LINCOLN — Nebraska's rural hospitals could be forced to close down or cut services if the state does not expand Medicaid, an expansion proponent said Wednesday.
State Sen. Steve Lathrop of Omaha took time during debate about another bill to warn about what could be at stake if the controversial expansion measure remains stalled.
“There is a downside to not doing this,” he said. “It will be significant for rural Nebraska.”
As envisioned in the federal health care overhaul, expanding Medicaid to cover more low-income people was to be part of a tradeoff with hospitals.
Providing coverage through Medicaid to people who were previously uninsured would provide hospitals with additional revenue. That revenue would then help offset reductions in federal Medicare and Medicaid payments, most of which were enacted as part of the Affordable Care Act.
But that revenue now depends on legislative action because a U.S. Supreme Court ruling last year made the expansion optional for states.
The Medicare and Medicaid changes are expected to cost Nebraska hospitals a total of $159 million per year, according to Nebraska Hospital Association Vice President Bruce Rieker.
Changes pending at the federal level would mean losses of another $61 million a year.
Lathrop said some rural hospitals will be unable to manage the cuts without the offsetting revenue from more Medicaid recipients and would have to close.
“It's like taking the courthouse, taking the co-op, taking the school,” he said. “Take the hospital and what's left? A bar and a gas station.”
Some experts have estimated that one in six hospitals could be in jeopardy.
In Nebraska, that would mean 15 hospitals.
Other hospitals could survive, but only at the cost of shutting down some services.
Losing a hospital would be a substantial blow to a rural area, said Sen. John Harms of Scottsbluff.
Like post offices and public schools, hospitals are key institutions in rural Nebraska.
Lathrop used an uncommon legislative move to raise the Medicaid expansion issue.
The expansion measure, Legislative Bill 577, has been pulled from the legislative agenda after supporters could not find enough votes to break a filibuster.
So Lathrop filed a motion to bracket, or table, an unrelated bill, then used his speaking time to address the Medicaid issue.
He said he did so because he felt strongly that lawmakers had not debated the potential risks of failing to expand Medicaid, especially the risks to rural parts of the state.
Other senators who spoke Wednesday criticized expansion opponents for their uncommon moves.
The opponents had sought to keep LB 577 from returning for debate by collecting signatures of lawmakers who agreed not to vote for a cloture motion to end the filibuster.
Speaker of the Legislature Greg Adams of York has said he will not put the bill back on the agenda unless supporters can show they have the 33 votes needed for cloture.
By the end of Wednesday's debate, proponents were one vote closer to that goal.
Sen. Jerry Johnson of Wahoo said he will now support cloture and will ask for his name to be taken off the pledge document. He said the bill needs to come before lawmakers for a vote.
His change of heart does not give supporters enough for cloture yet, said Sen. Kathy Campbell of Lincoln, the Health and Human Services Committee chairwoman.
But she remains hopeful about reaching that goal.
“I'm a woman of patience and perseverance,” she said. “I just keep talking to people.”
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