Live Well Nebraska
“White House advocates Medicaid expansion in Nebraska; Ricketts calls move too costly”
June 7, 2015
By Rick Ruggles / World-Herald staff writerThe White House has stepped up efforts to promote expansion of Medicaid in Nebraska and 21 other states that have declined to participate in that element of Obamacare.That effort, as is typical of the Affordable Care Act in general, was praised by some and criticized by others.The White House Council of Economic Advisers estimated that 42,000 more Nebraskans would have health insurance coverage if Medicaid were expanded here. Information distributed by the White House said Medicaid expansion in Nebraska also would enable about 6,000 people to avoid trouble paying other bills because of the burden of medical costs, and reduce the amount of uncompensated medical care in the state by $40 million in 2016.Gov. Pete Ricketts, however, said in a written statement that Medicaid expansion would prove far too costly for the state over the long term. Ricketts said he would work with the state health department and the Nebraska Legislature to find “financially responsible Nebraska-based solutions to health care.”The Nebraska Hospital Association had a different view. The organization of hospitals “is very supportive of Medicaid expansion in Nebraska,” spokesman Adrian Sanchez said. Among the reasons, he said, is that the insured are more likely to use primary care providers for ongoing care than to fall back on emergency-room care when a condition reaches crisis level.“It’s better for someone to manage their diabetes than to have to amputate a leg,” Sanchez said.But Jim Vokal, head of the Platte Institute for Economic Research in Omaha, said the problems of Medicaid expansion outweigh the benefits.Even though the Medicaid expansion program is currently funded entirely by the federal government and would continue to be largely paid by it, it makes no sense for a government that is about $18 trillion in debt to take on that burden, Vokal said. The institute favors free enterprise and limited government.Drawing in part from a report by the James Madison Institute, a Florida research group that also espouses limited government, Vokal said enrollment in Medicaid expansion in Illinois has far outstripped expectations. Consequently, he said, when the state’s obligation kicks in two years from now, Illinois’ costs will go from an originally estimated $573 million to $2 billion in state expenditures from 2017 through 2020.Underestimates of cost aren’t unique to Illinois, Vokal said.Nebraska needs to improve its existing Medicaid program to provide better care at lower cost, Vokal said. “So before we open the door to able-bodied adults, let’s take care of those who are truly in need in Nebraska,” he said.So far, Nebraska leaders, including former Gov. Dave Heineman and now Ricketts, and its Legislature have not backed Medicaid expansion.Amanda Gershon of Lincoln said she would fit the description of one who truly needs Medicaid, but she can’t get it in Nebraska. She is, she said, in the Medicaid gap — she has no children, can’t get government-supported insurance and can’t afford commercial insurance.Gershon, 32, has multiple medical conditions, including fibromyalgia, an auto-immune disorder, bladder and pelvic problems and other conditions.Gershon, who has had to quit her work in restaurants and now receives about $935 a month in disability income, said she can’t afford all of the testing and treatment that she needs to get healthy enough to return to work even part time.“Right now I really am not treating the majority of my conditions. And I just keep getting worse,” she said. “I haven’t had insurance in the last five years.”Allan Jenkins, one of two University of Nebraska at Kearney professors who did a study in the spring of Medicaid expansion, said no one can be precise about the impact the program would have in Nebraska.But the evidence from states that have expanded Medicaid shows that their hospitals and doctors generally absorb less uncompensated care than before.“That’s what the facts are saying,” said Jenkins, an economics professor. Further, the “evidence is clear that Medicaid expansion reduces personal bankruptcies. Personal bankruptcies are a real drag on local economies.”He said opponents are good at “cherry-picking” negative consequences in other states, but the results are generally positive. Jenkins and Ron Konecny, a UNK management professor, did their 50-page report for the Nebraska Hospital Association and AARP Nebraska.James Goddard, director of the health care access program for Nebraska Appleseed, said it’s illogical for Nebraska to refuse the about $2 billion in federal money that would support Medicaid expansion from 2015 to 2020. Nebraska taxpayers are among those sending that money to Washington, D.C., anyway, Goddard said.Amanda Gershon spoke Saturday in Lincoln at a rally sponsored by Nebraska Appleseed. She talked about how she has had to rely on family and friends and about being unable to get the medical care that might help her get back on the job.“Give me a chance to feel better, to do better,” she said. “Give me a chance to get out of the Medicaid gap.”Article: http://www.livewellnebraska.com/health/white-house-advocates-medicaid-expansion-in-nebraska-ricketts-calls-move/article_7cd166c3-158b-5fec-8ff5-f0ded63e48f6.html
