Dr. Zetterman is a past president of the Nebraska Medical Association, and Mahlman is the group’s executive vice president.
In 2007, the Nebraska Medical Association, the unifying physicians organization for the state, developed a proposal to ensure that all Nebraskans had health care coverage.
The preamble stated that “all Nebraskans should have good access to timely needed health care that emphasizes good health habits, wellness and prevention; that health care of Nebraska must be of high quality, efficient, affordable and equitably accessible to all. It also posits that good health and access to needed health care are social goods that contribute to the well-being of the state and all its residents.”
Why are Nebraska’s physicians concerned about a lack of health care coverage? Because they know that lack of health care coverage can make Nebraskans sick. Those lacking insurance have greater mortality (25 percent higher) from all causes and have greater mortality from accidents and longer hospital stays.
Uninsured patients also delay routine care and screening, resulting in more unexpected hospitalizations. As examples, uninsured diabetics are 11 times more likely to require emergency hospitalization than insured diabetics and uninsured patients are three to five times more likely to delay medical care.
Uninsured children are less likely to have seen a physician in the past year and uninsured pregnant women delay routine prenatal care and tragically are three times more likely to have an adverse outcome. They are also 30 percent more likely to have an infant who dies or requires long hospitalization.
There are approximately 225,000 uninsured Nebraskans. Nebraska Medicaid does provide coverage for some low-income Nebraskans. Children living in Nebraska households with incomes up to 185 percent of poverty can receive health coverage through Kids Connect.
For adults with children, Nebraska Medicaid covers those jobless parents with incomes less than 47 percent of poverty and working parents with incomes less than 58 percent of poverty. For a family of three, this is family income of approximately $7,200 and $8,900, respectively. But for nonelderly adults without children, Medicaid coverage is not available.
Beginning in 2014, the federal Patient Protection and Affordable Care Act will expand Medicaid eligibility for those between 18 and 64 years up to 138 percent of poverty income. The U.S. Supreme Court made this expansion optional for each state. If a state expands Medicaid, the federal government pays 100 percent of the cost the first three years, 95 percent in year four, 94 percent in year five, 93 percent in year six and 90 percent of annual costs thereafter.
At its 2012 annual meeting, the Nebraska Medical Association reaffirmed its support for Medicaid expansion in Nebraska in keeping with the association’s precept of health care coverage for all Nebraskans.
The University of Nebraska Medical Center’s Center for Health Policy indicates that 90,000 to 108,000 newly enrolled Nebraskans would receive Medicaid through expansion with an estimated state cost of $140 million to $168 million, roughly 2.5 percent additional annual spending over current Medicaid expenditures. The federal revenue received by the state during that same interval would be $2.9 billion to $3.5 billion, which would reduce uncompensated care from $1 billion to $400 million.
Uncompensated care is currently covered by cost-shifting dollars from premiums paid by Nebraskans with insurance, a “hidden tax” of approximately $1,100 per year. Furthermore, additional federal money spent for care in Nebraska will generate $700 million to $850 million of economic activity and 10,000 new jobs annually through 2020. This is an economic return from Medicaid expansion of roughly $35 for every $1 spent from state revenue.
In three states with expanded Medicaid eligibility as compared to neighboring states without expansion, those with expanded Medicaid eligibility had lower patient mortality (which was greatest in those 34 to 64 years of age, in minorities and in those living in the poorest areas) and a reduction of delayed care. For every 176 people who gained Medicaid coverage, one death was prevented. This suggests that approximately 500 deaths of Nebraskans would be prevented annually by expanded Medicaid coverage.
Data show that Nebraska Medicaid expansion can reduce uninsured numbers by 50 percent, reduce delayed care and unnecessary deaths, and improve citizen well-being while putting us closer to health care coverage for all. Medicaid expansion really is good for Nebraska.