Nebraskans who may have depended on state senators this year to expand Medicaid saw a swift end Wednesday to their hopes.
Supporters of expansion couldn’t even hang on for an eight-hour filibuster.
The Medicaid Redesign Act (LB472) essentially died after senators failed to adopt an amendment on a 22-24 vote. The amendment was necessary to change the makeup of the proposed Medicaid Redesign Task Force and ensure the bill was constitutional.
After that sure sign of defeat, the only discussion was whether the bill should be postponed until the last day of the session or killed outright. A little more than three hours after debate began, it ended with a 28-16 vote on a motion to bracket, or postpone until the last day of the session.
Lincoln Sen. Kathy Campbell, who introduced the bill, said after the vote she wouldn’t give up on it. There’s always next session.
And although some supporters are now wondering if the vote should go to the people, instead, Campbell said a ballot question would be difficult to craft.
“I would guess that there would be discussion of it among some supporters, and we’ll see what they think,” Campbell said.
As Campbell began debate on the bill early Wednesday afternoon, she said she recognized the proposal represented a bold move.
But the state needed to be bold in its vision of the future. Besides saving lives and taxpayer dollars, there would be savings for the state, Nebraska hospitals and businesses with expansion, Campbell said.
Two University of Nebraska at Kearney professors released a study last week that showed the state's economy would conservatively avoid more than $1 billion in silent taxes, medical-related bankruptcies and unnecessary state spending in the next five years with expanded Medicaid.
With expansion, the state would receive nearly $2.1 billion during that time, drawing $992,000 daily in federal expansion funding and generating $5 billion in increased economic activity, the study showed.
Campbell gave senators handouts that told them how many in their districts don't have health insurance. That number for Campbell's Lincoln district is 473. For Sen. Jeremy Nordquist's south Omaha district, however, the number is 4,322.
Lincoln Sen. Patty Pansing Brooks made a plea for Nebraskans to call and write their state senators and governor to tell them of the need for the bill.
"We're talking about billions of dollars" in savings and income for the state, she said.
Sen. Roy Baker, from Lincoln, Lancaster and Gage counties, said Nebraska has fought against the Affordable Care Act and "we've lost." Now many rural hospitals are struggling under the burden of providing care for those without insurance, he said.
The bill would have created a task force to redesign Medicaid in Nebraska and develop a way to promote access to affordable care in a patient-centered system.
It was Campbell's third attempt to get Medicaid expansion passed in the Legislature. In the first two tries, she could not get the required 33 votes to break a filibuster. This was the quickest and most profound defeat.
When she began her introduction Wednesday afternoon, Campbell quoted Michael Jordan, saying she could accept failure, but she would not accept not trying.
But opponents said they were skeptical of getting involved with the federal government to solve the dilemma of Nebraskans without health insurance.
Gov. Pete Ricketts this week reinforced his opposition to expanding Medicaid, saying it would be a “risky proposition” for taxpayers, not only because of the expense, but also because “we cannot trust the federal government’s long-term financial commitment to state programs.”
Reforms need to happen, said Sen. Ken Schilz of Ogallala, but to get to them the state has to expand Medicaid. That's a big risk, he said.
"I understand that this is an important issue for folks who don't have coverage," he said. "The problem is this is the wrong way to go about it."
Sen. Bill Kintner of Papillion said federal programs just don't pay for themselves or come in at budget, as proponents want Nebraskans to believe. Government programs just grow like wild weeds, he said.
Senators shouldn't be trying to find ways to get more people on Medicaid, he said. They should be finding ways to get people off Medicaid.
Amanda Gershon, a young woman who falls into that gap between Medicaid and private insurance with about 77,000 others, was watching the debate from the chamber balcony.
Defeat of the bill meant another year in which she will not have health coverage, and another without a diagnosis of her specific kind of immune disorder. If she can’t afford a diagnosis, she can’t get proper treatment, she said.
She grew up in Lincoln and has considered moving to a state that has expansion, but her family is here.
The repeated defeats of Medicaid expansion shows a lack of understanding on the part of some senators of how the system works, she said.
As the bill neared the end, Sen. Paul Schumacher of Columbus told senators they need to “sober up a little bit away from the political rhetoric.”
A bunch of Nebraskans need care, and the state and those with private insurance are going to pay for that care through one mechanism or another.
“Do we really believe that Obamacare is just going to go away and our health care problems are going to be solved?” he said.