Author’s Note: This is the first in a series of articles about Nebraska’s Medicaid program, the Unicameral’s apparent intent to expand it, and the many reasons why expansion is an uncommonly bad idea.
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Last year when the Unicameral expanded the state’s already generous Medicaid program to cover prenatal care provided to women who were ineligible to receive such benefits under federal Medicaid law, I dubbed the bill they passed over the governor’s veto the “Procreation Protection and Affordable Sex Act.” Judging from what I’m reading in the local press and elsewhere, Version 2.0 of that legislation is in the pipeline and headed this way. And, you won’t believe this, dear readers, the selling point for Version 2.0 is that further expansion of Nebraska’s Medicaid program will . . . save money.
Just in case readers question whether I’ve mischaracterized the state’s Medicaid program when I call it “generous,” let’s compare Nebraska’s program to federal requirements and, also, to the Medicaid programs operated by the other 49 states. The left-hand column of the chart below, taken from the Medicaid Annual Report for 2012 compiled by the Nebraska Department of Health and Human Services, lists the services federal law requires any state Medicaid program to include once the state elects to participate in Medicaid. (Yes, any state’s participation in Medicaid is VOLUNTARY.) The right-hand column lists the additional benefits and services, over and above those the state is required to provide, that the Nebraska Unicameral has voted to extend to Nebraska Medicaid beneficiaries. That’s quite a list there on the right, isn’t it?
Judging from the list contained in the chart above, of the 30 some-odd optional services Medicaid will cover under federal law, Nebraska has chosen to offer and pay for at least two-thirds of them.
But even this comparative listing of services is not completely transparent, to use one of the handful of trendy political buzzwords of the day. For example, “pregnancy-related services” are required under federal law and so are listed in the left-hand column. But just last session, as I noted above, the Nebraska Unicameral voted to extend prenatal care services to women who were otherwise ineligible to receive them under federal law. They voted to cover women who were illegally in this country, as well as women who had failed and/or refused to meet federal eligibility requirements (e.g., they made too much money, they refused to attend required counseling, or they refused to name the father of their child so the government might hold him financially responsible for his own offspring).
So, our Unicameral has already expanded the state’s Medicaid program in two different ways. First, it has elected to offer more comprehensive benefits than federal law requires, hence the long list of “optional” services in the right-hand column of the chart above. And, second, it has expanded eligibility for otherwise required services. With regard to prenatal care, for example, the Unicameral has said, in effect, it doesn’t matter that federal law requires a person to be in this country legally in order to get Medicaid. We’ll give you coverage and benefits, regardless of your immigration status. You make too much money to qualify under federal law? We’ll provide you benefits even if you make 185% of the federal poverty level. Federal law requires you to name the father of your child in order to get Medicaid coverage? How unreasonable! We don’t care who he is or whether he might have some money to support you and his child. We’ll take care of you both. Who needs a husband/father anyway, when you can have ready access to the wallets and pocketbooks of the citizens of the State of Nebraska instead!
Have the other 49 states followed Nebraska’s example? Just how does Nebraska’s Medicaid program compare to the programs in the other states? A 50-state comparison completed by Public Citizen Health Research Group1 in 2007 ranked Nebraska’s Medicaid program 2nd overall based upon:
- its expansive eligibility,
- the breadth of services offered,
- the quality of the care provided, and
- the levels of reimbursement paid.
To put Nebraska’s 2nd place showing into complete context, Nebraska was second only to MASSACHUSETTS in the rankings! You know, Massachusetts, where Romneycare (Obamacare’s elder brother) was born?
Nebraska easily outscored all of its sister states with whom it shares a border, as the table nearby clearly demonstrates.
Ask yourselves, is the race to provide the most extravagant Medicaid benefits in the nation a race Nebraskans really want their state to win? If you think not, you should be aware your elected representatives in the state legislature do not agree with you. The race is on in the Unicameral, and the winner in this race ultimately loses all.
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- Public Citizen is an ultra-liberal lobbying group founded by Ralph Nader in 1971. It’s Health Research Group conducted the 50-state comparison of Medicaid programs with the express intent to eschew objectivity. According to the researchers, “While there are abundant data on Medicaid, these tend to avoid making value judgments. This report therefore seeks to fill the existing gap. We feel that it is not enough to say ‘this is the way things are;’ instead, we should assess and say ‘this is the way things should be.’” With that goal in mind, the researchers set out to answer the question, “If I were a poor, sick person, in which state would I have the best chance of becoming eligible for Medicaid and getting comprehensive, quality health care?” The researchers’ evaluation criteria and the indicators they used to measure them reflect that bias — favoring programs which offer more services to more people at the least cost to beneficiaries and the greatest cost to the states. ↩
Good article Linda! How much is this costing the taxpayers, how long did it take to get to this point and what we can do to roll back to a more competitive plan?
Glenn:
Thanks! The next article in the series, which will be published shortly, will answer your first two questions. It remains to be seen what we can do to roll back to a more competitive plan. I think we first have to ask if that’s what we WANT to do — stay in Medicaid and roll back benefits or strike out on our own as a state. Of course, most of our elected officials would hyperventilate at the suggestion that we leave the Medicaid program entirely because we would lose all that “free” federal money for indigent health care in our state, don’t you know.
It amazes me that they still think that money is “free.” I had a discussion about a week ago with one of our state legislators about the Medicaid expansion. He was quick to tell me about how it wasn’t going to cost the state anything for a few years and then the feds would be picking up 90 percent of the tab in perpetuity. I asked him, “Senator, where does the federal government get the money it sends to Nebraska?” There was a big pause, total silence. So, I answered my own question — “From taxes all Nebraskans pay. Calling that “free” money is like taking the cash out of my back pocket and telling me I didn’t really lose anything because you didn’t touch the cash in my front pocket.” He grudging admitted that I “had a point there.”
Keep reading. I’ve got several more articles to come on this subject.
Linda
Glen,
In regard to rolling back to a more competitive plan, I suggest the first order of business is to prevent the current plans for another expansion from being advanced in this years legislative session. The radio interviews I’ve heard with state senators, as well as some published articles, suggest that this has already been extensively discussed among the legislators, a consensus has emerged, and passage of another Medicaid expansion is probably a done deal, UNLESS there is big push by citizens AGAINST passage. So the first thing to do is inform voters – your friends, family, co-workers, etc. – about what is about to happen, and get them to contact their senators in big enough numbers to stop it.