If you're State Senator Kathy Campbell, or one of the co-sponsors or supporters of her bill LB 577 (the bill to expand Medicaid in Nebraska) then you've probably already taken your spot on the cliff’s edge, waiting only for the rest of the state's residents to join you for the
Governor Heineman’s recent decision to opt for a federally-operated health insurance exchange for Nebraska was freighted with meaning for the advocates of the state exchange model. The insurance companies, the large hospital groups and information technology vendors saw their anticipated big payday evaporate like a mirage. The premium subsidies that insurance companies would've received under a state exchange model don't flow under the federal model.
The massive expenditures for IT infrastructure necessary to build and maintain a state exchange will now be awarded through contracts let by the federal government, not the state. Countless hours and many thousands of dollars spent by these groups to lobby for the adoption of a state exchange proved inadequate.
Despite this setback, these folks have not given up, they have merely shifted focus to a new front – expanding Medicaid under the Affordable Care Act. Requiring states to participate was ruled as unconstitutional by the Supreme Court, but such expansion is permissible if the state chooses to "opt-in."
Months ago, Governor Heineman chose not to opt for expansion, so ObamaCare advocates in the Legislature are now trying to overrule the Governor and legislate this expansion into existence with
Next year, in 2014, the ObamaCare individual mandate kicks in, requiring all folks to have health insurance coverage, or face fines and penalties. By that time, the health insurance exchanges are to be up and functioning, providing a place for the uninsured to go in order to find coverage and avoid the fines. The exchange will determine the least expensive option for coverage for that person, and enroll them.
In Nebraska, the least expensive option for roughly 48,000 people is Medicaid. These are people who are eligible for Medicaid under current rules (without LB 577 expansion) but are not presently enrolled in the program.
We already have nearly a quarter-million Medicaid recipients in Nebraska. The additional 48,000 that will be shepherded into the program next year, will swell our current and mandated obligation under ObamaCare to a figure approaching 300,000 residents.
This is the reality of ObamaCare in Nebraska. Bear in mind, this number does not include the estimated 80,000- 95,000 additional enrollees that would come from expanding Medicaid under LB 577.
Medicaid expansion under ObamaCare features a promise from the feds to pay all of the costs incurred by the newly eligible for the first three years. Nebraska’s obligation would then rise each year until 2020, when we reach our maximum contribution responsibility of 10%. So what's the problem?
Well, many Nebraskans aren’t comfortable relying on a funding promise from a federal government that is already borrowing 40 cents of every dollar it spends. Beyond that, it is important to ask what impact expansion will have on current recipients of Medicaid, the abject poor and disabled, who are arguably among the most vulnerable of all our citizens, and those for whom Medicaid was enacted to
In addition to LB577, Senator Campbell also introduced Legislative Resolution 22 (LR22) this session, calling for a committee to review and reform our medical payment and delivery system in Nebraska. LR22 makes it clear that our state is already experiencing a shortage of primary care physicians – stating that this shortage is certain to be made much more acute by the further implementation of the Affordable Care Act.
It goes on to assert that limited access to care often leads to less than ideal outcomes. Clearly, the take-away from LR22 is that the existing system needs to be studied and optimized before any expansion takes place.
LB577 will dramatically increase the number of people trying to see an increasingly scarce pool of physicians, resulting in longer wait times for routine care. This will lead people to utilize more expensive Emergency Room care as a means of avoiding that ever-lengthening line at the doctor’s office.
It is irresponsible to further burden an already struggling program before addressing the inadequacies that are already evident. It is heartless to elbow the truly needy and vulnerable out of the way by overwhelming the system they rely on for life-saving care.
By grotesquely expanding Medicaid, LB577 shows itself to be an unwise and premature piece of legislation that should be defeated. How do we know this? In LR22, the bill’s sponsor told us herself.