The writer, M.D., of Omaha, is a clinical associate of family medicine at the University of Nebraska Medical Center and medical director of the UNMC SHARING clinics for the underserved. This commentary represents his personal views and not those of the university.

It's hard to think of an aspect of life in our state that has not been impacted by COVID-19. The pandemic is a public health crisis that has also devastated our economy, and our state will be feeling its disastrous effects for some time.

For many Nebraska families, COVID-19 has resulted in job losses and, as a result, the loss of health insurance coverage. The Kaiser Family Foundation estimates that more than 100,000 Nebraskans lost their employer-sponsored health coverage in the last two months. During a pandemic, it is critical that people have insurance and access to the care they need, both for their own health but also to prevent the spread through our communities. It is also especially important for people to have health insurance during difficult economic times for the financial security that it provides.

Medicaid has long been viewed as a program that is responsive to crises and economic downturns. It is a program that can open its doors to more people when times are tough, making sure that people have the health care and financial protections they need in a challenging economy. Medicaid has played this role before during the Great Recession and after natural disasters like Hurricane Katrina. And it will play this role again during the COVID-19 pandemic. The program is designed to be there when people need it, helping them protect their health and avoid the financial ruin that can result from experiencing a health event when uninsured. It also provides the state with an infusion of federal funds to pay for this care, which is increasingly important in light of a difficult economic outlook for the state, especially its struggling rural hospitals and other vital health care providers.

Nebraska voters passed Medicaid expansion in November 2018. The program, which is slated to begin coverage in October of this year, is a critical tool missing from our state's response to this unprecedented crisis. Only about a third of the tens of thousands of Nebraskans who have lost coverage in the last few months are eligible for our state's current Medicaid program. If Nebraska had Medicaid expansion in place now, over half of those who have lost insurance could access Medicaid coverage.

There are also tens of thousands of Nebraskans who could access coverage who have long been without insurance — those without offers of employer coverage and stuck in the gap between Medicaid coverage and being able to afford private insurance.Medicaid coverage would allow not only for coverage of COVID-19 diagnosis and treatment but also treatment of other needs including preventive care and chronic disease management.

Even with the federal government assuming 90% of the cost of Medicaid expansion, concerns are raised about the effect on the state budget. A recent article in the New England Journal of Medicine, however, shows that Medicaid expansion has had neutral effects on the budgets of participating states, due to offsets of other state costs "such as direct subsidies to public hospitals and mental health centers, health care costs for people involved with the justice system, and a more generous match rate for optional groups previously covered by many state Medicaid programs." Knowing this, the state could also avoid most of the barriers that have been mentioned to rapidly opening Medicaid posed by its current Medicaid waiver application by simply enrolling everyone in the traditional Medicaid system.

Medicaid expansion is uniquely situated to respond to both the health care and financial needs of Nebraskans being hit hardest by this pandemic, and voters intended for this program to be in place to provide care for those who need it. Our leaders should begin Medicaid expansion as soon as possible to ensure that those who need it have the coverage they need, while also protecting our public health and aiding our economy.

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