Medicaid expansion

                The Legislature gave first-round approval to both bills introduced on behalf of Governor Ricketts, containing his plan for property tax relief. However, the bills have been completely rewritten through the amendment process.

LB 959, as amended by committee amendments, eliminates the minimum levy penalty which reduces state aid to districts with levies less than .95 cents, removes the levy criteria from the averaging adjustment calculation, and caps the special levy school districts can use to address health, safety and accessibility problems in school buildings at 3 cents, down from 5.2 cents. LB 959 will allow a number of school districts to reduce their levy and will also provide more state aid to some districts that depend heavily on property taxes to fund their schools.

The budget bills were discussed during the second stage of debate this past week. Senator Ernie Chambers offered an amendment to strip $5 million in one-time funding for county jails. A number of county jail facilities in the state have available empty beds. The intent was to temporarily ease current state prison overcrowding by contracting with willing counties to house up to 150 inmates in county jails, while a study is taking place on the feasibility of building a new prison and the Legislature is working with a national organization on alternatives to prison. However, the state’s two most populated counties have indicated that they may not be interested in taking state prisoners, since their facilities are not designed for long-term prisoners and due to funding concerns. The amendment offered by Senator Chambers failed on a 16-22-11 vote. Following the adoption of a technical amendment, the budget bills were given second-round approval.

The Legislature debated LB 887, the Wellness in Nebraska Act, this past week. The Affordable Care Act, proposed by President Obama, was passed into law on the federal level in 2010. Due to a Supreme Court ruling, the mandatory provision requiring Medicaid expansion became voluntary for the states. LB 887 proposed to expand Medicaid in Nebraska by increasing eligibility for Medicaid coverage to adults ages 19-64, with incomes at or below 133% of federal poverty level, regardless of whether they have dependent children. Currently eligibility for Medicaid is limited to low-income children, pregnant women, parents with Aid to Dependent Children, and the disabled, blind and elderly. The federal government has pledged to pay 100% of the costs of expansion for the first 3 years, with the federal share dropping to 90% by 2020. However, this does not apply to administrative costs, which are shared by the state and federal government.

Seat belts, texting, and Medicaid expansion were the topics of bills heard this past week by the committees on which I serve. LB 807, the Nebraska Roadway Safety Act, was heard before the Transportation and Telecommunications Committee on Tuesday, January 28. LB 887, the Wellness in Nebraska Act, was heard by the Health and Human Services Committee on Wednesday, January 29.

Currently, the laws pertaining to safety belts and texting are secondary enforcement laws. This means that motorists may only be ticketed if they have been stopped for another offense. LB 807 would place Nebraska among 33 other states that have primary seat belt enforcement laws and at least 36 states with a primary texting enforcement law. Enforcement of provisions applying to the Graduated Driver’s License law for young drivers would also change from secondary to primary. LB 807 would require back seat passengers to use seat belts and ban the use of cell phones and other wireless devices by school bus drivers.

The Governor gave his final State of the State address to the Legislature this past week. He began his speech on the topic of health care, referring to the many problems with the federal Affordable Care Act. The Governor said that the new federal health care law will cost the State of Nebraska more than $200 million in state general funds over the next six years. He is still strongly against the expansion of Medicaid, which was originally part of the federal plan, but due to a lawsuit became voluntary for states.

Senator Kathy Campbell, the chair of the Health and Human Services Committee, introduced LB 887, the Wellness in Nebraska Act. It is her second attempt to expand Medicaid in Nebraska, proposing to offer Medicaid coverage to adults age 19-64 with incomes up to 100% of the federal poverty level, while those with incomes above 50% of the federal poverty level would have to contribute 2% of their income. For these newly eligible with incomes between 100% and 138% of the federal poverty level, insurance would be purchased through the marketplace, with the enrollees paying 2% of their income and Medicaid paying the remainder. The plan would have to be approved by the federal government.

The One Hundred Third Legislature, Second Session, began on Wednesday, January 8 and got right down to work. This is considered the short session of the Legislature, lasting 60 days, and is tentatively scheduled to adjourn on April 17. During the 90-day legislative session in even-numbered years, the biennial budget is the Legislature’s primary responsibility. Only minor budget adjustments and deficit requests will be dealt with during this session.

Senators began introducing legislation on the first day of session and can introduce bills through the tenth day, which falls on January 22 this year. We will meet in full day session, discussing carry-over bills beginning on Monday, January 13. The public hearing process will start on January 21, lasting through the end of February. Every bill that is introduced is guaranteed a public hearing, allowing for the input of the residents of Nebraska.

The passage of the Affordable Care Act (ACA) by the federal government requires citizens to have health insurance or be subject to a penalty. As passed, the ACA required states to expand their Medicaid program to include adults between 19-65 years of age with incomes up to 138% of the federal poverty level (FPL). Currently, childless adults that are not disabled or elderly do not qualify for Medicaid. Parents of minor children with incomes above 56% of FPL also do not qualify. Last year, the U.S. Supreme Court upheld the federal law but ruled that the Medicaid expansion portion should be optional for the individual states.

For the third year in a row, the Legislature debated a bill that proposed to expand Medicaid. Initiated by President Obama, the Affordable Care Act was signed into law on the federal level in 2010. Medicaid expansion was mandatory in the original legislation, but due to a Supreme Court ruling it became voluntary for states. LB 472 would authorize eligibility for Medicaid coverage for adults ages 19-65 with incomes at or below 133% of federal poverty level. This year’s version of the legislation also proposed to create the Medicaid Redesign task force to review health care policy.

Supporters of the legislation referred to a recent report by two business professors at UNK, which found that our state would receive more than $2 billion in federal funds during the first five years of expansion. It was estimated that this would increase our state’s economic activity by more than $5 billion. The professors projected that the increased economic activity would generate more than enough tax revenue to pay for the state’s portion of the increased costs of expansion. However, Governor Ricketts warned against using subjective measures in determining the justification for entitlement expansions.