Sunday, March 3, 2013

Medicaid expansion critical for rural Nebraskans

Before discussing the proposed legislation in Nebraska, it might help to know a little background regarding the Patient Protection and Affordable Care Act (known better as the Affordable Care Act, ACA, or Obamacare).  The Affordable Care Act is a 700 page tomb that is unbearably difficult to understand. The subsequent litigation around it makes it even more difficult. Last year, the Supreme Court found most of the Affordable Care Act constitutional in the landmark case National Federation of Independent Business (NFIB) v. Sebelius. Note that I said most of the ACA was upheld, not all. The intracies of the ruling confused even news organizations such as CNN and Fox.  The one portion of the health care reform was struck down was federal government’s role in cutting states’ Medicaid funds. Chief Justice John Roberts said as part of the 5-4 decision that states can't be penalized for refusing to join the law's expansion of Medicaid eligibility.  The federal government will initially cover all the expenses for the expanded coverage, until ultimately cutting back to 90 percent. The would mean states would have to cover the extra 10 percent. The ruling allows states to decline to do so.

Enter Nebraska legislation LB577. Nebraska lawmakers have proposed the legislation to expand Medicaid coverage as part of federal health care law.  The bill is said to extend coverage to more than 54,000 uninsured Nebraskans. Without the expansion, individuals who make too much to be covered by Medicaid, but cannot afford the insurance offered in the market place will be left out in the cold. However, that 10% additional cost is more than some Nebraskans are unwilling to take on. Governor Dave Heineman and other opponents have argued that the plan is simply unaffordable.

Expansion of Medicaid is crucial for rural Nebraskans. Nebraska’s rural counties have lower health insurance coverage rates than more urban counties for residents under 65 and most recent Census Bureau data show that Nebraska’s rural counties have a 15.5 percent uninsured rate, higher than any other county type in the state. As county population decreases uninsured rates increase. Counties with “high” uninsured rates (21 percent or greater) exist only in non-metropolitan (rural) Nebraska.

The bill is also important for the rural Nebraska’s health-care infrastructure. Medicaid is a crucial source of revenue for rural physicians, hospitals, and long-term care providers. But a rural health insurance market that leaves more rural people without insurance or without adequate insurance also leaves rural providers without payment for the services provided to many of their patient.

While the cost may be difficult in the short-term, it is likely to be cost-effective in the long term. After all, those individuals will continue to live in your state. As opposed to getting preventative care and managed care, they will getting sicker and ultimately increase the cost to manage their illness. Further, they are going to utilize emergency rooms, which are both costly and already overcrowded.   Either way, the state will have to pay for it. It is hard to see how a state would say thanks but no thanks to the Medicaid expansion option. Not only do you get a significant amount of federal aid, but you are able to help your residents live healthy lives, bolster medical infrastructure, minimize long-term costs, AND help vulnerable rural communities. It seems like a foolish option to leave on the table.

1 comment:

Imron Bhatti said...

Thanks for elucidating an issue I only had a vague sense of! It will be interesting to watch this play out in the coming years. There are a handful of states that likely have a similar spatial distribution of vulnerable populations, and it seems that those states (like Neb.) have Statehouses that are likely the most inclined to fight against covering that gap.