had not spent enough time debating the amendment and other possible solutions. He said the federal government can’t be relied on because they’re broke and Congress can’t pass a budget.
“We’ve all heard it said, ‘well, they have never reneged on Medicaid funding,”‘ McCoy said. “Well guess what? There’s a first time for everything.”
McCoy encouraged lawmakers to consider a measure passed Tuesday by the Arkansas Senate that would let the state buy private insurance for low-income residents with federal Medicaid dollars rather than expanding the Medicaid program.
Omaha Sen. Jeremy Nordquist said he thinks Nebraska shouldn’t be quick to follow what Arkansas has proposed. He thinks the Medicaid expansion plan before Nebraska senators is the best option for the state.
“It is the most fiscally prudent path for Nebraska to get our low income uninsured working citizens the health care they need,” Nordquist said.
A June U.S. Supreme Court ruling said Medicaid expansion should be optional for states. The federal government has agreed to fully fund the cost for newly insured Medicaid recipients from 2014 to 2016. Federal aid would gradually decrease to 90 percent by 2020. The bill would allow more low-income people and adults with disabilities to receive Medicaid benefits.
The legislative fiscal staff has estimated Medicaid expansion would cost $57.4 million over seven years, while Gov. Dave Heineman’s administration estimated Nebraska would pay $116 million.
The Legislature’s Appropriation Chair Sen. Heath Mello, who supports Medicaid expansion, said the Legislature never considers costs calculated by agencies because they can have political motives.
Heineman said Monday that Medicaid expansion should not pass because potential costs are unclear. The governor said he will not approve the measure if the legislature gains 25 votes to send it to his desk. Bill supporters have said they’re optimistic they’ll have the votes to pass Medicaid expansion. But, they aren’t sure they can muster the 30 votes needed to override Heineman’s veto.
Sen. Charlie Janssen of Fremont and other conservative lawmakers said it is unlikely that the Legislature would repeal Medicaid expansion in the future if the federal government were to reduce or not pay its share to fund Medicaid expansion.
“Don’t even kid yourself with this amendment,” Janssen said. “This is a band aid on Obamacare. It will not be sunset.”
Sen. Dan Watermeier said he also was concerned how the state would pay for Medicaid expansion in the future, and said it would be difficult for the Legislature to get rid of Medicaid expansion once an estimated 54,000 to 80,000 Nebraskans would be receiving health care from Medicaid expansion.
Sen. Bill Kintner said extending government programs often cost more than expected, and expanding Medicaid will take away funding for education and other interests. He also said people who already have insurance through their employer could qualify for Medicaid. He said he thinks people will ditch their private insurance in favor of Medicaid.
“I would rather lift people up, give them a job and not give them a way to muddle around in their lives, going paycheck to paycheck,” he said.
Sen. Al Davis of Hyannis is a one lawmaker remains on the fence. He said he has received more emails and calls from constituents on Medicaid expansion than any other piece of legislation this session. Davis said he can’t ignore the fact that more than 30 percent of people who are 64 years old or younger in his district would qualify for Medicaid benefits if the program is expanded. But he also has to consider the many people in his rural district who think people should be responsible for paying for their own health care.
Sen. Steve Lathrop of Omaha supports Medicaid expansion because he sees insurance premiums becoming increasing unaffordable for families and individuals.
“These people have no way to get care and we owe it to them to take advantage of an opportunity,” Lathrop said. “If it turns out being a bad deal, we can deal with that in three years. “
Lawmakers will continue debating the bill Wednesday.