Medicaid redesign proposal stalls
A bill that would initiate a redesign of the state’s Medicaid program was bracketed during general file debate April 8.
Lincoln Sen. Kathy Campbell, sponsor of LB472, said the proposal would increase economic efficiencies in the Medicaid program and better serve all Nebraskans. The bill would create a 16-member Medicaid Redesign Task Force composed of representatives from the Legislature, the state departments of Health and Human Services (DHHS) and Insurance and experts in health care delivery, workforce, insurance, education and advocacy.
The task force would perform a review of the Medicaid program and make recommendations on cost effectiveness and quality improvement, reporting annually to the Legislature and governor.
A Health and Human Services Committee amendment would have changed the legislative task force representatives to nonvoting members. Campbell said the change was to alleviate concerns regarding separation of powers.
The amendment failed on a vote of 22-24. Twenty-five votes were required.
LB472 also would require DHHS to submit a state plan amendment to the Centers for Medicare and Medicaid Services to provide coverage to a newly eligible population of adults ages 19 to 65 with incomes below 133 percent of the federal poverty level (FPL) and individuals who currently fall in a coverage gap because their income is between 50 and 100 percent FPL, making them ineligible for federal premium assistance subsidies.
Costs would be covered by Medicaid with matching dollars starting at 100 percent in 2015, and gradually dropping to 90 percent after 2020. LB472 includes a termination clause if federal matching dollars fall below 90 percent.
Campbell said the time for waiting to gauge the experience of other states had passed.
“We can no longer stand by the side of the road,” she said. “We need to look to the future and maximize the federal dollars that our citizens send to Washington and bring them back. We need to be bold in our vision of the future.”
Within 12 months of the bill’s passage, DHHS would be required to develop a Medicaid demonstration waiver that would coordinate health care delivery to the newly eligible population. The waiver would include:
• premium contributions up to 2 percent of income;
• a co-pay for overuse of the emergency room; and
• wellness incentives for preventive care.
Campbell said the bill incorporated lessons learned from the two previous attempts at Medicaid expansion that she has introduced—both of which stalled during floor debate.
“The urgency for passage of LB472 is only increasing,” she said. “The case for it only becomes stronger.”
Omaha Sen. Jeremy Nordquist supported the bill, saying that while LB472 would cost the state approximately $45 million per year—including administration and the cost of care— it would save money in the long run.
“For that investment, we would leverage a federal match of about $450 million,” Nordquist said.
Lincoln Sen. Patty Pansing Brooks also spoke in favor of the bill, saying Nebraskans are willing to take federal dollars for agriculture subsidies, correctional services and roads, but not for Medicaid expansion. She said passing LB472 would return over $2 billion in federal tax money to the state.
“We cannot turn down these kinds of dollars,” she said. “We are not a state willing to turn our back on people in need.”
Omaha Sen. Beau McCoy opposed the measure, noting that Nebraska currently has the lowest unemployment rate in the nation. Instead of expanding Medicaid, he said, funds would be better spent helping low-income workers develop the technical skills necessary to obtain jobs that offer quality health insurance.
“Imagine what we could do if we took a good chunk of that money and put it toward job training,” McCoy said.
Sen. Bill Kintner of Papillion also spoke in opposition. He questioned the wisdom of expanding a government program, which already has grown exponentially and at a greater cost than anticipated.
As an example, Kintner said Medicaid accounted for a little less than 3 percent of Nebraska’s state budget when he graduated from high school in 1979. Currently, he said, that proportion is 19 percent.
“This is a government program; it grows like a wild weed,” Kintner said. “That is what government programs do.”
Following rejection of the committee amendment, Omaha Sen. Ernie Chambers offered a motion to bracket the bill until June 5. The motion was adopted on a vote of 28-16, effectively ending debate on the bill for this session.
