Ben Nelson: Medicaid provision wasn’t special deal for Nebraska

The writer, a Democrat, is Nebraska’s senior U.S. senator.

The current debate about Medicaid funding should be a discussion of unfunded federal mandates.

When I was governor of Nebraska in the 1990s, I often was frustrated by federal mandates passed onto our state and other states without enough — or even any — federal money to execute them. These unfunded mandates played havoc with the state budget and the ability of governors like me to follow our constitutional requirement to balance state finances.

Unlike the federal government, fortunately, Nebraska can’t borrow its way out of debt. So, when a new unfunded or underfunded mandate arrived, I didn’t have much choice but to find a way to pay for it with unappealing options.

They were: Cut a portion of the state budget, or pass the cost onto Nebraska taxpayers. We never did the latter, so we cut other spending.

I complained that we had our foot on the brake and the feds had their foot on the accelerator. I would wonder aloud, “Why didn’t anyone tell me I had been elected branch manager for the federal government?”

Many fellow governors in both political parties chafed at these Washington mandates, and their successors continue to do so.

As a senator, I’ve repeatedly fought unfunded federal mandates. Most recently, I’ve had a number of concerns with the Senate health care bill, in particular with Medicaid expansion and the sizable burden it would impose on the states.

The bill says that effective Jan. 1, 2014, Medicaid income eligibility levels would expand nationwide for parents and children. Studies estimate that the expansion could cover an additional 83,000 to 106,000 Nebraskans.

The federal government will pay 100 percent until 2017, after which the states would begin to pay a small but costly percentage. During negotiations I participated in with colleagues, I suggested ways to minimize the cost to states, such as allowing states to opt in or opt out. But the idea was not pursued.

Then, on Dec. 16, Nebraska Gov. Dave Heineman wrote to me expressing similar concerns. The governor noted in his letter that “the state of Nebraska cannot afford an unfunded mandate and uncontrolled spending of this magnitude.” State officials estimated that the mandatory Medicaid expansion would potentially cost the state of Nebraska $45 million by 2019.

I took the governor’s concerns to the Senate majority leader, and he added a provision extending federal payment for Nebraska’s new Medicaid enrollees beyond 2017, when the federal share is set to begin to decline.

When details of the leader’s newest changes became available last weekend, the provision drew attention. Then it drew criticism from partisans mainly interested in finding any way to derail health reform.

As a result, I wrote back to the governor on Dec. 20 saying that I would ask that the provision be removed from the legislation if that was his desire. I’m awaiting his request.

But I would like to make clear that this was not a special deal for Nebraska. It is in fact an opportunity to remove an unfunded federal mandate for all states. I drew a line in the sand and said it was unacceptable to me because I agreed with the governor’s concerns.

Since states don’t have to pay anything until 2017, there is more than ample time for all states to seek relief.

Unfunded mandates intrude on state priorities and force governors and state legislatures to redirect what they think is best for their state to pay for what Washington says is a priority.

This is why I brought my concerns to the Senate majority leader about the impact of unfunded mandates upon Nebraska, not to ask for a special deal but for a fair deal that should be open to all states.

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