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Nebraska lawmakers looking at options to extend Medicaid coverage to low-income residents


LINCOLN, Nebraska — A new coalition of Nebraska lawmakers is considering options for expanding Medicaid coverage that could be approved by the Legislature, which has rejected similar measures three times in as many years.

Supporters of the effort quietly convened last week for a "listening session" to hear concerns and questions about Medicaid and the Affordable Care Act from fellow lawmakers. They also are reaching out to chambers of commerce and hospital groups for evidence of the potential business impact on Nebraska. A second listening session is scheduled for October.

Leading the effort is state Sen. John McCollister of Omaha, the former director of an Omaha think tank that staunchly opposes Medicaid expansion. McCollister, who took office in January, said he is looking at expansion combined with other reforms that could lower costs, such as incentives for healthier lifestyles.

"There's no question it's the ultimate political football," McCollister said. "I recognize that people have deep feelings about Medicaid expansion. I share some of those concerns. But when you look at the number of people who are uninsured and the number of rural hospitals that are feeling the pinch, you at least have to look at how expansion might work."

Nebraska is one of 19 primarily conservative states that have not expanded Medicaid, the health care program that helps the poor and disabled. Thirty states and the District of Columbia have done so, and Utah is considering its own proposal.

McCollister said he began to see the potential benefits after reviewing research by two University of Nebraska at Kearney professors. Their study, released in April, predicted that state would see at least $1 billion in economic benefits if Medicaid was expanded.

The benefits included the elimination of so-called "silent taxes" paid through higher premiums to cover the cost of the uninsured, a reduction in medical related bankruptcies, and increased consumer spending because fewer patients would face financial hardship. The research was commissioned by the Nebraska Hospital Association and AARP Nebraska, which have lobbied for Medicaid expansion.

Opponents, including Gov. Pete Ricketts, argued that the expansion was too expensive and disputed arguments that it would help the economy.

McCollister said it's too early to know whether supportive lawmakers can sway their colleagues, but he wants to ensure that all senators at least understand the program and its impact on the state economy.

Sen. Kathy Campbell of Lincoln, the lead sponsor of the last three expansion bills, said supporters are studying other states that opted for expansion or rejected such efforts to see how they have fared and what changes they have made. She pointed to Kansas, where one hospital reported last week that it is losing $14 million a year because of that state's decision not to expand.

"We're just getting started on the process," Campbell said. "I think what we're seeing here is that the freshmen senators want more information."

Sen. Joni Craighead of Omaha, who opposed this year's measure, said she still doesn't support Medicaid expansion but wants to learn more about the state health care system to see if there are other ways to provide coverage.

"I believe every single person deserves health care, but the way we deliver it is not correct," Craighead said. "We need to keep researching this, and maybe we can come up with some good, common sense ideas."

If the Medicaid expansion plan considered by lawmakers last session had passed, an additional 79,600 people would have been covered by 2020, according to the estimates by the Legislature's Fiscal Office. The federal government had promised to cover 100 percent of the program's costs through 2016 and then ratchet its share of the payments down to 90 percent by 2020.

With cost savings included, Nebraska would have saved $3.5 million in the current fiscal year by expanding Medicaid. The state would have paid an increasing amount in future years, from $4.4 million in fiscal 2017 to $26.6 million by 2020. Payments by the federal governments would increase as well, to nearly $447 million by 2020.

Bruce Rieker, a lobbyist for the Nebraska Hospital Association, said some lawmakers are still skeptical the state has enough health care providers to handle the likely surge in patients if Medicaid was expanded. But without coverage, he said, that population is simply waiting until their health problems are more severe and expensive to treat.

"We're already providing care right now to many if not all of those individuals," Rieker said. "But we're doing it in an uncompensated manner."

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