Lawmakers have unveiled a new plan to cover the so-called Medicaid gap population in Nebraska, but the proposal faces a steep uphill climb



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LINCOLN, Nebraska — Lawmakers unveiled a new plan Tuesday to cover the so-called Medicaid gap population in Nebraska while opponents made clear that the proposal faces a steep uphill slog.

Supporters hailed the latest bill as a bipartisan, business-friendly approach to cover an estimated 77,000 childless, low-income adults. Three previous attempts to expand Medicaid coverage under the federal health care law have failed because of conservative opposition.

The new bill would use federal Medicaid dollars to buy private health coverage for residents without access to an employer-sponsored plan, and would pay a worker's share of premiums if an employer does offer coverage. People deemed medically frail would receive coverage through the state's current Medicaid program.

Sen. John McCollister of Omaha, the bill's leading sponsor, said it would help the state economy by pumping an estimated $2 billion into the state economy, providing new health care jobs and helping the uninsured become more healthy and productive.

"Those states that expand Medicaid will have an economic tail wind versus those that don't," said McCollister, a Republican.

It also would create a program to refer new enrollees to optional job-training and education programs, in hopes of weaning them off of public benefits.

"We feel this is an extremely important new component to help people transition out of their dependence," said Sen. Kathy Campbell of Lincoln, a leading co-sponsor.

Campbell said the bill encourages personal responsibility and makes use of employer-sponsored coverage when it's available, reducing the cost to the state.

Even so, opponents said they had at least 19 of the Legislature's 49 votes — more than the 17 required to block the bill with a filibuster. Fifteen of those lawmakers stood with a leading opposition think tank Tuesday morning during a news conference to criticize the new bill.

"Every single conservative in the Legislature opposes Medicaid expansion," said Sen. Bill Kintner of Papillion.

Jim Vokal, the CEO of the Omaha-based Platte Institute for Economic Research, said similar legislation adopted in Arkansas resulted in far greater enrollment and expense for the state than initially predicted. Vokal argued that the new proposal would extend benefits to able-bodied adults when the program has traditionally been used for poor children, pregnant women, seniors and people with disabilities.

Nebraska is one of 19 primarily conservative states that have rejected efforts to expand Medicaid, the health care program for the poor and disabled. Thirty-one states and the District of Columbia have agreed to the expansion, and governors of three non-expansion states — South Dakota, Virginia and Wyoming — are now advocating it in their latest budget proposals.

The Nebraska plan would cover an estimated 77,000 childless adults whose incomes are too high to qualify for regular Medicaid but too low to receive tax subsidies available through the federal health care exchange.

The coverage gap exists because tax subsidies are only available to people with household incomes between 100 percent and 400 percent of the federal poverty level.

The Affordable Care Act doesn't provide the subsidies for people who make less than that because the law originally required all states to expand Medicaid, which would have covered that population and made the subsidies unnecessary. But in 2012, the U.S. Supreme Court ruled that the federal government can't punish states that don't expand Medicaid.

Among those in the gap is Sarah Parker of Lincoln, who said she worked full-time until her father was diagnosed with Parkinson's disease in 2011. Parker said she now works part-time without coverage so she can care for her father, while her medical bills have mounted. A recent eight-day stint in the hospital is pushing her toward bankruptcy.

"I don't need an entitlement program," Parker said. "But I do need a little help."

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