Will Medicaid expansion become a reality?

It’s not about politics or the haves versus the have-nots. It’s about doing the right thing.
Medicaid expansion to cover some 90,000 Nebraskans who have fallen through the cracks has been kicked around the block for the last six years. Supporters tried, but could never get anything past the governor and his conservative cronies in the Unicameral.
Former State Senator Kathy Campbell and current Sen. Adam Morfeld collaborated to get the matter before voters. It was a bi-partisan effort between the longtime Republican and her former colleague, a Democrat.
The group, Insure the Good Life, has turned in petitions bearing more than 133,000 signatures. The secretary of state requires that 85,000 must be validated for the question to be on the November ballot.
Just what is the question?
Official language says approval of the measure would add Section 2 to Section 68-901 of the Revised Statutes of Nebraska to provide that the state shall amend its Medicaid state plan to expand eligibility to cover certain adults ages 19 through 64 whose incomes are 138 percent of the federal poverty level or below as defined and authorized by federal law, and to maximize federal financial participation to fund their care.
“Now people will speak out and get the job done that should have been done long ago,” Morfeld said.
He had introduced two of the failed proposals to expand Medicaid in the Legislature. As proposed, the measure would bring an estimated $1 billion in federal funding flowing into the state while requiring a state match that officials in the administration of Governor Pete Ricketts have said would accumulate to some $800 million over a 10-year period.
Proponents say expansion of Medicaid coverage would spur economic development and help secure the future of rural hospitals in Nebraska, as well as address basic health care needs for Nebraskans before ailments spiral into serious health challenges that would be more expensive.
“People without health care insurance wait far too long” to receive treatment, Campbell said, and the result is that “illnesses progress” into more serious and expensive challenges.
Andy Hale, vice president of advocacy for the Nebraska Hospital Association, joined in support of the initiative proposal, suggesting the issue is important to “neighbors, friends and families (and has been) politicized way too much.”
News of the petition submission drew immediate opposition from Americans For Prosperity.
“Enrollment has far outpaced estimates in states where Medicaid was expanded,” said the group’s Nebraska Director Jessica Shelburn. “As a result, states are left scrambling for ways to cover budget shortfalls while still paying for other essential community services like education and public safety.”
Help me out here folks, isn’t public health part of public safety? If not, just what is that red herring that seems to be dragged into nearly every discussion about measures which the Koch Network-backed organization opposes. Oh, and can I have a list of those states that are scrambling?
Matthew Buettgens of the government and foundation-supported policy research group—the Urban Institute—says states that have done detailed estimates of the effect of Medicaid expansion on budgets have generally found it to be a net gain for the state.
He cautioned that there has to be a practical, funded plan to implement it. That will require the Legislature and the governor to cooperate.
The states where Medicaid expansion has been most successful have state government support. Given past struggles with the measure in the Legislature, it could take a miracle to meet that requirement. Ricketts, who is campaigning for re-election, says he will not participate in a campaign against the measure.
Given their history, the Koch Brothers and Ricketts’ dad, Joe, could be expected to contribute to a campaign against the ballot issue.  
Under the proposal, the federal government would be required to pay 90 percent of the cost of the additional Medicaid coverage. Ricketts has questioned the ability and the commitment of the feds to guarantee that funding and has often said he opposes Medicaid expansion on fiscal grounds. He said needs of the Medicaid expansion recipients could be addressed by the private sector creating jobs that have those types of benefits.
Sure, assuming those recipients are able to work.
Supporters say expansion could bring health insurance to around 90,000 low-income Nebraskans—single people making up to 138 percent of the federal poverty line, or $16,753 a year, or $34,638 for a four-person household.
So far, 34 states have approved expanded Medicaid under the Affordable Care Act. Utah voters will address the question in November. It’s likely that Idaho and Montana may also have the question on the ballot.
To be enacted in Nebraska, an initiative needs to receive approval from at least 35 percent of the total vote as well as a majority.  
Campbell sums up the situation quite well. “It’s unconscionable to not support one another.”

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