Nebraska lawmakers consider new Medicaid 'redesign' bill to close the state's coverage gap

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Neb. State Sen. Kathy Campbell, of Lincoln, introduces LB472, a bill to expand Medicaid coverage in Nebraska, during a hearing of the Health and Human Services Committee, Wednesday, Feb. 25, 2015, in Lincoln, Neb. (AP Photo/Nati Harnik)

Shelly Sedlak of Seward, Neb., testifies before the Health and Human Services Committee in Lincoln, Neb., Wednesday, Feb. 25, 2015. Sedlak, 54, said she doesn’t qualify for Medicaid because she isn’t old enough and makes too much money from disability payments, which began after she suffered a stroke in 2009. (AP Photo/Nati Harnik)

LINCOLN, Nebraska — Lawmakers who want to close Nebraska's health care coverage gap are taking a new approach after two previous attempts to expand Medicaid failed.

Sen. Kathy Campbell presented her Medicaid "redesign" bill Wednesday to a legislative committee, saying it would help the state uncover more efficient ways to provide health coverage while giving Nebraska officials flexibility to design a state-specific plan.

"Whether you like Obamacare or not, our health care system was and still is in need of reform," Campbell said in testimony to the Health and Human Services Committee.

The bill is still likely to face resistance from conservative lawmakers as well as Republican Gov. Pete Ricketts. Ricketts has said he opposes any effort to expand Medicaid under the federal health care law, and administrators from two agencies he oversees testified against the bill.

Campbell said the measure would allow Nebraska to collect billions in federal matching dollars to help cover the newly eligible population while giving state officials time to overhaul the entire system.

The bill would require the state to apply for a federal waiver to develop its own Medicaid plan, as other states reluctant about the expansion have done. Residents who fall into the coverage gap would be pulled into the current Medicaid program until the federal waiver is approved.

Campbell said the bill was created after lawmakers looked at waiver plans in Arkansas, Iowa, Pennsylvania and other states.

Unlike previous versions, the new bill would create a state task force to look for ways to deliver more efficient care in the current Medicaid program.

Lawmakers who oppose Medicaid expansion have defeated two measures in as many years. More than one-third of the Legislature is new this year because of term limits.

Shelly Sedlak, 54, of Seward, said she doesn't qualify for Medicaid because she isn't old enough and makes too much money from disability payments, which began after she suffered a stroke in 2009. Doctors inserted a stent into her brain, but it was too short and now requires regular follow-ups.

Before the stroke, Sedlak said she worked as a manager at a Dollar General store in Steward. She said her Medicare coverage only pays 80 percent of her medical bills, and she can't afford the physical therapy to help her return to work without going deeper into debt.

"I slipped through the cracks like a piece of dirt," she said. "I loved what I was doing. I loved it. And now I feel so worthless."

Marty Fattig, a lobbyist for the Nebraska Rural Hospital Association, said a failure to expand Medicaid would place additional strain on the state's rural hospitals. At the national level, he said more hospitals have closed in the last year than in the previous 10.

Dr. Amanda McKinney, a lobbyist for the Nebraska Medical Association, said nearly two-thirds of the state's uninsured population live in rural areas, and most rural physicians accept Medicaid patients. Without the expansion, she said, that population would continue to go without adequate care.

The new bill would offer traditional Medicaid coverage to residents who make less than 100 percent of the federal poverty level, which is $19,530 for a family of three.

Participants who make between 50 percent and 100 percent would have to pay as much as 2 percent of their income for premiums, which could be waived if they participate in a wellness program that would initially include a medical checkup and health assessment.

Courtney Miller, a deputy director for Nebraska's Medicaid and Long-Term Care Division, said the eventual decline in Medicaid matching dollars from 100 percent to 90 percent would shift a greater burden onto the state.

Miller said the Medicaid program is one of the fastest-growing programs in the state budget, with the current program covering an average of 235,000 individuals a month.

Bruce Ramge, director of the Nebraska Department of Insurance, pointed to the financial problems with CoOportunity Health, the Iowa health insurance cooperative set up with federal loans under the federal health care law.

Ramge said the federal government has faced technology problems and repeatedly had to extend deadlines set under the federal health care law.

"There's great uncertainty for regulators," he said.

The bill is LB472.

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