LINCOLN, Neb. (AP) — Now that voters have approved a proposal to expand Medicaid in Nebraska, groups that supported the measure are gearing up to put the new law into effect — and keeping watch for attempts to sabotage it.
Nebraska lawmakers still need to approve funding for the expansion, and Gov. Pete Ricketts’ administration has to submit a request to the federal government to amend the state’s current Medicaid plan so that an additional 90,000 low-income citizens can qualify.
Opponents in the Legislature acknowledged it’s highly unlikely they’ll get the 33 votes needed to amend the voter-approved law, but they promised a contentious debate over how to pay for it.
“As the opposition has warned all along, the only way to pay for it will be to cut other programs,” said Sen. Tom Brewer, of Gordon. “These programs will each be trying to protect their piece of the budget pie. When the music stops, some of them won’t have a chair. It’s unavoidable.”
Nebraska faces a projected $95.1 million general fund revenue shortfall in its upcoming two-year budget, which includes the estimated $48 million net cost of expanding Medicaid, according to new estimates released Thursday. The shortfall would shrink to about $15 million, however, if lawmakers tap other funds, as they routinely do to balance the budget.
Brewer — whose rural, western district voted overwhelmingly against the ballot measure — said he may introduce legislation “to address the problems Medicaid expansion is going to cause our state.” He declined to give specifics.
Expansion supporters said they’re wary given the experience in Maine, where a 2017 statewide vote for Medicaid expansion was met by numerous delays and allegations that Republican Gov. Paul LePage was stalling to keep it from going into effect.
In Nebraska, lawmakers faced a comparable situation after they approved a 2012 measure to provide state-funded prenatal care benefits to pregnant women who were in the country illegally. Then-Gov. Dave Heineman opposed the measure so fervently that he refused to fund the measure in his budget proposal, forcing lawmakers to find the money themselves.
Sen. Adam Morfeld, a leading proponent of the ballot measure, said he’s confident Ricketts and other opponents will follow the law approved by voters, and he promised a lawsuit if they don’t. Morfeld, of Lincoln, said he will filibuster any attempt to amend the ballot measure in the Legislature.
“The will of the people was clear,” he said. “People wanted substantive action on the affordability of health care, but they didn’t see elected officials taking action.”
Efforts to expand Medicaid in the Legislature failed for six years before advocates took the proposal to voters.
In a written statement, Ricketts spokesman Eric Maher said the governor “will follow the law enacted by the people of Nebraska,” but did not say whether the governor will include funding for the expansion in the budget he will propose to lawmakers in January.
The ballot measure requires the Nebraska Department of Health and Human Services to submit a state plan amendment to its federal counterpart, the U.S. Department of Health and Human Services. The measure will offer coverage to adults, ages 19 to 64, who earn up to 138 percent of the federal poverty level — about $16,753 per year.
Citizens who qualify could start receiving benefits by late 2019 or early 2020. State officials must submit the amendment to receive contributions from the federal government, which is required to pay 93 percent of the overall costs in 2019 and then 90 percent beginning in 2020.
Voters in Idaho and Utah also expanded Medicaid in this month’s election, but the Utah ballot measure included a sales tax increase to pay the state’s share of the expansion costs. In Idaho, the Republican-controlled Legislature will have to decide how to cover its costs.
Backers of the Nebraska measure chose not to ask voters for a funding source because Nebraska’s constitution prohibits ballot measures that pose more than one related question to voters at the same time.
Members of Nebraska Appleseed, a leading proponent of the measure, promised to closely track Nebraska’s progress in expanding Medicaid and fight any attempts to stall, obstruct or delay it.
“That’s something we’re aware of and certainly will keep an eye out for,” said Molly McCleery, a deputy director for the group. “Members of the Legislature and the governor have said they will implement it, and this is the will of the people. Really, at this point, it’s a question of how they will fund it.”