Nonprofit believes answer is to expand Medicaid eligibility from poverty level

As many as 100,000 Nebraskans fall into a “coverage gap” in which they aren’t eligible for Medicaid and can’t afford health insurance.

According to the most recent American Community Survey’s five-year estimates, released in 2014, more than 1,300 people in Lincoln County are uninsured.

Medicaid has strict requirements; the only low-income residents who qualify are children, pregnant women, seniors, people with disabilities and some very low-income-earning parents, according to Nebraska Appleseed.

Nebraska Appleseed is a nonprofit, nonpartisan organization whose goal is to provide justice and opportunity to all Nebraskans. The organization hopes to help find a solution for those who are uninsured or underinsured.

Members of Nebraska Appleseed recently visited communities across Nebraska to speak with those who fall into the gap and with health providers.

“Every Nebraskan should have affordable health insurance,” said Jeff Sheldon, the group’s communications director. “It’s just the right thing to do.”

Sheldon said that not having health coverage prevents some people from having checkups and important diagnostic tests.

“Some of these folks are not going to find out they have cancer until it’s too late,” Sheldon said.

More than 70 percent of people who fall into the coverage gap statewide are working, Sheldon said. Small business owners or producers can’t necessarily afford private insurance, don’t have employer-provided benefits and likely do not qualify for Medicaid.

“If you are working in Nebraska, you should be able to have health insurance,” Sheldon said. “It’s not like having a nice car. It’s literally something that everyone needs.”

Sheldon said not having health insurance is costly — not just for the patient but for hospitals, taxpayers and the state. Appleseed says that a rural health insurance market that leaves people without insurance also leaves providers without payment.

According to the 2014-15 Great Plains Health Community Impact booklet, the hospital provided more than $10 million worth of services, unpaid, to those who were uninsured. In total, the hospital provided more than $20 million of unpaid services due to underinsured patients, bad debt and donated care.

“Nebraska Medicaid Expansion,” a study by two University of Nebraska at Kearney professors published in April 2015, states that Medicaid expansion could avert a projected $142.7 million in bankruptcies over a five-year period by enabling providers to be paid. The study said Nebraska would avoid at least $1 billion in silent taxes, medical-related bankruptcies, unnecessary state spending and reduced consumer spending power over five years. The state would also receive $2 billion in federal funding over the next five years.

Sheldon said Appleseed believes the solution is to expand Medicaid. Medicaid expansion would extend eligibility to adults with incomes at or below 138 percent of the federal poverty level — or about $2,130 a month for a family of three.

“Most lawmakers realize this is a problem and we have to fix it,” Sheldon said.

Gov. Pete Ricketts has opposed expansion. In January, he said it would shift Medicaid from its core mission as a safety net for the poorest and sickest citizens and create an unreasonable risk to the state budget.

Recent efforts to expand Medicaid have failed in the Legislature. In 2013, Legislative Bill 577, which would have created modified Medicaid expansion, was rejected. In 2014, the Wellness in Nebraska Act was introduced but was indefinitely postponed. It would have expanded traditional Medicaid to those in the coverage gap and would have relied on federal Medicaid funding to purchase private coverage for those between 100 and 130 percent of the poverty level.

Another bill was proposed in 2015, but never made it out of committee. The most recent effort to expand the program was spearheaded by Sen. John McCollister of Omaha this year.

McCollister introduced LB 1032 “The Transitional Health Insurance Program Act.” The program would have covered the same population covered by traditional Medicaid expansion. Some participants would be able to receive assistance buying insurance through their job if their employer offers coverage, some participants would be enrolled in a private-market insurance plan and others would have traditional Medicaid coverage.

McCollister and the bill’s supporters felt the act was a conservative version of Medicaid expansion.

In a statement issued in February, Ricketts said expanding Medicaid would require nearly $1 billion in state spending in the first 10 years, with the potential for costs to rise to over $600 million a year if Congress ever required the state to fund the program at its traditional Medicaid matching rate.

Calder A. Lynch, director of the Division of Medicaid and Long-Term Care for DHHS, testified against the bill on Feb. 10, citing concerns of a higher share-of-cost for the state as well as uncertainty surrounding operations and services proposed by the bill. The bill didn’t receive enough backing from lawmakers and was postponed indefinitely.

Sheldon said that Appleseed stood behind each of the recent approaches to Medicaid expansion and that the organization has extended an “open invitation” to lawmakers to come up with a solution.

Currently 31 states and Washington, D.C., have expanded Medicaid programs.

“More states are considering [expansion],” Sheldon said. “It will come to Nebraska eventually. ... How many more millions of dollars do we waste and how many more hardworking people do we let suffer?”

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