The two-year wait to expand Medicaid access will cost Nebraskans who need it and could lead to increased costs to the state, those gathered at a rally and hearing said. 

State voters passed an initiative petition on Medicaid expansion in November 2018, but the Nebraska Department of Health and Human Services has delayed its implementation until Oct. 1, 2020.

More than 50 people who want to see Medicaid expand in Nebraska now, rather than a year from now, gathered in the Capitol rotunda Friday before a hearing on requirements the state plans for expanding Medicaid for up to 90,000 uninsured Nebraskans. 

In front of people carrying signs that read, “Nebraska Spoke, Honor the Vote,” two doctors and state Sen. Adam Morfeld talked about the problems of waiting a year for coverage, especially for middle-age Nebraskans and those with chronic health conditions. 

Dr. Jane Potter, an internal medicine physician for 37 years and a professor at the University of Nebraska Medical Center, said good health care in middle life is important. 

“Chronic diseases are really the No. 1 killer and disabler in America, and certainly in Nebraska, where we have a high rate of many chronic diseases,” Potter said. “In order to be effective in our delivery of medical care, it needs to be timely, patient-centered and evidenced-based, good practice.”

Waiting another year for coverage could cause irreversible harm, and that harm increases health care costs, she said.  

At the hearing of the Legislature’s Health and Human Services and Appropriations committees on the Medicaid expansion interim study (LR170) that followed, Kevin De Liban, attorney with Legal Aid of Arkansas, said planned work requirements do nothing but endanger the stability and progress of low-income folks and give them another way to trip up and fall back. 

If people are concerned about promoting economic advancement and opportunities, viable options are to invest in meaningful job training, child care assistance and state earned income tax credits, he said. 

With the support of Gov. Pete Ricketts, Nebraska HHS plans to use what is known as an 1115 waiver for the medical expansion program under the federal Social Security Act, with work requirements and benefit limits.

Supporters of Medicaid expansion call them nothing more than barriers, and the requirements will make significant changes to Nebraska’s current medical assistance program. 

Molly McCleery of Nebraska Appleseed said the work requirements in the proposal are contrary to the purpose of Medicaid and legally suspect. 

The majority of Nebraskans in the health coverage gap are already working, she said, many in low-wage jobs that don’t provide insurance. Evidence suggests work requirements don’t promote employment and don’t address barriers to employment such as transportation, child care and other challenges, McCleery said. 

Appleseed has filed a lawsuit to challenge the timeline for expansion implementation. The Nebraska Supreme Court declined to take the complaint, and it has been refiled in District Court. 

Tiffany Friesen Milone, policy director for OpenSky Policy Institute, said the state could spend three times more money implementing Medicaid expansion with the federal waiver than simply allowing those newly eligible under the expansion to enroll in the state’s traditional Medicaid program. 

More than half the increased cost because of the waiver will go to additional staff, Friesen Milone said. The state has already begun hiring 108 new staff at a projected cost of $3.9 million. 

“This would effectively shift dollars away from health care for families to added bureaucracy and contracts with private vendors,” she said. 

Lincoln Sen. Anna Wishart asked if the Legislature could introduce a bill to speed implementation or to get rid of the barriers of a waiver. 

Morfeld, the interim study’s sponsor, said the reason supporters offered an initiative petition in the first place was because opponents in the Legislature were able to block expansion through filibusters. 

Even with support of the Legislature, it appears the administration wouldn’t have implemented the law without a waiver, he said. 

What HHS has done diminishes the people’s power to use the initiative petition process and reduces confidence Nebraskans have that government is going to carry out the will of the people, he said.

But more importantly, it impacts people without access to health care who are suffering unnecessarily, unable to work, and dying prematurely, he said.

“These aren’t just numbers. They’re not just statistics. It’s not just federal dollars. It’s people’s lives,” Morfeld said.

Rather than testifying at the hearing, HHS Director of Medicaid and Long Term Care Matthew Van Patton sent a letter. That ensured Van Patton did not have to answer questions at the hearing from committee members. 

He said in the letter he had a prior commitment in Omaha with health care providers, academic institutions and the Nebraska Health Information Initiative.

Van Patton said work to implement Medicaid expansion is on schedule. It is a significant project to build the system, staff it, and hold discussions with the federal government.

“Launching an expanded Medicaid program that is right for Nebraska takes time to do well,” he said. 

The waiver would provide a system with greater value to beneficiaries and providers, and would allow the state to prioritize accurate Medicaid eligibility, he wrote. 

The department has public hearings scheduled on the topic for Oct. 29 in Scottsbluff, Oct. 30 in Kearney, Nov. 7 in Norfolk and Nov. 12 in Omaha. 

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