Gov. Dave Heineman on Wednesday challenged a state lawmaker pushing for Medicaid expansion through the Affordable Care Act to call for a vote on the issue as soon as the legislative session begins in January.

"Let's find out who's got the votes," Heineman said in remarks aimed at Sen. Jeremy Nordquist of Omaha, who was among senators who supported a bill (LB577) last session that would have expanded Medicaid for about 54,000 newly eligible adults, including those 19 to 64 who have no children and earn zero to 138 percent of the federal poverty level.

The bill was filibustered on first reading and never got a vote because supporters did not have enough support to end debate.

Heineman has said he opposes expanding Medicaid, even though the federal government says it will pay the full cost for doing so for several years. The governor said he was dubious about the federal government continuing the funding, and losing it would result in cuts in other areas, such as education.

Nordquist recently vowed there would be a vote on the issue this session

"I think Sen. Nordquist, on the very first day of the session, should call for a cloture vote on Medicaid expansion," Heineman said Wednesday. "Let's see where the votes are.

"Why are they waiting? They could have asked for it the last session, so let's get it over with. The very first day of the session … let's get to work. Let's go for a cloture vote. It's time for Sen. Nordquist to demonstrate some leadership and call for that vote. What's he waiting for?"

Nordquist said there will, indeed, be such a vote.

"We didn't have one last session because there were a number of senators who … were uncommitted," he said. "They had a lot of questions about it. They wanted us to go back and look at what options were available to us."

He said that he, his staff and Sen. Kathy Campbell of Lincoln and her staff have been working on the issue in the interim.

"We will be coming with a new proposal that likely will have to have a new public hearing to make sure we do not run afoul of our rules," Nordquist said. "We're going to have an early hearing on it, and we will take it to a cloture vote."

Medicaid offers coverage to low-income children, parents, pregnant women and seniors, as well as other disabled adults. Beginning in 2014, with the Affordable Care Act, states may expand Medicaid to low-income childless adults.

The federal government has said it will pay 100 percent of the costs of the new recipients for three years, then 90 percent in 2020 and years after that.

Supporters of expansion said Nebraskans already were paying the costs of having about 180,000 uninsured Nebraskans who would be eligible either to purchase insurance in the marketplace or qualify for Medicaid. Those costs include:

* Expensive emergency room care for unaddressed medical needs.

* Uncompensated care by hospitals and health care providers.

* Increases to everyone's medical bills and health insurance premiums.

* Lost productivity from employee illness.

* County general assistance funds for medical expenses, paid with property taxes.

Both Campbell and Nordquist are watching the actions of other states, including Arkansas, which recently was approved for an alternative plan using Medicaid dollars to buy private health insurance for its new Medicaid enrollees. Iowa is seeking approval for an alternative plan modeled after benefits offered to Iowa state employees.

"This is one of the biggest policy decisions we're going to make … probably in a generation," Nordquist said. "We're talking about billions of dollars over the next decade that we would be turning away.

"If we turn those dollars away, we're going to see rural hospitals close, (and) emergency rooms will continue to be filled with the uninsured, low-income working Nebraskans. We do need a vote on it."

Reach Kevin O'Hanlon at 402-473-2682 or kohanlon@journalstar.com.