Medicaid expansion

In this Oct. 16 photo, yard signs are stacked outside a public hearing in Lincoln for Initiative 427, which would expand Medicaid.

On Nov. 7, 2018, Nebraskans awoke to learn that Initiative 427 had passed the night before with 53% of the vote, with voter approval beginning the process to expand Medicaid in Nebraska.

On Nov. 7, 2019, Nebraskans, including state senators, were still trying to determine exactly what Medicaid expansion will mean for the roughly 90,000 people newly eligible for health care coverage, when it goes live next October.

This lingering uncertainty must be cleared up soon. Some 5% of Nebraskans are hanging in limbo as the finer details are still being debated, much less ironed out.

People who now qualify under the expansion have annual incomes at or below $16,000, or 138% of the federal poverty line, meaning a medical emergency could very well bring financial ruin. Hence the need for a swift resolution to the ongoing discussion about what Heritage Health Adult will contain once it’s active.

By the time this initiative takes effect, 23 months will have elapsed from the approval of Initiative 427. In comparison, Nebraska needed just 20 months from the time voters reinstated the death penalty in 2016 before convicted killer Carey Dean Moore was executed last August.

Yes, this is somewhat apples and oranges. But the former – an arduous process, to be sure, as is any involving the federal government this heavily – seems like it’s stuck in neutral, while the state charged ahead with the latter at reckless speed. It invited a lawsuit for moving too slowly, as Nebraska Appleseed as alleged, rather than too fast on the death penalty.

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Most of the heartburn from critics of the deliberate approach taken by the Nebraska Department of Health and Human Services stems from the responsibility and community engagement requirements it’s proposed for the top step of coverage, beyond the basic level.

This two-tier system is unlike any other in the states that have expanded Medicaid. And it's being rolled out more slowly than any other, too.

The intent behind this structure is to ensure Nebraskans take an active role in their own health care. That’s understandable, but such a construct further complicates an already challenging transition and would presumably create additional bureaucracy. Plus, work requirements – a more onerous means to a similar end – in states such as Arkansas and Kentucky were struck down in court.

The state’s working poor need health coverage as they work their way to employment that provides benefits, as we wrote earlier this year, rather than staying underemployed to preserve their eligibility for Medicaid before it was expanded.

Therefore, this new system should serve as a temporary boost for the Nebraskans who qualify, rather than as their health coverage forever. But they can certainly be forgiven for anxiously awaiting resolution of a process that seems to be taking forever.

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