Dr. Rowen Zetterman had a question Thursday for the Legislature: Why would the state even consider not expanding Medicaid, such an important opportunity for the health of Nebraskans?
Testifying on behalf of the Nebraska Medical Association at a hearing of the Health and Human Services Committee, Zetterman said people without health coverage die at a rate 25 percent higher than those with insurance. They are more likely to delay needed medical care and skip preventive care, he said.
Expanding Medicaid would provide routine and preventive care to more Nebraskans, reduce costly hospitalizations and deaths and have a positive economic effect, Zetterman said.
He said the state never will be able to control health costs until every patient has some sort of health care coverage.
"My personal belief is, let's get everybody into the system and then let's begin to look at the issues of costs and how we're going to take care of those issues," Zetterman said.
The bill (LB577), introduced by Lincoln Sen. Kathy Campbell, would require Nebraska Medicaid to add the newly eligible adults -- people 19 to 64 with incomes of as much as $15,856 for an individual and $26,951 for a family of three -- to Medicaid rolls under the federal Affordable Care Act. It also outlines the health coverage that would be offered under the plan.
It's a choice for the state, and Gov. Dave Heineman has expressed his opposition to Medicaid expansion for months, saying it would cost too much money and take dollars away from other state priorities.
Campbell said the state already is paying for expenses related to not covering health care for low-income adults. Those include emergency room care for uninsured Nebraskans' unaddressed medical needs and uncompensated care of hospitals and providers.
The greatest, most graphic, costs, she said, are human -- the avoidable deaths of those who wait too long to get care. An estimated 500 of them die annually, and a disproportionate number are people of color and residents of low-income counties.
Campbell said the bill also is needed to gain coverage for childless adults who don't qualify for subsidies to purchase insurance through health insurance exchanges.
"LB577 is a smart investment," she said.
It is estimated that 12 percent of Nebraskans are uninsured, Campbell said.
Jim Stimpson, director of the Center for Health Policy at the University of Nebraska Medical Center, said a UNMC study shows nearly 55,000 Nebraskans would be eligible for Medicaid next year if the program is expanded. In addition, nearly 21,000 likely would take advantage of care in the first year for which they already are eligible.
Vivianne Chaumont, Medicaid director with the state Department of Health and Human Services, said the cost is the significant barrier to bringing more people onto the Medicaid rolls.
The effect of the Affordable Care Act on the budget will be significant even before expansion, she said.
"We're already into it $770 million before we even start talking about adding more people to the rolls," Chaumont said.
There also is a substantial cost for administration, she said.
With the expansion, through 2020, there could be a $2.7 billion impact to the Medicaid budget, Chaumont said.
The other important concern is access. There just aren't enough doctors and other providers, she said.
Chaumont said it never is fun to turn down people for Medicaid. But the state has an obligation to balance its budget and take care of its citizens. It has to draw the line somewhere.
There's a lot of talk about hidden costs or a silent tax for Nebraskans in higher insurance premiums or hospital charges, she said. No hospital or insurance company has said it will lower its rates Jan. 1, 2014, if Medicaid is expanded, she said.
Linda Rohman, who said she has a doctorate in social psychology and has looked at a number of Medicaid studies, said people who support Medicaid expansion are making a lot of assumptions that are not merited.
For one thing, they assume people with Medicaid coverage would stop using emergency rooms for care. They won't, she said, because there is no personal incentive to do so.
And, she said, the shortage of doctors is not improving.
"I think your hopes that these people are going to find a medical home with a particular doctor and they're going to begin to use them, it's unrealistic," Rohman said.