The Legislative Fiscal Office analyzes state government financial and program issues. Specific roles and responsibilities of this objective are defined in statute. A primary responsibility of this Office is to develop a fiscal note for every bill before its public hearing, which identifies an estimate of the anticipated change in state or local government expenditures or revenue due to the bill's specific provisions.
As debate on LB 577 to expand Medicaid in Nebraska unfolded this week, I used the bill's fiscal notes and several other sources of unbiased and nonpartisan information to help me understand the true consequences of accepting or rejecting this important health initiative.
I want to share with you some of the factual information I received.
District 43 includes about 17,000, 3-4 person households. A conservative estimate shows more than 3,000 of these households would qualify for Medicaid expansion under LB 577.
The population to be covered by LB 577 includes a wide array of minimum wage, yet poverty-level Nebraskans. Seventy-six percent of this population works full-time or part-time, and many have more than one job.
These are the people who work in construction and other skilled-trade occupations, in retail stores, in the food service industry and, surprisingly, for city, county and state government.
The Association of County Officials, or NACO, is the membership organization for all of Nebraska's 93 counties. NACO supports LB 577.
Health care providers in District 43 overwhelmingly support passage of LB 577.
The providers include hospitals in Ainsworth, Alliance, Chadron and Valentine; the Nebraska Association of Family Physicians, and physical, occupational and speech therapists.
Primary provider payment rates for Medicaid patients would increase by 40 percent. This should improve Nebraska's ability to attract providers to under-served areas of the state. If we do not participate in Medicaid expansion, this provider rate increase would be unavailable.
Our hospitals currently receive what are known as Disproportionate Share Hospital adjustment payments to offset the losses they incur by treating uninsured patients. If LB 577 is not enacted, these payments would be lost.
Hospitals that currently serve uninsured patients would have to decide to stop serving this population or to reduce operating costs. This would undoubtedly mean staff reductions.
Medicaid expansion would actually save $2.3 million in General Funds for the state of Nebraska during the next two-year budget cycle.
The expansion would cover several current state expenditures for disability programs, the Department of Corrections, behavioral health services and the Comprehensive Health Insurance Pool.
LB 577 could be fully paid for through 2020 without raising additional revenue and without making cuts to other budget priorities.
The Affordable Care Act is the law of the land. Some people approve of it; others do not. Because it is now the law, Medicaid expansion is an option that states must decide to accept or reject.
The final decision on this issue has yet to be made in Nebraska. AM 1045 is a proposed amendment to LB 577. Unless a future legislature decided to continue it, the amendment would eliminate the expansion program before our state budget would bear any of the supporting costs. If LB 577 is scheduled for debate again, AM 1045 will be a key component in the ongoing discussion of this important policy change.
As always, I value your input, and welcome phone calls, emails and personal visits from you.
Senator Al Davis, State Capitol, PO Box 94604, Lincoln, NE 68509, (402) 471-2628, firstname.lastname@example.org.