Medicaid expansion proposal includes job training

One of the high-stakes policy battles in this year’s session of the Nebraska Legislature began Tuesday, as senators introduced the latest proposal to expand Medicaid, and opponents immediately pushed back.

For the fourth year in a row, supporters have introduced legislation to expand Medicaid in Nebraska. Expansion was originally required by the Affordable Care Act, also known as “Obamacare.” But the U.S. Supreme Court made it optional for the states. Nebraska is one of 19 states that have so far refused to do so.

This year, supporters of expansion like Sen. John McCollister are arguing it would be good for the state’s economy.

“The financial incentives to adopt programs like transitional healthcare insurance are compelling. Expansion will bring an estimated $2 billion into our state over five years, and create 10,000 jobs either directly or indirectly,” McCollister said.

Under the proposal, Nebraska would use federal dollars to buy private insurance for people with incomes below 138 percent of the federal poverty line – that’s about $22,000 for a single parent with one child. Sen. Kathy Campbell says one new wrinkle in this year’s proposal is the idea of making job training or education available to recipients.

“What’s really important is the new component, and that is to provide a workforce education, training, pathway to help people move beyond public assistance,” Campbell said.

Sen. Heath Mello says the combination of Medicaid coverage and job training will be more effective lifting people out of poverty than cutting taxes.

“Cutting taxes does not give people higher-wage jobs when they’re working an $11 an hour job at a restaurant. This is going to help them get the skills they need to move from an $11 an hour job without health insurance to an $18 an hour job with health insurance. They then can pay their premium and transition off of this private program,” Mello said.

The proposal is modeled after the Medicaid expansion proposal passed in Arkansas. (For a study of the program in Arkansas, click here). In a news conference immediately after the senators spoke, Jim Vokal of the Platte Institute, which opposes expansion, criticized that model.

“The Arkansas approach to Medicaid expansion is an example of a government program that leaves recipients of aid worse off. It crowds out support for traditional Medicaid from state budgets, and at the same time it traps recipients of (a) private insurance entitlement by creating disincentives for earning more income,” Vokal said.

Vokal noted the Arkansas Legislature has voted to scrap that state’s program at the end of this year. (To see the Arkansas legislation repealing that state's expanded Medicaid program, click here). The scheduled end of the program in Arkansas is not new -- it was a "sunset "included in the legislation creating the program in 2013, and was reaffirmed by a vote last year. A task force and Gov. Asa Hutchinson are pursuing changes they want in order to continue the program.

Opponents have also argued if the federal government falls short of its promise to fund 90 percent of the cost of expanded Medicaid, the state will have to make up the difference.

Supporters say if the feds fall short, the state program will terminate automatically. But McCollister said he doesn’t think the risks of that happening are very high. Referring to his commute from Omaha to Lincoln on a wintry morning, McCollister said, “Life is full of risks. As I drove down here this morning, there’s probably a pretty good chance that I’d end up in the ditch. As we look at the situation with this particular bill, and expansion in general, it’s a risk we can accept.”

Mello, a registered Democrat in the nonpartisan Unicameral, praised the support of Republicans like McCollister and Campbell.

“This is a commonsense, bipartisan, third-way approach to address a lingering issue that that we have not seen leadership from our executive branch or the opposition to provide an alternative plan to provide health insurance to working Nebraskans. And I’m confident the more our colleagues learn about it, the more they will see this is a conservative approach to addressing a lingering issue facing the state economically and fiscally in years to come,” Mello said.

Gov. Pete Ricketts has maintained his opposition to the proposal, and at the opposition news conference, Sen. Bill Kintner predicted a unified front among opponents.

“I think the key there’s not a single conservative in this body who supports Medicaid expansion. If you watch the body over the last year you know that we’re usually splintered; there’s always a couple that peel off and go this way or that way,” Kinter said. However, he added, “Not this time. Every single conservative in the Legislature opposes Medicaid expansion.”

Fifteen senators attended the opposition press conference. It takes only 17 to block legislation using a filibuster, and opponents said there were five more senators opposed to expansion who wanted to attend but weren’t able to. If that’s true, the push for Medicaid expansion could be frustrated once again this year.

And on another subject, lawmakers decided not to spend any more time this year debating legislation that would have authorized counties to collect co-payments from jail inmates for medical treatment. The decision means that proposal will not pass this year.

Editor's note: This story has been expanded to clarify the status of Medicaid expansion in Arkansas.