Among the proposed legislative changes made in the current session of the Nebraska's Unicameral, a group of senators proposed Legislative Bill (LB) 577 to expand Medicaid coverage to low-income adults. Their goal is to offer health care to more people on the fringe of coverage, but who miss Medicaid support because they do not have minor children, or earn too much even with children, or other disabled adults. It would move us closer to the changing federal health care mandates, impacting state governments and businesses. State Senator Kathy Campbell of Lincoln, chairwoman for the Health and Human Services Committee, said, "This is an opportunity to make a smart investment in our state's economy and workforce. A healthy workforce depends on access to health care." Campbell was one of 12 co-sponsors of the bill.
Senator Jeremy Nordquist (D), my neighbor in Omaha (literally lives on my block) suggests the changes could produce net savings for the state. His calculations show potential off-sets in costs on mental health, substance abuse, a state-funded disability program, prison health care, and some smaller programs.
Governor Heineman opposes the measure, because like much of the national health care mandate, it is not funded. He points out Medicaid expansion will lead to raising taxes or cutting spending on education.
Into this discussion, the Obama Administration is proposing to allow state Medicaid providers to charge premiums and add co-payments to their system in exchange for doctors' services, prescription drugs, and various hospital care, including the "non-emergency" use of emergency rooms. The 2010 health care law (Obamacare) calls for extending Medicaid to childless couples and others who were ineligible. The US Supreme Court ruled the Medicaid expansion is optional, not a requirement, for states.
The Administration is trying to ease the impact and encourage states to add people to their system. The changes simplify the standards, allowing states to add low-income households with no dependents, setting up co-payments and deductible payments. A family of three, with an annual income of $30,000 could be required to pay $1500 in premiums and co-payments. The proposal needs further clarification of the "non-emergency services" which could lead to charges to low-income people.
With the new policy at the federal level, combined with Nordquist's off-sets, it seems possible, and likely, benefits will be expanded to match the federal governments expectations. Of course, the history of entitlements in federal and state programs is, once they exist there is a push to expand them. It is always "unfair" to provide support to some but not others. Once expanded, they continue to grow until they cannot be sustained. This is how we've reached our climbing federal debt. Governor Heineman should proceed with great care and consider what potentially could also be put on the table to balance this expansion. Perhaps the state income tax that he wants to eliminate?