Medicaid expansion bill headed to Legislature

LINCOLN (AP) — A bill to expand Nebraska Medicaid coverage has advanced for debate in the Legislature, and supporters presented their case Tuesday in anticipation that Gov. Dave Heineman will veto the measure.

The committee vote sets up a likely confrontation between lawmakers and Heineman, a Republican who remains firmly opposed to the bill.

Sen. Kathy Campbell, who led the introduction of the bill, said she’s “very confident” that the measure’s backers have at least 25 votes to push it through the Legislature. But Campbell said supporters will still work to persuade colleagues that the expansion would benefit the entire state.

The bill has more than a dozen sponsors, but it’s unclear whether supporters have the 30 votes needed to override Heineman’s likely veto.

“This issue impacts every community, every county, and every legislative district across the state of Nebraska,” Campbell said. “That’s what’s critical, and we will have more information to share with senators as time goes on.”

The expansion was originally required as part of the health care law, but the U.S. Supreme Court ruled in June that the federal government cannot penalize states that refuse to participate. Expanded Medicaid is also backed by the health care industry and groups that advocate for low-income residents.

“I feel very strongly that this money needs to come back,” Campbell said. “We’ve all paid our federal taxes, and it needs to come back to Nebraska.”

Sen. Jeremy Nordquist of Omaha said the expansion would eliminate the need for state programs that cover behavioral health patients, prison inmates and Nebraska residents with pre-existing medical conditions.

“Unfortunately, too often, we catch people at the deep end, and not the front end of health care,” Nordquist said. “We don’t catch them in time to get them preventative, primary health care.”

Nordquist said a decision not to expand Medicaid would also hurt the state’s efforts to recruit new doctors and nurses, because hospitals that receive the federal payments will enjoy wider margins.

AARP in Nebraska released a survey on Tuesday that said 53 percent of those who took the poll support expanding Medicaid. Support grew to 62 percent if the cost could be covered by eliminating unnecessary government programs, the poll results said.

The survey sampled 600 adult Nebraska residents, between March 1 and March 7. It had an error margin of 4.08 percent. AARP supports the Medicaid expansion bill.

“The way we will gain control of health care costs is to have as close to universal health care coverage as possible,” said Mark Intermill, the group’s advocacy director. “If we don’t have that opportunity, you’ll continue to have cost-shifting, and we’ll never be able to get a handle on health care costs.”

Heineman has remained adamantly opposed to the Medicaid expansion proposal, without saying outright whether he would veto it. The Republican governor has argued that the potential costs are unclear, even after Medicaid expansion gained support from GOP governors in Florida, Arizona, Nevada, New Mexico and New Jersey.

In Iowa, Republican Gov. Terry Branstad remains opposed to the expansion.

Lawmakers said the bill would extend coverage to more than 54,000 uninsured Nebraskans, and state officials predict that some insured Nebraskans would switch from their current plans. The proposal would cover 117,000 to 159,000 residents in all by fiscal year 2016, when the program is in full swing, according to a January report commissioned by the state Department of Health and Human Services.

The bill was introduced in the wake of a U.S. Supreme Court decision that struck down part of the federal health care law, one of President Barack Obama’s top domestic achievements in his first term. The court upheld most of the law, but ruled that the federal government cannot withhold funding from states that choose not to expand their Medicaid programs.

One provision of the Affordable Care Act, which the U.S. Supreme Court deemed optional, called for states to expand Medicaid coverage to people who make up to 133 percent of federal poverty levels, starting in 2014. The federal government would pay all costs until 2017, when states would gradually begin contributing, though the federal share wouldn’t drop below 90 percent.

Supporters argue it’s a great deal for states compared to current Medicaid rates, wherein Washington pays as little as half of the cost. For hospitals, more patients covered by Medicaid would reduce the amount of care they give to people without reimbursement.

A study released last year by the University of Nebraska Medical Center found that the number of uninsured residents topped 217,100 in 2010 — a 67 percent increase over the decade.

Researchers found that the number of Nebraskans with employer-based health insurance fell 9.3 percent between 2000 and 2010. Meanwhile, the number of residents who bought insurance directly — usually at a much higher cost — increased roughly 16 percent.