LINCOLN — More than two-thirds of Nebraska lawmakers put in their two cents worth Tuesday on a controversial proposal to expand Medicaid to more low-income adults.
Backers talked of doing the right thing and helping working families and bringing in federal dollars.
Opponents focused on fiscal sustainability and tax liabilities and the availability of health care providers.
The day ended without a vote on Legislative Bill 577.
Debate will resume Wednesday, and Speaker of the Legislature Greg Adams of York said he hopes to wrap it up before lawmakers adjourn again.
State Sen. Kathy Campbell of Lincoln, chief sponsor of LB 577, said she was pleased by the thoughtful discussion and the many questions her colleagues have raised.
“I still feel very good about where we are,” she said. “It's a complicated issue and it takes time for people to digest.”
Campbell declined to speculate on the level of support for the bill based on a 30-12 vote taken to adopt an amendment.
Other senators have said they believe they have the 25 votes needed to pass the bill but are unsure about getting 30 votes to override an expected gubernatorial veto.
The amendment would trigger legislative reconsideration of the expansion if the federal government reneges on its funding promises.
Under the Affordable Care Act, the federal government is to pay 100 percent of costs for Medicaid expansion coverage from 2014 through 2016. The federal funding will phase down to 90 percent of costs by 2020.
Campbell began the day by telling colleagues that the decision they ultimately make on the bill will send a message to Nebraskans about health care.
“This isn't a message to the president, the Congress and the political parties or to groups,” she said. “It is about what the Legislature deems is the best policy for Nebraskans.”
Sen. Bill Kintner of Papillion answered by questioning the cost of the expansion and the wisdom of adding to the size of government. He said the expansion would require tax increases or cuts to education spending.
“I would rather lift people up, give them a job and not give them a way to muddle around in their lives, going paycheck to paycheck,” he said.
Campbell and others said senators need to consider the costs of not doing the expansion, as well as the cost of doing it. Those costs are both financial and human, they said.
Sen. Sara Howard of Omaha said she believes the expansion could have helped her sister get treatment for prescription drug problems and might have prevented her death at the age of 33 from an overdose.
Carrie Howard had no insurance at the time of her death in 2009, although she was working.
But Sen. Mike Gloor of Grand Island expressed concern about adding more people to an already dysfunctional health care system. He said Nebraska doctors and hospitals have limited capacity to add Medicaid patients.
Sen. Charlie Janssen of Fremont said the proposed expansion would not control rising health care costs. He took issue with the idea that the expansion would not cost the state, saying that Nebraskans pay federal taxes as well as state ones.
He was answered by Sen. Steve Lathrop of Omaha, who said rejecting the federal expansion money means Nebraskans would be paying federal taxes to help people in other states get health coverage.
LB 577 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.
Backing the bill are a long list of health care providers and advocacy groups. Opponents include the governor and some tax activist groups.
The Medicaid expansion was made possible by the Affordable Care Act. A U.S. Supreme Court ruling in June made the expansion optional for states.
Gov. Dave Heineman's administration has estimated the state's net cost of Medicaid expansion would be $116 million over the next seven years. A revised estimate from legislative fiscal staff put the net cost at $57.4 million over that time period.
Both estimates include savings from reducing or eliminating state health programs that would no longer be needed.
Medicaid is the joint federal-state program that now provides coverage for low-income children, pregnant women, disabled people, the elderly and some parents.
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