Proponents of utilizing Obamacare’s provisions that allow and encourage states to expand Medicaid-insured health-care coverage are back with implementing legislation for a third time in as many years in Nebraska. This time it’s LB 472. Will it be the charm?
The cause behind LB 472 is basically the same as it was for its two predecessors—LB 577 in 2013 and LB 887 in 2014: ensure access to health care for adults with household incomes less than 133 percent of the Federal Poverty Level. Obamacare promises an enhanced federal share of no less than 90 percent of the costs for newly eligible individuals. Nebraska law already provides more extensive coverage for children and pregnant women, but gaps exist for adults.
The glaring gap is for impoverished, childless adults who have annual income slightly greater than 50 percent of FPL, but less than 100 percent. Under current policy, they have too much income to qualify for Nebraska’s Medicaid, but not enough to qualify for federal subsidies in the marketplace, because that assistance starts at 100 percent FPL.
Relatively considered, the original Medicaid-expansion legislation, LB 577 in 2013, was straightforward in relation to implementing expanded eligibility and financing per Obamacare. But the bill encountered insurmountable opposition, so proponents of the policy changes—most notably Senator Kathy Campbell, chairperson of the Legislature’s Health and Human Services Committee—came back with LB 887 in 2014. It was more complex and complicated than its predecessor, with provisions for using private insurers, implementing more extensive cost-sharing, and promoting personal responsibility.
It appears that LB 472 follows suit; that it is more complex and complicated than LB 887. It reiterates much of that bill, but adds some new planning and management concepts. It brings in ideas and expressions of health-care transformation, a popular concept for Senator Campbell and Senator Mike Gloor, chairman of the standing committee that oversees insurance issues.
LB 472 has a lot of wording. If legislation can be intense, this is it. It might be the first-ever bill with the words “superutilizer,” “silos,” “targeting strategies” and “value-based payments” all together. It uses a version of “shall include, but not be limited to,” 11 times.
LB 472 has four basic components:
- It would create a 16-member Medicaid Redesign Task Force to conduct a comprehensive review of the medical-assistance program and make recommendations.
- It would give the state Department of Health and Human Services 12 months to develop a Medicaid-demonstration-waiver application, in accord with extensive, prescribed criteria, to access the enhanced federal funding.
- In the meantime, it would give NE-DHHS 30 days following the bill’s effective date to submit an amendment for the current state plan in order to cover all “newly eligible individuals” with a “benchmark benefit package,” defined by federal law, including mental-health parity.
- And it would create the “Health Care Access and Support Fund,” to annually receive 23.5 percent of the net balance of the state’s Comprehensive Health Insurance Pool Distributive Fund.
Senators Campbell and Gloor, and their allies, will have to work hard to explain, justify and sell this newest version of Medicaid expansion.
LB 586 is the latest version of legislation that would add both “sexual orientation” and “gender identity” as protected classifications for which discrimination in hiring, firing and terms and conditions of employment would be punishable pursuant to the state’s Fair Employment Practices Act. That set of proscriptions applies to all employers of 15 or more employees and to all contractors and subcontractors of the state and local governments.
The public hearing on this year’s version of such legislation included what has to be darn close to the ultimate exhibit in political correctness; namely, the testimony presented in support of the bill on behalf of the Greater Omaha Area Chamber of Commerce and the tag-along Lincoln Chamber.
Another observation: in editorially expressing its support, the Omaha World Herald described LB 586 as “a straightforward measure.” That opinion might be flawed.
The bill encompasses not only “sexual orientation,” but also “gender identity.” The latter is defined as follows: “the actual or perceived appearance, expression, identity, or behavior of an individual, whether or not that appearance, expression, identity, or behavior is different from the individual’s assigned sex at birth.”
Puzzler. Have to wonder what standard of “straightforwardness” the World Herald uses.
And finally... news of the death last week of Sister Mary Evangeline Randolph was for me a source of both sadness and fond memories.
As founder and long-time director of Madonna School for Exceptional Children in Omaha, Sister Evangeline was unique and special; full of energy and love for the special-needs children to whom she was so devoted. Her earthly journey was one of compassion and service.
On numerous occasions, I consulted Sister Evangeline, or she collaborated with the Nebraska Catholic Conference, on public-policy issues affecting her school or her students. She was informed, engaged, passionate and effective as an advocate and administrator. She was one of those you learn from, and don’t forget.
