Letter to the Editor:

Medicaid Expansion Vote Faces Roadblocks

By KATHY WARD

Last November, more than 356,000 Nebraskans voted for Medicaid Expansion. The vote in Box Butte County was nearly evenly split (1,738 Against, 1,714 For).  People voted for the ballot initiative to provide health insurance coverage for more than 90,000 uninsured citizens, to protect rural hospitals, to increase early detection of cancer and other chronic diseases, and to improve availability of behavioral and mental health services.

Six months have passed, and while many other states have successfully implemented Medicaid Expansion programs within that time period, the projected start date for coverage in Nebraska is not until October of 2020.  A blog written by national health policy expert Adam Searing from Georgetown University notes that in addition to the nearly two-year delay, the Ricketts’ Administration has added a complexity that is estimated to triple administrative costs.  It would change Medicaid from one comprehensive benefit package to at least three different types of coverage, each level with fewer benefits.

This complexity affects not only Medicaid Expansion, but also reduces benefits for some current Medicaid recipients, mostly parents with children in the home.  Patients can be moved to lower levels if they miss appointments, don’t complete wellness visits as prescribed by the managing insurance company, or don’t file reporting paperwork correctly.  A new mom covered under standard Medicaid during pregnancy will lose some of her benefits after delivery and can lose even more if she doesn’t keep up with all the state’s requirements while juggling the demands of an infant.

Another change with major implications for rural areas of the state is the Administration’s proposed elimination of retroactive eligibility. Currently, if a patient who qualifies for Medicaid is treated by a hospital or physician’s office, he or she has retroactive eligibility three months prior to qualification. This allows the hospital or other provider to give immediate treatment, knowing that they will likely be paid. Searing cites the case of a Florida hospital that lost at least $4 million this year from a similar change.  This is particularly dangerous for rural hospitals when a recent study estimates that nearly a quarter of rural hospitals around the country are at risk of closure due to finances.

We frequently hear the words “the will of the people”, especially when that will is consistent with the will of politicians. For Medicaid Expansion, it does not seem that the will of the people, as demonstrated by the statewide ballot initiative vote, is really being respected at all. 

Kathy Ward grew up on a ranch near Alliance and worked in public health at the State level for 35 years, administering cancer and chronic disease prevention programs such as Every Woman Matters. She became an advocate for Medicaid Expansion from years of trying to help working Nebraskans access health coverage.

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