We Need The Medicaid Expansion Now More Than Ever

Largely overlooked in the general relief when the U.S. Supreme Court narrowly found the Affordable Care Act to be constitutional in 2012, was the Court’s holding that the Medicaid expansion wasn’t mandatory for the states.  Instead, the 50 state legislatures and Governors would have to actually adopt the Medicaid expansion through the legislative process.  That was the price that Chief Justice John Roberts extracted for his necessary fifth vote which found most of the ACA to be constitutional. Since that ruling was handed down, 30 states – including several red states – have adopted the Medicaid expansion.

Unfortunately, Nebraska is one of the 20 hold out states.  Despite three previous efforts to pass the Medicaid expansion through the Unicameral, a right wing Republican filibuster has blocked an up or down vote on the measure.  Moreover, both Governors Heineman and Ricketts have voiced their opposition to the Medicaid expansion.  This despite the fact that there has been a consistent majority in the Unicameral which supports this effort to insure 77,000 additional Nebraskans.

Despite these setbacks, the backers of the Medicaid expansion haven’t given up.  Senator Heath Mello has teamed up with two Republican State Senators to sponsor a bill that would create a private option for expanding Medicaid, similar to what has been done in some other red states.  Under Mello’s bi-partisan bill, Nebraska would use Medicaid funds to purchase private health insurance for low income people instead of having them enroll in traditional Medicaid.

Adoption of the Medicaid expansion would bring into Nebraska over $2 billion in federal money over the next five years, insure approximately 77,000 additional Nebraskans and provide a vital lifeline for many rural hospitals.

What many people don’t seem to realize is that the federal government would be paying the lion’s share of the costs of the Medicaid expansion.  As Don Walton of the Lincoln Journal Star wrote: “The federal government would pay 100 percent of the costs through 2016; the federal share then would gradually begin to phase down to a 90 percent floor in 2020.”

The proposed Medicaid expansion isn’t some untested or novel idea.  It has actually worked very well in the states where it has been adopted.  For example, in Kentucky, the Medicaid expansion has injected more than $3 billion into the Blue Grass state’s economy in the form of payments to Kentucky doctors, hospitals and other health care providers.  The bottom line result for Kentucky has been higher tax revenues, improved job creation, and overall better economic activity, in the amount of approximately $1 billion net benefit through 2021.

Despite the proven benefits of the Medicaid expansion in 30 other states, Governor Ricketts and his band of right wing supporters in the legislature have opposed the Medicaid expansion on cost grounds.  They are of the misguided belief that Nebraska can’t afford the Medicaid expansion.

Apparently, the right wing opposition to the Medicaid expansion is based upon the belief that the federal government will renege on it’s obligation to finance most of the costs.  However, the bi-partisan bill being co-sponsored by Senator Mello has a trigger mechanism that would end the Medicaid expansion in the unlikely event the federal government broke it’s promises.  However, that is a remote prospect since the federal government has paid it’s promised 60% share of the costs of  traditional Medicaid since it’s implementation in 1965.

What Governor Ricketts and his followers fail to recognize is that uncompensated medical care is already costing the state’s residents and health care providers.  All of us pay a hidden tax in higher health care costs and insurance premiums to cover the costs incurred by health care providers who provide uncompensated care to the uninsured.   According to a study by two University of Nebraska at Kearney professors, “expanding Medicaid would reduce the amount of uncompensated care for Nebraska hospitals by $483 million by 2020.”

What this is means is that refusing to adopt the Medicaid expansion won’t save Nebraska citizens and health care providers any money.  Instead, all of us would continue to pay for the cost of uncompensated care through what I would term the “Ricketts tax.”  Refusing to adopt the Medicaid expansion won’t make the cost of uncompensated care go away.  It will still be with us and we will all be paying the price.

The opponents of the Medicaid expansion aren’t fiscal conservatives.  They are all big spenders.  Ricketts and his supporters have no problem with the hundreds of millions of dollars that the state’s taxpayers have spent on ineffectual corporate welfare programs that didn’t prevent Conagra from leaving Omaha and the millions of federal dollars spent on roads.  As then State Senator Steve Lathrop said in 2014: ” We are being sidetracked by the discussion of bigger government.  It becomes a battle cry every time we want to spend money on a poor person or sick person or elderly person.  I have heard no one complain about the money we get and spend from the federal government on roads.  It’s a lot. “
Ricketts and his right wing allies in the Unicameral haven’t presented an alternative to the proposed Medicaid expansion. All they’ve done is obstruct and prevent 77,000 Nebraskans from being insured. They owe the voters a serious alternative.
There is a new found optimism that the right wing obstruction of the Medicaid expansion can be overcome in this year’s legislative session.  Leading Omaha business men Mike Yanney and Walter Scott have come out in support of Senator Mello’s bi-partisan bill and they will be attempting to round up support for it among their fellow business owners.  Their advocacy for the bill may change some Republican votes in the Unicameral.
As Nebraska Democrats, we must contact our State Senators and encourage them to back this Medicaid bill that will help all Nebraskans.  I know it will be tough because it takes 30 votes to override a gubernatorial veto and 33 votes to break a filibuster.  Nevertheless, we must be relentless in our support for the Medicaid expansion.
If we once again fall short in this session, we must all work hard to elect more Democrats to the legislature in the 2016 cycle.  Former State Senator Steve Lathrop and Executive Director Hadley Richters have worked hard to recruit an impressive slate of five star recruits to run for the legislature this year.  We have an excellent chance to add more to our numbers in the legislature.  Now let’s get it done!  I know we can do it!