Senators continued debate Wednesday on a bill to expand Medicaid eligibility to some low-income adults under a provision of the federal Affordable Care Act, commonly known as Obamacar.LB 577, introduced by Sen. Kathy Campbell of Lincoln, would add adults ages 19-65 whose incomes are at or below 138 percent of the federal poverty line -- about $15,000 a year for an individual -- to the list of groups eligible to receive Medicaid benefits.
An estimated 54,000 more Nebraskans would become for Medicaid.
Under the Affordable Care Act, the federal government would pay the full cost of the expansion for three years, until 2016. After that time, the federal share of the cost would gradually decrease to 90 percent by 2020, where it would remain.
Lawmakers passed an amendment to the bill Tuesday (AM1 028) that would allow the Legislature to affirm, amend or repeal the Medicaid expansion should the federal assistance ever drop below 90 percent of the program’s cost.
Sen. Galen Hadley of Kearney introduced an amendment Wednesday that would see the Medicaid expansion expire after three years, at which time the Legislature would have to vote to renew the law.
Hadley chose three years because it is the same time period when the federal government will pay the full cost of the expansion.
He said it would provide the state a window of opportunity to see if the expansion is effective before committing state funds to finance it.
“It gives us the chance to study what we should do with this problem,” he said.
Several senators expressed support for Hadley’s amendment, calling it a legislative compromise.
But Sen. Tom Carlson of Holdrege said potentially taking away Medicaid for thousands of Nebraskans after three years was something none of the senators would be able to do.
“After covering 54,000 to 94,000 people for three years who aren’t covered now, you will not make the decision to take that coverage away. It will not happen,” Carlson said.
Sen. Bill Avery of Lincoln said he is now convinced that Nebraska “cannot afford not to do this.”
Avery cited a number of taxes and fees under the Affordable Care Act -- including a tax on drug importers and high-end insurance plans -- that will take effect in 2014 regardless of whether the state expands Medicaid.
Avery said those taxes would result in a revenue loss for Nebraska residents of about $253 million over 10 years. Meanwhile, he added, federal funds from the expanded Medicaid program would return $2.3 billion to Nebraska’s economy over that same 10-year period.
With Wednesday’s discussion heavily focused on numbers, Campbell urged senators to also focus on the human element of Medicaid expansion.
“We have to remember that behind all those numbers are people,” Campbell said.
She said that during the Keystone XL Pipeline special legislative session in 2011, her husband had health problems that resulted in a $100,000 medical bill because of problems that escalated after a “simple fall,” she said.
“We had insurance, we had a higher deductible, so we were able to deal with that,” she said. “But if you are zero to 138 percent of poverty, could you have paid a $100,000 bill?”
Some senators continued to oppose the bill despite the proposed three-year expiration date.
“Consider the people that would enter the program and then be dropped from the program,” said Sen. Lydia Brasch of Bancroft.
Brasch also questioned whether states have the ability to leave the program once they’ve opted into it.
Brasch said that the expiration date, also called a sunset date, meant that lawmakers were expecting trouble.
“When that’s the case, we should avoid trouble,” she said.