LINCOLN — Paulette Jones could get back to work if she could get her chronic insomnia and other health problems straightened out.
But she can't afford tests and treatment, and she can't get health coverage. She makes too much to qualify for Medicaid, even as a single parent, and too little to get a premium subsidy through the health insurance exchange.
"After years of hard work, I have no way to afford health insurance," she told state lawmakers Wednesday.
Jones was among nearly 40 people who gave passionate, sometimes emotional testimony at a hearing about the latest proposal to extend publicly funded health coverage to more low-income Nebraskans.
Most spoke in favor of Legislative Bill 1032, introduced by State Sen. John McCollister of Omaha.
But there were also those like Bryan King, a Republican state senator from Arkansas, who warned Nebraska lawmakers against following his state's lead.
He said he opposed the Arkansas model of using Medicaid dollars to buy private health insurance from the beginning. Now, two years in, he said the program has not lived up to its promises, and it costs more than traditional Medicaid.
"This has turned into an extreme boondoggle for insurance companies," King said.
LB 1032 is based on the Medicaid expansion program offered in Arkansas since 2014.
It would use Medicaid funds to buy private health insurance for some Nebraskans and to pay the employee's share of insurance premiums for others.
Medicaid would cover copays and deductibles and fill some coverage gaps. Enrollees would have to pay 2 percent of their income for the coverage.
Those who are medically frail would be covered under the regular Medicaid program.
The measure is the fourth version of Medicaid expansion proposed in Nebraska.
Expansion bills failed in the face of filibusters in 2013 and 2014. Last year, supporters put the bill on hold after it became clear that it did not have the votes to advance.
McCollister told the Health and Human Services Committee that LB 1032 represents a market-driven solution for the 77,000 Nebraskans who, like Jones, fall into a coverage gap.
"Our goal is to make people healthier, more productive and better able to increase their employability and earnings," he said. "We can make a difference in the lives of those people."
He argued that Nebraska should not pass up the federal funding available through the Affordable Care Act to provide that coverage.
Under the act, federal funds pay 100 percent of the cost for covering additional Medicaid recipients through 2016. After that, the federal share will decline to 90 percent by 2022, then stay at that level.
But, as with past proposals, the governor and his administration came out against LB 1032.
Calder Lynch, the state Medicaid director, and Bruce Ramge, the state insurance director, said the measure would be expensive and would put the state at risk if the federal government does not live up to its commitment of funding.
An actuarial study released by the Nebraska Department of Health and Human Services on Tuesday calculated that LB 1032 would cost the state nearly $1 billion over the next decade.
The study estimated that the measure would provide coverage to nearly 124,000 Nebraskans and would bring in nearly $14 billion in federal funds.
Lynch came in for sharp questioning from some committee members, who criticized the late release of the analysis and challenged him to offer an alternative solution for the uninsured.
Other committee members directed their skepticism toward supporters of the bill, asking whether it would be sustainable and how the cost could be justified to taxpayers.
LB 1032 would provide health coverage to people who cannot qualify for Medicaid now.
Under current state law, able-bodied adults without minor children cannot qualify for Medicaid no matter how low their income. Parents and disabled adults can qualify only if their incomes are well below the poverty level.
But people making less than the federal poverty level — $24,300 for a family of four — cannot qualify for tax credits in the health insurance marketplaces, leaving many Nebraskans in a coverage gap.
The Affordable Care Act envisioned Medicaid expansion as a means to cover people with incomes up to 133 percent of the federal poverty level.
The number of states adopting Medicaid expansion has grown steadily, to 31 states and the District of Columbia. Four more states are considering it.