LINCOLN — Last spring, Gov. Dave Heineman lost a bitter and emotion-filled battle with state lawmakers over publicly funded health coverage.
This year promises to bring the combatants back for another match.
60%-75% would be expected to take advantage of the coverage.
Coverage would be extended to all adults who make below $14,856 for a single person or $25,390 for a family of three.
Source: Nebraska Legislature fiscal staff
At issue then was providing prenatal coverage for the unborn babies of illegal immigrants. Lawmakers approved the coverage over Heineman's veto.
At issue now is whether to expand Medicaid to cover all low-income Nebraskans.
The expansion was required by the 2010 federal health care law but made optional for states by a U.S. Supreme Court ruling issued in June.
Heineman has made his opposition to the expansion clear.
He calls the expansion an “unfunded” program that Nebraska cannot afford. He has said that undertaking the expansion would mean cutting spending on education or raising taxes.
“Those who want to expand Medicaid need to answer the question 'How are you going to fund it?'” the governor said.
But several lawmakers — along with a coalition of health care providers and advocacy organizations — argue that the expansion makes fiscal and moral sense for Nebraska.
A similar battle is brewing in Iowa, where Republican Gov. Terry Branstad has labeled the expansion unaffordable and State Sen. Jack Hatch, a Des Moines Democrat, plans to push a bill approving the expansion.
In Nebraska, some of the same senators who led the fight on the prenatal issue are gearing up to make a push this year for the expansion.
State Sen. Kathy Campbell of Lincoln, the chairwoman of the Health and Human Services Committee, introduced the prenatal bill last year and plans to offer legislation on the expansion.
She said Nebraska pays in many ways for not providing health coverage for those who could gain it with the expansion.
“I think we should participate in it,” she said. “We certainly would, in the long term, save money.”
Sen. Jeremy Nordquist of Omaha sees the expansion as a “moral imperative” for the state, as well as an economic boon.
The federal health care overhaul will make health insurance available to people making federal poverty level incomes or more, starting in 2014.
But, without the expansion, some of the poorest Nebraskans would remain without health coverage.
Nordquist points to a recent Harvard School of Public Health study that found Medicaid coverage reduces deaths.
“In Nebraska, there would be 500 lives in a year that would be saved,” he said.
Heading into the Jan. 9 legislative session, Nordquist said he believes backers have the 25 votes to pass a Medicaid expansion. He hopes they can find five more to override an expected Heineman veto.
Nordquist looks to the prenatal care battle for encouragement.
“That certainly gives me confidence to keep pushing forward on this one,” he said.
Campbell said she doesn't know how much support the expansion has. She said many senators are waiting to learn more about its potential costs and benefits.
Among that group is Sen. Tom Hansen of North Platte, one of the candidates for Appropriations Committee chairman.
“I'm open to the expanded Medicaid,” he said. “We certainly need to talk about it and find out if there's interest in the state.”
Sen. John Harms of Scottsbluff said the issue boils down to cost and the state's priorities.
But figuring out the cost has been controversial. Studies come to different conclusions, depending on their assumptions about how many people would take advantage of it, how much their care would cost and what expenses and savings should be counted.
Federal funds will pay 100 percent of the costs from 2014 through 2016, declining to 90 percent of the cost by 2020.
Legislative fiscal staffers estimated that the expansion would increase state Medicaid spending by $123.3 million from fiscal year 2013-14 through fiscal year 2019-20.
A consultant brought in by the Department of Health and Human Services pegged that cost at around $500 million from 2011 through 2020.
“The bottom line is the unfunded Medicaid expansion will ultimately cost the state of Nebraska hundreds of millions of dollars,” Heineman said.
He said Nebraska should not count on the federal government to live up to its promises, noting that federal support for special education has not kept pace with costs.
Backers look beyond Medicaid and say the expansion, along with other provisions of the health care overhaul, could produce savings in several state and local programs.
Among government programs potentially affected are regional behavioral health and public health services, correctional services, breast and cervical cancer screenings, state employee insurance premiums and county general assistance programs.
Backers also argue that a healthier workforce is an economic development asset.
In addition, having expanded Medicaid coverage would shield the state's larger employers from paying penalties for not providing affordable insurance to employees.
“The savings to the entire system are huge,” Nordquist said.
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