On March 18, the Legislature will take up the “Wellness In Nebraska (WIN)” Act. The bill, LB 887, establishes a method for Nebraska to expand insurance options to thousands of Nebraskans who do not have insurance and are not eligible for medicaid through existing Nebraska programs.The bill has strong support from all five hospitals in the 43rd district, as well as from many medical professionals who are concerned that many rural Nebraskans are not receiving necessary medical services because they lack insurance.
The best estimates are that over 54,000 Nebraskans are uninsured, mostly because insurance options are unaffordable to them. These individuals are unable to buy insurance through the Affordable Care Act website, because their incomes are too low, but they do not meet the criteria for Nebraska medicaid because they are single or married adults with no dependents.
Several of these individuals have contacted my office with complaints about the existing system with questions about how they can access affordable insurance.
When the Affordable Care Act was enacted, the assumption was that the federal government would provide subsidies to each state for the working men and women whose incomes were above the poverty line but below 138% of that level. That portion of the law was set aside when the case was heard by the US Supreme Court, leaving the decision about whether to expand medicaid to each state.
Many Nebraskans have grave concerns about the Affordable Care Act. I share those concerns.
At the same time, it is no longer realistic to think that the ACA will ever be repealed, and we need to consider whether or not we should access the hundreds of millions of dollars in federal grants to the state to expand medicaid to the working poor.
I support LB 887 because legislative district 43 will benefit tremendously from passage of this bill. The five hospitals in the district contribute enormous economic benefits to the communities in which they operate and losing any one of them would devastate the community.
Box Butte General Hospital has written off over $6 million in un-collectable debt, over the past four years, and Box Butte is the strongest hospital in the district because so many in the community have excellent insurance through BNSF. Gordon, Valentine, Chadron, and Ainsworth do not have this healthy, well-insured pool of patients to rely on so their loan loss ratios are much higher and their future is more tenuous.
One of these four hospitals has only 11 days of cash flow between solvency and insolvency.
When a hospital closes scores of good-paying jobs are lost. The associated healthcare jobs are also affected.
Nursing homes often lose patients to other nearby communities where healthcare is available. Doctors and nurses will move away. Opportunities to bring in other businesses are diminished since most corporate entities will not develop jobs in communities without good schools and adequate healthcare.
In District 43, which is already beset by grave population losses, this is something we cannot afford.
Further, passage of LB 887 will help Nebraska businesses who are now obligated to provide health insurance under the ACA but do not do so and therefore must pay a penalty. LB 887 removes that responsibility for those businesses which pay low wages but have over 50 employees. Their employees will be able to access insurance through LB 887, and the employer savings are estimated at around $12 million dollars in penalties avoided.
LB 887 has several safeguards built into it which will help to prevent encumbering Nebraska with a huge unfunded liability. First and foremost, the federal funding will be reimbursed at 100% for the first two years. After that date the amount is reduced to 90%. Should the federal reimbursement rate every fall below 90%, then LB 887 forces the senators who are serving at that point to reexamine whether to continue with the program or scrap it.
LB 887 does not provide “free” care to anyone. Each participant pays a co-pay for care they receive and higher co-pays will be in place for visits to the emergency room rather than a clinic to drive consumers to the least-cost enterprise rather than to the E.R. where most of them currently receive care.
Finally, I think it is important that Nebraskans really consider who will benefit from the passage of LB 887.
The vast majority of people who will benefit from this bill will be the hard-working Nebraskans who work low-wage jobs with no benefits. Who are they? Many ranch hands, most fast food workers, convenience store workers, retail workers, the self-employed, and the like.
Nebraska's unemployment rate is very low, and that indicates that almost everyone who can work is already working. By adopting LB 887, Nebraska will bring in more than $360 million new dollars into the state each year and provide healthcare to working people who are valuable, contributing members of our communities.
In District 43, about 1 person in 3 is uninsured. When they get sick they get care — it is done at the E.R. in the nearest community at the highest rate and the bill is often written off by the hospital. LB 887 will bring dollars that are desperately needed back to those hospitals. In addition, we will finally be able to offer some preventive rather than crisis healthcare to these individuals. Over time, that should result in a healthier population and reduced visits to the E.R., thus saving us money. I believe that rural Nebraskans should have better access to healthcare and passage of LB 887 will take us several steps along the way towards that goal.
Like it or not, we Nebraskans will pay our share of the federal subsidy provided to other states accessing the ACA medicaid expansion — and that just doesn't make sense to me. If we have to pay the tax we need to gain the benefits, plain and simple. And that is why I believe LB 887 should become law in Nebraska.
As always, I value your input, and welcome phone calls, emails and personal visits from you.
Sen. Al Davis, State Capitol, PO Box 94604, Lincoln, NE 68509, (402) 471-2628, firstname.lastname@example.org