Medicaid expansion passes in Nebraska; lawmakers must decide how to pay for it

November 10, 2018 GMT

LINCOLN — With Nebraska now the 34th state to increase access to Medicaid, the question becomes how will the expansion of the federal-state health insurance program for low-income people be implemented.

Speaker of the Legislature Jim Scheer of Norfolk said he expects that the Legislature will fulfill its obligation to fund the expansion, now that it has gotten voter approval. Although he has been among the opponents of Medicaid expansion, he said he doesn’t anticipate an effort to block implementation.

“From my perspective, it was up to the voters of Nebraska to decide what they wanted to do,” he said.


With just over 53 percent of the votes cast, Initiative 427 passed. It amends state law with the goal of bringing Medicaid coverage to an estimated 90,000 Nebraskans — ages 19 to 64 and under the federal poverty line — and creating jobs in the health care industry.

It’s a win for the nonprofit Medicaid expansion organization Insure the Good Life, which pulled together more than 135,000 signatures this summer to put the initiative on the ballot. Insure the Good Life coupled with the nonprofit advocacy organization Nebraska Appleseed and others to campaign for affordable health care for Nebraskans who otherwise don’t have or can’t qualify for medical insurance.

“Nebraskans voted for a healthier future for our friends, neighbors and family members who have gone too long without the life-saving health care everyone needs,” said Rebecca Gould, Nebraska Appleseed executive director. “Lives will be saved and families have more hope without facing the terrible choice between physical suffering and financial collapse.”

Gov. Pete Ricketts, who handily won re-election Tuesday, opposed the Medicaid expansion. With voter approval of the expansion, Ricketts and state lawmakers now will now have to decide how the state pays for it. In late October, Ricketts said, “Medicaid expansion for able-bodied adults would make property tax relief nearly impossible and cut funding for education.”

Under the expansion, 90-percent of Medicaid cost will covered by the federal government and the state will have to make up the rest. Estimates show Nebraska’s contribution will be $18 million to $20 million in the state’s budget in the first year of Medicaid expansion in the state.

State Sen. Lydia Brasch of Bancroft, who will be leaving the Legislature due to term limits, said, “Nebraskans could be forced to choose between increasing taxes or cutting funds to existing programs, such as K-12 education, roads, or current Medicaid benefits.”


Her successor, Ben Hansen of Blair, who won the election in District 16, also opposes Medicaid expansion.

Gould said after Tuesday’s win for expanded Medicaid: “We encourage the Department of Health and Human Services to quickly develop a strategy to integrate these newly insured Nebraskans into our health care system, and the Legislature to implement the program without taking away resources from other essential responsibilities like education, child welfare or public services that help hard-working Nebraskans meet their other basic needs.”

Implementing the expansion assures more Nebraskans will be insured in health care. According to a study by the Urban Institute, the 12.4 percent of Nebraskans without health insurance will drop to 9.6 percent under new Medicaid laws.

Health care jobs are also expected to rise. Insure the Good Life estimates 11,000 new jobs in the health care industry will occur in the coming years.

Nebraska hospitals, which lost $175 million over the past two years from patients unable or unwilling to pay their bills, are also projected to recover over the next few years.

Now lawmakers will have to decide how the state will pay for its portion of expanded Medicaid.