Nebraska wont expand Medicaid， When the Legislature adjourned June 5, it left on the table the issue of Medicaid expansion called for by the Affordable Care Act,サングラスオークリー, as a way to get more Americans covered with health insurance. The idea was that states would make more people eligible for Medicaid, the federal-state arrangement that pays for health care for the poor and nursing home stays for the middle class. Last year, though, the Supreme Court ruled that states were not required to expand Medicaid eligibility, and so far 24 have either decided not to do that or are still undecided. Nebraska joins states such as Texas, Florida and Kansas, which will not expand their programs this year. The refusal to expand Medicaid does have financial consequences for many families.
According to the Kaiser Family Foundation, about 49,000 Nebraskans will be uninsured because the state will not expand eligibility to include families with incomes up to 138 percent of the federal poverty level: incomes of about $15,900 for a single person and about $32,500 for a family of four. Single people whose incomes fall between $11,490 (100 percent of poverty) and $15,900 and families of four with incomes between $23,550 and $32,500 can shop in their state insurance exchanges and receive tax subsidies to help pay the premiums. The federal government will run Nebraskas exchange. Families with low incomes will get larger subsidies than those higher on the income ladder, but out-of-pocket costs could still pinch.
A family of four with an income of $30,657 would not have to pay more than 2 percent of its income for a plan designed to cover about 70 percent of its medical expenses. But for some even a $613 bill might be hard to swing. Besides that,オークリー激安, the exchanges may not be as good as what Medicaid could provide. Under expanded Medicaid, the family would pay very small copayments for some services. Out-of-pocket costs will be much higher with policies bought in the exchange. The real problem comes for those with incomes below the poverty level, which leaves what Kansas insurance commissioner Sandy Praeger has called some of the poorest of the poor in an insurance no-mans land. Those who fall into this group have no options for coverage.
They are too poor to buy coverage on their own, and the Affordable Care Act does not permit them to shop in the exchanges and receive a subsidy to help pay the premiums. Some may be eligible for Medicaid under the states current rules,oakley サングラス, but under expansion everyone in this group would have been eligible. Thousands uninsured now will still be uninsured. Where will they get care? Where they do now at community clinics that charge little or nothing for their services and at emergency rooms where hospitals may try to work out payment plans or eventually write off their bills as charity care or bad debt. With Medicaid expansion we believe people will get more appropriate care at the appropriate time and place, says Bruce Rieker, vice president for advocacy at the Nebraska Hospital Association. If we dont expand, well continue to see higher levels of bad debt and charity care.
The NHA tried to build legislative support this year for expansion, but in the end opposition from Gov. Dave Heineman and many legislators managed to effectively filibuster the bill, Rieker said. It never came up for a vote, and the governor was expected to veto it anyway. Even though the federal government would have paid 100 percent of the expansion costs for the first three years and 90 percent through 2020, some legislators worried that the state could not afford to add more people to the Medicaid rolls, that the feds would not honor its commitment, and expansion would result in a massive move toward a welfare state.
Rieker says the chances are very high proposed expansion will be back in 2014. This years lobbying efforts may be a taste of whats to come. Trudy Lieberman is a contributing editor to the Columbia Journalism Review who has taught public affairs reporting at the University of Nebraska-Lincoln. Liebermans Rural Health News Service columns are a pilot project of the Nebraska Press Association in cooperation with The Commonwealth Fund.