Will greater emphasis and reliance on integrated delivery, care coordination, innovation, private-sector insurance, patient-centered medical homes, personal responsibility, prevention and wellness, and a cancel-that opt-out if the federal pledge changes, be enough to “WIN” at least 30 legislator votes for an alternative approach to Medicaid expansion in Nebraska?
Proponents of exercising the Obamacare option, and taking advantage of its funding to create access to health-care coverage for some 54,000 impoverished adults who cannot qualify now for either regular Medicaid or marketplace subsidies, are hoping so and working at it.
Wellness In Nebraska—WIN—is the tag created for the new plan. The compilation of ideas is in LB 887, which was introduced on the fifth day of the new Unicameral session by the chairperson of the Legislature’s Health and Human Services Committee, Sen. Kathy Campbell from Lincoln. She has eight co-sponsors so far: Senators Danielle Conrad, Tanya Cook, Sue Crawford, Ken Haar, Sara Howard, Amanda McGill, Jeremy Nordquist and Norm Wallman.
An initial reading of the WIN bill indicates it has four components for creating health-care coverage for currently ineligible individuals of ages 19 through 64, whose household income is between zero and 133 percent of the Federal Poverty Level. A reason this is regarded as an alternative is it would still leverage the federal funding pledged by Obamacare: 100 percent funding for the new eligibility in Fiscal Years 2014 through 2016; 95 percent for FY2017; 94 percent for FY18; 93 percent for FY19 and 90 percent for FY2020 and thereafter.
For those with income between 100 and 133 percent of FPL, there would be WIN Marketplace Coverage, dedicated to enrollee participation in the private Marketplace for Qualified Health Plans with premium assistance paid by the federal dollars. For those with income between zero and 99 percent of FPL, there would be WIN Medicaid Coverage, with participation in managed care, including primary-care enrollment, patient-centered medical homes, integrated-care, health assessments, preventive care and incentives for personal responsibility, wellness and healthy behavior. Such aspects might attract support from otherwise skeptical or reluctant legislators.
For any newly eligible with access to employer-sponsored health insurance, there would be the WIN Employer-Sponsored Insurance Private Premium Plan; if cost effective, the state would pay the employee-share using the federal dollars.
The fourth component would be for any newly eligible whose medical condition fits a category aptly described as the WIN Medically Frail and Exceptional Medical Needs. This would use a patient-centered medical home and coordinated chronic-care management.
There are other aspects as well. If the federal funding drops below the pledged minimum of 90 percent, that would trigger legislative authority to halt the program. Also, newly eligible with household incomes above 50 percent FPL would be required to make a two-per-cent-of-income monthly contribution, but it could be waived by fulfillment of wellness responsibilities. Also, the Legislature would have a WIN Oversight Committee to guide the process.
Senator Campbell’s committee will hold a public hearing on LB 887 Jan. 29. Subsequent to that, it is likely the bill will be advanced to the full Legislature. Then the outlook becomes much more uncertain. The Governor hasn’t signaled that the alternative softens his adamant opposition to trusting the federal pledge on funding. Although not directly on point with LB 887, his State-of-the-State address included this statement: “We have researched and studied the Medicaid expansion issue carefully, thoughtfully and methodically. The responsible choice is to reject this optional Medicaid expansion.”
There are more than a few legislators who agree with the Governor, some of whom have political motivations on top of philosophical and policy concerns. If they are strongly enough motivated to carry on a filibuster, LB 887 would need 33 votes to invoke cloture for a vote on advancement to the second stage of floor debate. Even the absence of a filibuster and ultimate passage of the bill with 25 votes would still leave the likelihood of a gubernatorial veto. An override would need 30 votes from among the 49 legislators.
A WIN won’t come easily.
On another legislative matter: Senator Ernie Chambers has introduced LB 675, which would terminate the traditional, longstanding exemption from taxation afforded by law to property that is both owned by a religious organization and used for religious purposes.
As a practical consideration, determining valuations for churches would cause an inappropriate, unwarranted governmental intrusion into and entanglement with religion.
But there is more to this longstanding policy as well.
Senator Chambers exclaims that religious organizations and religious people are called to “render unto Caesar what is Caesar’s.” They do, of course; if not in strict monetary terms then in the alternative of the substantial and significant contributions they make to the betterment of society, of family lives and of individual lives. Parishes and congregations are voluntary associations of citizens who assemble in and on church property for unity, support and humanitarian purposes as well as worship. But even more, churches help to affirm meaning in life and generate hope. Caesar benefits from the great value of that rendering unto God.
