Nebraskans approve expanding Medicaid to cover more of the state’s low-income residents

November 9, 2018

Nebraska’s voters Tuesday did something its governor and state lawmakers declined to do for more than six years: expand Medicaid to cover more low-income Nebraskans.

Initiative 427 rode strong support from Omaha and Lincoln voters to victory on election night, adding Nebraska to the majority of states that have adopted the program that was part of President Barack Obama’s 2010 health care law.

“Nebraskans wanted action,” said State Sen. Adam Morfeld of Lincoln, who helped organize the Insure the Good Life drive and served as a consultant to it. “They provided action.”

Passage of Initiative 427 means an estimated 90,000 Nebraskans — most of them among the ranks of the working poor — will now be insured through the state’s public health insurance program.

Just when that will happen is unclear. The initiative requires the state by April 1 to file all the paperwork with the federal government to expand the program that is jointly funded by the federal government and states.

Gov. Pete Ricketts, who has opposed expansion for the past four years, has not yet indicated what posture his administration would take toward implementation of the initiative should it pass. Among other things, the state would need to budget for expansion. The state’s costs are estimated between $39 million and $57 million by 2022. The initiative does not say how that would be paid.

Supporters of Initiative 427 called Tuesday’s vote long overdue. They spent more than $3 million to secure the petition signatures and promote the measure.

Nearly half the money came from the Fairness Project, a labor-funded group that seeks to take issues of economic fairness directly to voters. Insure the Good Life also received major support from Nebraska Appleseed, the Nebraska State Education Association teachers union, the Center for Rural Affairs and Omaha billionaires Warren Buffett and Walter Scott Jr.

They ran a strong, well-funded campaign arguing Nebraska has passed up hundreds of millions of dollars in federal health care dollars that could have improved Nebraskans’ health and boosted the state’s economy.

Passage of the initiative came despite opposition from a group calling itself the Alliance for Taxpayers, which entered the race late and spent hundreds of thousands of dollars on television and radio advertisements criticizing expansion. One of the ads said the measure would raise taxes by hundreds of millions of dollars and give free health care to able-bodied adults, showing an image of a young man slouched on a couch eating potato chips.

Morfeld said the ads distorted the facts, exaggerating the cost of expansion, and glossed over the fact that the vast majority of those covered are hard-working Nebraskans caught in a coverage gap, ineligible for Obamacare subsidies but unable to afford health insurance on their own.

“I think a lot of Nebraskans saw through that,” Morfeld said.

With Tuesday’s vote, Nebraska joined at least 33 other states and the District of Columbia in expanding Medicaid. Two other traditionally red states -- Idaho and Utah -- also had it on the ballot Tuesday night, and it was prevailing in early returns. Montana had a ballot issue seeking to continue its expansion plan.

The carried by Douglas and Lancaster counties with 62 percent of the vote, providing all of the proposal’s winning margin. It narrowly prevailed in Sarpy County. Results were mixed in rural counties, as it was rejected by a two-to-one margin in some but won in others.

Morfeld said he wasn’t surprised by the rural opposition. He said some rural counties understood that the issue was critical for survival of many rural hospitals.

Morfeld said the next step is now to work with the governor, Legislature and state social services department “to carry out implementation in an efficient way.”