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Nelson: Effort intended for all states
As a United States senator I've said that I will put Nebraska first, Nebraska always, but not Nebraska only. That remains the case with questions about how the Senate health care bill dealt with an underfunded mandate for expanding Medicaid.
Unfortunately, a few missing facts have been overlooked in pursuit of a good story. The fact is about a week before the bill passed I brought to the attention of Senate leaders that beginning in 2017, substantial cost for the Medicaid expansion would shift to the states. I was concerned about the impact on all states, which stems from my two terms as governor and seeing the federal government pass on mandates and little or no money to carry them out.
I proposed to Senate leaders that the health reform bill be changed giving every state an opportunity to opt in to the cost of new Medicaid expansion responsibilities. That way, they could choose to pay the costs, or they could avoid this unfunded mandate.
My concerns were underscored by a letter Nebraska Gov. Dave Heineman sent to me on Dec. 16, saying: "The state of Nebraska cannot afford an unfunded mandate -- of this magnitude." I agreed and wrote back noting I had proposed an opt-in mechanism providing an opportunity for relief for the states. I was looking for a way to help every state beginning in 2017, when federal funds would be reduced.
In the absence of a fiscal analysis from the Congressional Budget Office, Senate leaders were unable to accept my provision. Instead they gave fiscal relief to Nebraska, which has been misinterpreted by many, including some attorneys general. Regardless of the language in the bill, my intent has been and remains clear. Every state should be treated the same.
I pointed this out in a Dec. 22 speech on the Senate floor about the provision. "It is, in fact, an opportunity to get rid of an unfunded federal mandate for all the states. Let me repeat that: For all the states, "What we've done is we've drawn a line and said that this is unacceptable for all states."
Now, during the Senate and House conference committee negotiations an effort must be made to treat all states equally and fairly concerning the Medicaid expansion. At the end of the day, whatever Nebraska gets will be available to all states, just like a deal I worked on for the 2003 tax cuts with Sen. Susan Collins of Maine. Back then, we persuaded Congress to approve $20 billion in additional fiscal relief for all states. They needed it to make up for state revenue losses resulting from the tax cuts.
Hopefully, this set of facts will eliminate any misunderstanding about my recent efforts. The next steps will occur during the conference negotiations. I am working for and expect a solution that will not apply to only a single state, but equally to every state.