Expanding Medicaid will force cuts to K-12, elderly, disabled

Friday, October 12, 2018

Nebraska is a generous state when it comes to healthcare for poor people. We offer more Medicaid services at tax-payer expense than almost any other state. Our State provides more than 20 different programs and services over and above the federally mandated minimum. Behind aid to K-12 education and the University system, Medicaid is the third largest item in the budget. We spend almost $1 billion dollars of Nebraska tax payer’s money in every budget on Medicaid today. Those costs continue to rise each year.

“Initiative 427” is the Medicaid “Expansion” effort that will put a question on the ballot in the election next month. This is a terrible idea. It is unaffordable. It is unsustainable, and worst of all, it is really going to hurt a lot of people who utterly depend on this program.

In my first two sessions in the legislature, we faced a tough economy and tax revenues were down in FY 17 and FY 18, $900 million and $173 million respectively. Because Nebraska’s Constitution requires us to balance the budget, we had to cut over a billion dollars in these two sessions. As you might imagine, most of the cuts came from the programs that get most of the budget; K-12 education, the University system, and the Department of Health and Human Services. If Medicaid Expansion passes, massive cuts will have to be made - again. It’s only logical those cuts will come from these big programs – again.

Cutting programs will have to happen to fund Medicaid Expansion because there is not 33 Senators in the legislature willing to raise taxes to pay for it. Like me, most Senators realize Nebraska is already a high-tax state; nearly the highest in the country.

No one really knows how much this will cost. Estimates range from $30-60 million for just the first year. That money will come from Peter robbing Paul. So what will be on the chopping block? Will funding to K-12 schools be cut, putting even more pressure on property taxes? The last time we had to cut the budget, state aid to schools was cut $48 and then $75 million. Will we have to cut vocational rehabilitation, help for the blind and deaf, early childhood care and education? Will we cut the prescription drug, physical therapy, optometry, dental, eyeglasses, hospice, nursing home/long term care, people with developmental disabilities? These are all paid for by Nebraskans over and above the federal minimum, and are part of our Medicaid program right now. Can we afford to keep paying for all this AND pay for Medicaid Expansion? Pick your poison.

States that have implemented Medicaid Expansion already are all facing these kinds of cuts right now. In every case, the “real” costs have always been at least 50% higher. If this passes, the “new” people who enroll in Medicaid will get 90% of their doctor bill reimbursed by the federal government. The people already on the “old” version of Medicaid only have about 53% of their doctor bill reimbursed by the federal government. Which patient would you chose if you were one of the few doctors still willing to take Medicaid? The folks currently on Medicaid will be “crowded out” by the new folks able to be reimbursed at the higher rate. Important services in our current Medicaid program will be luxuries we will no longer be able to afford in Nebraska. K-12 funding and the University will have to deal with yet another massive cut, and those cuts will be permanent.

Putting 90,000 able-bodied adults on Medicaid at the expense of poor single mothers, young children and the elderly and disabled is wrong. Wrecking the budget and cutting other important programs like K-12 is wrong. Making it impossible to address the #1 issue in Nebraska (our of control property taxes) is wrong. I strongly urge you to vote NO on Medicaid Expansion next month.

Please contact my office with any comments, questions or concerns. Email me at; tbrewer@leg.ne.gov. Mail a letter to; Sen. Tom Brewer, Room #1202, P.O. Box 94604, Lincoln, NE 68509 or call us at (402) 471-2628.

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  • Expansion sounds good but how will the state pay our share? What cuts to the existing program will happen? Who pays when the feds do not meet their obligation? What taxes will be raised? What existing other state funding will be cut?

    -- Posted by dennis on Fri, Oct 12, 2018, at 3:55 PM
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