LINCOLN — Nebraska lawmakers are gearing up for round two of the legislative battle over expanding health coverage to more low-income Nebraskans.
A plan that would combine Medicaid, private insurance, wellness incentives and cost sharing was advanced out of committee on a 5-1 vote Monday.
The new Wellness in Nebraska Act, or WIN, won over a key senator who opposed last year's proposal to provide coverage by expanding the traditional Medicaid program.
State Sen. Mike Gloor of Grand Island said he switched his vote because the new plan would make dramatic improvements in the health care system in Nebraska.
“What this bill does now is change to a new delivery model,” he said. “Unless it gets amended dramatically, I'll continue to be supportive of it.”
But Legislative Bill 887 hasn't won over all opponents.
Gov. Dave Heineman remains adamantly opposed, and Sen. Beau McCoy of Omaha responded to the bill's advancement by warning colleagues to get ready for a lot of talk. McCoy was among the senators who blocked last year's Medicaid expansion proposal by filibustering it.
Medicaid expansion has proved controversial in many states, given its link to the polarized debate about the federal health care law.
The law envisioned using Medicaid to cover people below the poverty level, but the U.S. Supreme Court ruled that expanding Medicaid, a federal-state program, was voluntary for states.
Gloor supported the filibuster in the Legislature last year. As a retired hospital administrator, he carried considerable weight with his opposition.
On Monday, he was one of five Health and Human Services Committee members who voted to send LB 887 to the full Legislature for debate.
The others were Sens. Kathy Campbell of Lincoln, Sue Crawford of Bellevue, Sara Howard of Omaha and Tanya Cook of Omaha.
Sen. Dan Watermeier of Syracuse voted against the measure, while Sen. Bob Krist of Omaha abstained.
Campbell, the HHS Committee chairwoman, said she doesn't know if the new plan has enough support to get past a filibuster and an expected gubernatorial veto.
“I haven't done a vote count because I want to talk to people about what's in here, instead of what they think is in here,” she said.
Heineman, who opposed last year's bill, was no more friendly to the new one Tuesday.
“We ought to call it by the right name,” he said. “It's Obamacare's Medicaid expansion program.”
Heineman said the new proposal, like the previous one, is unaffordable and unsustainable and would take money away from education in future years.
Campbell and three other lawmakers developed LB 887 based on concerns raised during last year's debate about Medicaid expansion. She called the new bill an improvement over last year's proposal.
“Our number one objective goal was to put forward good health policy,” she said. “We're going to use the federal dollars to transform our health care system.”
Under LB 887, as with last year's plan, federal Medicaid funds would pay 100 percent of the cost for covering additional people through 2016.
After that, the federal share would fall, reaching 90 percent by 2022.
The net state cost would be an estimated $64 million for the six years ending June 30, 2020, while the federal share would total $2.2 billion, according to legislative fiscal staff.
The new proposal would require legislative review if the share of federal funding dropped below 90 percent.
Campbell said the WIN plan would cover an estimated 55,000 Nebraskans with incomes up to 133 percent of the federal poverty level.
This year, the federal poverty level is $23,550 for a family of four. The 133 percent level for such a family would be an income of $31,321.50.
People with incomes from 100 percent to 133 percent of the federal poverty level could get private insurance coverage through the WIN marketplace.
Those with lower incomes would get WIN Medicaid coverage, which would incorporate managed care and new concepts in patient care.
Among the concepts would be a way to connect new enrollees with primary care providers before they got sick, as well as systems to coordinate care for people with chronic illnesses.
If the new programs proved successful, they could lead to changes in the state's traditional Medicaid program, Campbell said.
Expansion backers praised the vote. AARP Nebraska said the emphasis on preventive services and medical homes would improve the health of Nebraska residents.
Meanwhile, a liberal group, Americans United for Change, launched radio advertisements questioning why Heineman wants a state airplane to fly around in but says Medicaid expansion is unaffordable.
Heineman said the ads were inaccurate. He recommended buying a used airplane last year but did not request money for a plane this year. Krist introduced the bill directing the purchase of a plane.
Under Nebraska law, adults without minor children cannot qualify for Medicaid no matter how low their income. Parents and disabled adults can qualify, but only if their incomes are well below the poverty level.