Federal Cuts to Medicaid Carry High Cost to Nebraska

A message from our COO, John Cavanaugh: 

It is time for a true bi-partisan effort to establish American healthcare for all. The failure of the Republican rushed and secret effort in the U.S. Senate may provide the catalyst for a new approach. 

During his campaign for President, Donald Trump articulated the structure for what American healthcare should and could become. Candidate Trump called for universal healthcare for all with lower cost, better coverage, and lower deductibles. This should be the standard by which any replacement for the Affordable Care Act is judged. Preserving and improving Medicaid must be at the center of the new system. The American public is eager for a rational and reasonable route to universal healthcare. Republicans and Democrats should get us from here to there. 

Nebraska Senator Ben Sasse has accurately described the proposed "Obamacare" repeal bill in the U.S. Senate as far more about"reform" of Medicaid than repeal of the Affordable Care Act. The reform of Medicaid effort translates to dramatic cuts in the federal contribution to Medicaid which will force Nebraska to choose between raising state and local sales, income and property taxes - shifting spending from education, public safety and other programs - or cutting essential health benefits to seniors, the disabled and children. Combined with a massive tax break for the taxpayers earning more than $500,000 per year, the current Senate bill is the greatest transfer of wealth in the history of the nation from the poor and middle class to the super rich. 

According to the Congressional Budget Office cost estimate, the Senate bill would mean that "by 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law". This is not a solution to the problems with Obamacare but a formula for economic and health catastrophe. The latest polling reveals that 12% of Americans support the current version of the Senate bill. Nebraska healthcare and health quality would be a big loser under the Senate bill. 

In Nebraska, 67% of Medicaid benefits go to the elderly. Funding levels per enrollee for each category of the elderly, children, and individuals with disabilities all fall below the national average. Any shift to block grants based on current funding levels will leave Nebraska far behind in receiving federal dollars back. Nebraska's refusal to participate in Medicaid expansion has already placed the state in the back of the pack and the Senate bill would make that a permanent condition. 

While Nebraska has elected to reject federal dollars for health coverage for uninsured Nebraskans eligible for Medicaid, our state budget remains heavily dependent on federal Medicaid dollars. federal Medicaid funding (more than $1 billion in 2015) makes up approximately one third (33.1%) of all federal funding in Nebraska's budget. 

The Senate bill will leave most of the "Obamacare" structure of subsidies and tax credits in place, but diminished, while it grandfathers in the Medicaid expansion population only for those states who have expanded Medicaid already. The Senate bill promises lower premium costs through the removal of essential health services for coverage. This will seriously and permanently damage healthcare in Nebraska for everyone. This block grant shift to the states will damage every healthcare consumer and provider, whether doctor, nurse, hospital, nursing home or clinic. We all must make our voices heard if we are to stop this economic and healthcare disaster from happening. 

It is time for people to come together for a solution. It is not time to make the problems in our healthcare coverage and access more severe. 


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