LINCOLN — The proposal for expanding health coverage to more low-income Nebraskans was new.
But Wednesday's public hearing before the Legislature's Health and Human Services Committee seemed a lot like déjà vu.
There was the same packed house as at last year's hearing on a proposal to cover more people by expanding Medicaid.
Same long list of supporters representing health care providers, community groups, county officials, farmers, teachers, disabled people, retirees, restaurant and retail businesses, and groups advocating for the poor.
Same opposition from Gov. Dave Heineman's agency directors and groups advocating spending restraint.
Same arguments about cost and compassion, government expansion and improving health.
However, State Sen. Kathy Campbell of Lincoln, the committee chairwoman, said this year's proposal, the Wellness in Nebraska Act, or WIN, represents an improvement over last year's plan to expand traditional Medicaid.
Campbell and three other lawmakers developed Legislative Bill 887 based on concerns raised during last year's debate about a bill to expand Medicaid to more low-income Nebraskans. That bill stalled in the face of a filibuster. The new proposal would extend coverage using a mix of private insurance, wellness incentives, cost sharing and Medicaid.
“We didn't build it just to get votes. It is good health policy,” she said. “This is our opportunity to make our state's health care stronger, to ensure hardworking Nebraskans are healthier and to make a smart investment in our state's economy.”
She said she has become more passionate about the issue after hearing from Nebraskans who, like some other Americans, have found themselves stuck in a health coverage gap created when some states rejected the Medicaid expansion proposed in the Affordable Care Act.
They can neither afford private health insurance, even with the tax credits provided under the health care law, nor can they qualify for Medicaid.
Under Nebraska law, adults without minor children cannot qualify for Medicaid no matter how low their income. Parents and disabled adults can qualify, but only if their incomes are well below the poverty level.
Among them is Sarah Gershon of Lincoln, who said the WIN proposal could mean the difference between working full time and becoming too crippled to work at all.
The 31-year-old said she has no insurance now and can't afford a test to determine whether she has rheumatoid arthritis or lupus. Her condition has forced her to go from working two jobs to working three shifts a week.
Without a diagnosis, she can't get the treatment that could ease her pain and get her back to work.
Paul Von Behren's adult daughter also falls into the coverage gap. She has no insurance to pay for treating her herniated discs or the knee surgery she needs to get back on her feet.
But he opposed the WIN proposal, saying it would not improve people's health and would put Nebraska at financial risk if the federal government backs out on its funding promises.
“I've got to shove aside my emotions as a dad,” he said. “I will not mortgage my grandchildren's future.”
Under LB 887, as with last year's plan, federal funds would pay 100 percent of the cost for covering the additional people receiving Medicaid through 2016. After that, the federal share falls to 90 percent by 2022.
The new proposal would require legislative review if the share of federal funding drops below 90 percent.
LB 887 would cover an estimated 55,000 Nebraskans with incomes up to 133 percent of the federal poverty level.
Those with incomes from 100 percent to 133 percent of the federal poverty level could get private insurance coverage through the WIN marketplace.
Those with lower incomes would get WIN Medicaid coverage, which would incorporate managed care and new concepts in patient care.
This year, the federal poverty level is $23,550 for a family of four. The 133 percent level for such a family would be an income of $31,321.50.
Kerry Winterer, CEO of the State Department of Health and Human Services, said the new proposal amounts to “Medicaid expansion at a higher cost.”
He said the plan also would add to the complexity of coverage and put pressure on the limited number of Nebraska health care providers.