LINCOLN — On the eve of legislative debate about expanding Nebraska's Medicaid program, Gov. Dave Heineman is calling the proposal “unaffordable and unsustainable.”
“This bill should not pass,” he said Monday. “We cannot be all things to all people.”
The governor suggested healthy habits and private charities could help low-income people who cannot qualify for Medicaid now and cannot afford health insurance.
Advocates of the expansion argue that Medicaid would be a better way to provide health coverage for Nebraskans like Bonny Holtmeier's teenagers when they reach adulthood.
The Lincoln woman's name isn't likely to come up in the debate over Legislative Bill 577 that begins Tuesday. But the outcome will be critical for her children and an estimated 54,000 to 80,000 low-income Nebraska adults.
Lawmakers' decision also will affect the growth of state spending on Medicaid and other programs well into the future.
“I think this is, without question, one of the largest issues the Legislature is going to take up in quite some time,” said State Sen. Beau McCoy of Omaha, who counts himself among the opponents of the bill.
Both sides have been working for weeks in anticipation of the debate about Legislative Bill 577.
Backing the bill are a long list of health care providers and advocacy groups. Opponents include the governor and some tax activist groups.
Medicaid is the joint federal-state program that now provides coverage for low-income children, pregnant women, disabled people, the elderly and some parents.
Introduced by Sen. Kathy Campbell of Lincoln, LB 577 would make more of Nebraska's low-income adults eligible for Medicaid coverage.
The bill would cover low-income people without minor children, who cannot qualify for Medicaid now.
It also would cover parents and disabled adults who make too much to qualify for Medicaid under current income limits.
Among those who could benefit are Holtmeier's and her husband's four former foster children. The couple have guardianship of the teenagers, who are covered by Medicaid now.
Bonny Holtmeier's immediate concern is the oldest of those children, who has lived with them since age 5.
When the girl turns 19 in December, the guardianship will dissolve and she will be left without health coverage.
Even if the guardianship continued, the girl could not go on the Holtmeiers' insurance because they are both retired and on Medicare. The girl works a part-time job that does not offer health insurance.
“I'm not asking for them to be dependent on the state forever,” Holtmeier said. “I just want them to get through college.”
Jennifer Carter, director of public policy for Nebraska Appleseed, said cases like Bonny Holtmeier's make the best argument for Nebraska to undertake the expansion.
“I think it would be hard to say we're not going to cover you, we're not going to allow you to go to the doctor, when we could,” she said.
But opponents say the issue comes down to cold, hard dollars and cents.
Heineman argues that Nebraska cannot afford the price tag for providing such coverage, especially in coming years. He has made that case in public speeches as well as in meetings with individual senators.
“The expansion of the Medicaid program is going to result in reduced funding for the education of our children, K-12, higher education, or higher taxes,” he said Monday.
Heineman's administration has estimated that the state's net cost of Medicaid expansion would be $116 million over the next seven years. Legislative fiscal staff put the cost at $75 million.
Both estimates include savings from eliminating or reducing state programs that provide selected health services for some uninsured Nebraskans, such as breast and cervical cancer screenings for low-income women and behavioral health treatment for low-income adults.
Not counted in the total, but included in a legislative fiscal note, are the savings to county governments from being able to reduce general assistance for uninsured people.
Under the federal Affordable Care Act, which made the proposed Medicaid expansion possible, the federal government is to pay 100 percent of costs for the additional coverage from 2014 through 2016. The federal funding will phase down to 90 percent of costs by 2020.
For the next two budget years, legislative staff project, savings from the expansion would exceed the costs to the state.
But McCoy questions whether the federal government will make good on its promised funding level.
He said the proposal raises other “serious and substantial” concerns, such as whether there will be enough hospitals, doctors and other health care providers to treat people added to the Medicaid rolls.
Mark Intermill of AARP pointed to the federal government's long history of fulfilling its Medicaid funding promises and, even during difficult economic times, helping states by boosting its share of Medicaid funding.
Sen. Jeremy Nordquist of Omaha argues that the additional federal Medicaid money would draw more people into health care and that leaving people uninsured means providers would continue struggling with a large amount of uncompensated care.
Nordquist said he feels confident that there are 25 senators willing to pass the bill. He isn't as sure about finding 30 votes to override an expected veto by Heineman.
McCoy, meanwhile, said he doesn't know if there are enough votes for passage and predicted that the vote counts will fluctuate.
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