The writer, of Omaha, is a novelist and screenwriter. He teaches at the University of Nebraska College of Law. He writes as an individual and not on behalf of the University of Nebraska.
Happy New Year! But not so happy if you are one of the 80,000 or more low-income Nebraskans who fall into the looming health insurance “coverage gap.”
People fall in the gap when they earn too much to qualify for traditional Medicaid but not enough to qualify for tax credits in the new health insurance marketplace, meaning they go without health insurance.
The Affordable Care Act (aka Obamacare) required states to expand Medicaid to cover those in the gap, but in 2012 the U.S. Supreme Court ruled that states could decide for themselves whether to participate.
Gov. Dave Heineman is opposed to expanding Medicaid coverage in Nebraska, even though by most estimates Nebraska stands to lose a minimum of more than $700 million by not participating.
We lose that money because under the Affordable Care Act, Nebraskans will pay federal taxes to finance Medicaid expansion in states like California and New York, while turning down roughly $3 billion in federal funds through 2020, funds we otherwise would be entitled to under the ACA.
Meanwhile, we still have to pay, one way or another, for the uncompensated health care of Nebraskans in the gap to the tune of a billion dollars over the same period.
Nobody is saying that expanding Medicaid will be cheap, but for participating states the federal government has agreed to fund 100 percent of the cost for three years, declining to 90 percent or better thereafter.
The governor argues this is still too expensive. Moreover, he doesn’t trust the feds because “the federal government doesn’t have a history of fulfilling its commitments,” a curious observation from an official who has accepted more than $1 billion in promised federal stimulus funds since 2009, when he said: “I’m not trying to get into that judgment (about stimulus funds) ... They pass laws at the federal level. We’re about execution and implementation. ... I think we will meet the criteria that gives us an opportunity to capture those federal dollars.”
To which one might ask: What’s wrong with capturing some Affordable Care Act dollars?
Lucky for Nebraska, the governor was not in office in 1956 when the Federal Highway Trust Fund was established. Since then, Nebraskans have paid $6 billion in gas taxes and have reaped $7 billion in federal funds apportioned under the act. Imagine if we paid that $6 billion in taxes and got nothing in return.
Like many Nebraskans, the governor is philosophically opposed to big government and big government programs. He is justifiably concerned about the debt burden we will leave our children and grandchildren. These are great arguments for not passing Obamacare. But those arguments were made in 2010, Obamacare passed, and three years later it lives.
More than 2 million Americans have signed up for health insurance at HealthCare.gov, and the provisions dealing with pre-existing conditions and extended dependent care coverage are popular with both rich and poor.
Other states, including eight with Republican governors, have gazed into their crystal balls and relented; they’ve decided that if their citizens must pay federal taxes, it is irrational not to accept the federal benefits in return.
The pain of taxes is a given; why not accept the gain, which in Nebraska’s case is an estimated $3 billion in benefits and $700 million in new economic activity?
We ask only that the state accept three years of federally funded health insurance that Nebraskans have already paid for and then invest 10 cents on the dollar in the health of its citizens who cannot afford health care in the current marketplace.
Otherwise, we pay for health care in other states and then pay another billion dollars or so of uncompensated care here in Nebraska.