Uninsured young Nebraskans caught in healthcare dilemma

Gov. Ricketts vehemently opposes expansion of Nebraska's Medicaid program in line with the Affordable Care Act, saying it places the state budget at unreasonable risk.

Rejected three times in three years, expanding Medicaid eligibility would add primarily able-bodied adults to the program, Ricketts said, and adding that he doesn't trust the federal government's promise of matching at least 90 percent of the cost.

Many health care providers don't accept Medicaid patients because it reimburses about half of what private insurance does, and adding tens of thousands of new enrollees for the limited number of providers who take Medicaid would overload the system.

This year's Medicaid expansion proposal would use tax dollars to buy private insurance for Medicaid patients, but Ricketts said a similar program in Arkansas has expanded out of control.

After six months, the Arkansas program had expanded by $137 million, or 61 percent over budget. Now, more than 40 percent of Arkansas citizens are on Medicaid, making it one of the most Medicaid-dependent states in the nation, Gov. Ricketts said.

Medicaid has grown from 2.9 percent of the Nebraska state budget to almost 20 percent, and a 2015 study found that expanding coverage with private insurance would cost 94 percent more than traditional Medicaid, Ricketts said.

If taxpayers don't pay for additional healthcare, however, who does?

With Sunday being the deadline for signing up for Obamacare, millions of young adults will be facing fiscal realities as fines climb for not having insurance.

The minimum penalty is $695 in 2016 for someone uninsured a full 12 months and not eligible for one of the law's exemptions, more than double last year's $325.

That's the minimum, but it will be higher for many, because the law sets the penalty as the greater of $695 or 2.5 percent of taxable income this year. The nonpartisan Kaiser Family Foundation estimates the average 2016 penalty at $969 per uninsured household.

The IRS enforces the law, usually by deducting fines from tax refunds. The penalty will be increased by a cost of living factor in the future.

So where does that leave us?

For many, especially young working Nebraskans, it means jobs that don't offer insurance or pay enough to buy private policies, and being fined for not having coverage.

For others who have insurance, and the health care providers who serve them, it means higher prices to provide piecemeal, expensive, medical care to those who don't.

Sounds a lot like the situation before the Affordable Care Act was passed.