Medicaid expansion alternative proposed; bill's sponsor isn't sure it can pass -
Published Wednesday, January 15, 2014 at 12:00 am / Updated at 3:35 am
Medicaid expansion alternative proposed; bill's sponsor isn't sure it can pass

LINCOLN — A new Nebraska health care plan aims to win votes with a mix of private insurance, wellness incentives, cost sharing and Medicaid.

But it was unclear Tuesday whether the plan can attract enough support in the Nebraska Legislature to become law.

State Sen. Kathy Campbell of Lincoln, the Health and Human Services Committee chairwoman, would not predict how the Wellness in Nebraska, or WIN, plan might be received.

She introduced the plan Tuesday as Legislative Bill 887.

“We answered a lot of the questions we had last year,” Campbell said. “We’ll see.”

Last year’s effort to expand the state’s Medicaid system, as proposed by the federal health care law, stalled in the face of a filibuster and Gov. Dave Heineman’s adamant opposition.

Initial views about the new plan were mixed among some opponents of expanding Medicaid assistance for lower-­income Nebraskans.

State Sen. Bob Krist of Omaha said the new proposal comes close to what he wants to see. But Sen. Bill Kintner of Papillion said it makes no difference; he remains opposed to any expansion of government.

Sens. Mike Gloor of Grand Island, Tom Hansen of North Platte and Tom Carlson of Holdrege said they need to know more about the new plan before making up their minds about it.

Heineman declined to comment Tuesday. His spokeswoman, Jen Rae Wang, said he had not seen the new plan.

In an earlier interview, the governor said he would oppose any alternative “Nebraska plan” as just another form of the Affordable Care Act.

Backers said the new proposal incorporates ideas that could lead to better health care for all Nebraskans. It also would boost the state’s economy by helping workers stay healthier and bringing in federal dollars.

“It is centered on value-based, cost-conscious, quality care,” Campbell said of the plan.

LB 887 would provide coverage for Nebraskans who now cannot afford private health insurance yet cannot qualify for Medicaid. About 50,000 Nebraskans with incomes below the federal poverty level are stuck in this coverage gap that the federal law’s Medicaid expansion was designed to fill.

The legislation is aimed at people with incomes below the federal poverty level, as well as those just above it. People with incomes from 100 percent up to 133 percent of the federal poverty level could get private insurance coverage through the WIN Marketplace.

This year, the federal poverty level is $23,550 for a family of four. The 133 percent level for such a family would be an income of $31,321.50.

The bill should satisfy “those individuals who want the private sector to play a major role,” said Omaha Sen. Jeremy Nordquist.

People would have to pay up to 2 percent of their income toward premiums; Medicaid would pay the rest, as well as co-payments and deductibles.

Those with incomes below the poverty level would get WIN Medicaid coverage, which would incorporate managed care and new concepts in patient care.

Among the concepts would be a way to connect new enrollees with primary care providers before they get sick as well as systems to coordinate care for people with chronic illnesses.

Those making between 50 percent and 100 percent of the federal poverty level would have to contribute 2 percent of their incomes for coverage.

Those covered by either the private insurance or Medicaid would get their 2 percent contributions waived if they participated in wellness activities. In the first year, those would include a health risk assessment and an annual physical exam.

“The whole idea is to get them into a pattern of regular health care,” Campbell said.

Under Nebraska law, adults without minor children cannot qualify for Medicaid no matter how low their income. Parents and disabled adults can qualify, but only if their incomes are well below the poverty level.

The federal health care law provides tax credits to help buy private health insurance for people making 100 percent to 400 percent of the poverty level. It was intended to expand Medicaid to cover people below the poverty level, but the U.S. Supreme Court ruled that expanding Medicaid, a federal-state program, was voluntary for states.

Nebraska is among the states that have opted not to expand it.

While the latest proposal incorporates Heineman’s focus on wellness and prevention, the governor has sounded skeptical about the concept.

Recently, he has said that he is always willing to listen to alternatives but that Nebraska should wait on any plan because of the uncertainty and confusion surrounding the federal health care law.

He repeated his view that expanding Medicaid would take away funds from more important state priorities, such as education. He also questioned the federal government’s pledge that it will fully or mostly fund the expansion, calling that a false promise because of the enormous costs involved and the already large federal debt.

Under the new plan, as with last year’s plan, federal funds would pay 100 percent of the cost for covering the additional people through 2016. After that, the federal share would drop until reaching 90 percent in 2022.

Americans for Prosperity’s Nebraska director, Matt Litt, said his organization will continue fighting against expanding Medicaid, which he said the new proposal would still do.

“Nebraskans will not be fooled by the political gimmick” of naming the bill the Wellness in Nebraska Act, he said.

Nebraska Appleseed Executive Director Becky Gould urged support of the proposal as a way to provide insurance coverage to thousands of Nebraskans and improve the health care system.

“The bill will reduce the cost to the state in uncompensated care and bring in federal dollars that will support thousands of jobs,” she said.

The WIN proposal borrows ideas from Iowa, Arkansas and other states that have been working on their own alternatives to the Medicaid expansion.

Federal officials approved Iowa’s plan last month. Called the Iowa Health and Wellness Plan, it, too, uses private insurance for people with incomes of 100 to 133 percent of federal poverty level, Medicaid for those at lower incomes and incentives for adoption of healthy behaviors.

Republican Gov. Terry Branstad pushed for the plan, which built on an Iowa program that offered limited health coverage to some low-income Iowans not eligible for Medicaid.

If passed by Nebraska lawmakers, the WIN plan would need approval from federal officials. LB 887 calls for creating a special legislative panel to work with administrative officials on developing a plan for submittal.

Contact the writer: Martha Stoddard    |   402-473-9583    |  

Martha covers the Nebraska Legislature, the governor, state agencies, and health, education and budget issues out of our Lincoln bureau.

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