Recently the Nebraska Legislature committee considered Medicaid expansion, also known as the Wellness in Nebraska Act, LB 887.
The bill’s stated intent is to improve the health of and coverage for uninsured Nebraskans, reduce per capita costs of health care, and improve access to affordable health care for the poor.
We don’t see that it will, for many reasons:
This legislation does not expressly prohibit Medicaid or subsidized health insurance for illegal aliens.
A typical eligible participating family of 4 could have incomes up to $31,152, at 133% of the federal poverty line.
The bill relies on federal government total subsidization at 100%, dropping to 90% within years. However, the federal pledge is non-binding and the federal deficit may cause its reversal. Then, state taxpayers must pay for the entire program.
Remember, the feds reneged on their promises to fully fund No Child Left Behind.
A new bureaucracy would oversee its implementation. Medicaid would expand to provide health care coverage to more adults through health insurance premiums paid by the welfare department to purchase health plans on a health benefit exchange or employer-sponsored insurance.
The department would pay the full cost of the premium for buying a qualified health plan on the exchange and also pay the co-payments, co-insurance, deductibles and other costs for some.
Benefits would also be paid for some non-emergency transportation.
These options would convince employers to dump their current employee insurance plans and join the Wellness in Nebraska plan so that they would not have to pay the full premiums.
Then, their other employees would lose their insurance choices and become subject to a 2-tier plan at their disadvantage, forced to pay their own costs while fellow employees do not pay.
If a person declines to take a health risk assessment and an annual physical to test for drug and alcohol abuse, they could still enroll and wouldn’t necessarily pay a monthly contribution toward their premium.
This huge expenditure would siphon funds now pegged for the state highway system and state aid to education.
The Nebraska Taxpayers for Freedom suggest a number of alternatives for state senators that would accomplish most of the objectives that this bill intends to accomplish.
• Allow untaxed state health savings accounts.
• Permit groups of citizens to pool together to buy insurance policies.
• Permit small businesses to pool together to obtain lower insurance rates for their employees.
• Offer tax credits to the poor to purchase health insurance.
• Allow wellness tax credits of $500 or more to individuals and employees who follow a specific wellness regimen.
• Reform our state legal system to reduce medical malpractice liability, offering as a defense that a professional follows the "best practices."
• Permit medical licenses to apply across state lines, so that a physician could work remotely from another state.
• Allow the chronically-uninsurable to gain access to coverage in a high-risk state or multi-state pool.
• Safeguard individuals with pre-existing medical conditions from discrimination against purchasing health insurance by bolstering a state high-risk pool.
• Lobby Congress to allow purchase of policies across state lines.
These proposals would offer individuals, not government, control over their insurance and increase competition among insurance companies to drive down costs.
For example, regarding Medicare Part D, one NTF member, after shopping around, selected a private supplemental insurance plan to cover his prescription drugs and saved $10 per month, or $120 per year.
The state could establish an information center where citizens could find information on health insurance alternatives.
These options would encourage personal responsibility, benefit employers who want to offer employee insurance, and focus on prevention and wellness, health promotion, healthy behaviors, competition, consumer choice, and cost reduction in the private marketplace.
Moreover, these solutions would not make more Nebraskans dependent upon government.
By Doug Kagan, the chairman of the Nebraska Taxpayers for Freedom, headquartered in Omaha.