Hospitals see Medicaid expansion key to reducing losses

LINCOLN, Neb. — Within the past two years, Nebraska hospitals lost more than $175 million by providing care to people who couldn’t pay. That’s why hospital officials see next month’s vote on expanding Medicaid as important to their financial future.

Nebraska voters will have a chance to approve a ballot initiative that would expand Medicaid coverage to an estimated 90,000 low-income people without health insurance who don’t qualify for Medicaid under existing rules.

Expanding the pool of people who could get health coverage through Medicaid would mean hospitals would be reimbursed for treating people who now can’t pay.

Federal dollars would cover 90 percent of the cost of expanding Medicaid, an estimated $420 million to $500 million, with the state paying 10 percent, or around $49.3 million in the first full year, according to state agency estimates.

Opponents of Medicaid expansion say that’s money the state should be spending elsewhere, like education.

The Nebraska Hospital Association (NHA) is on the frontline for Medicaid expansion, hoping to see improvement on the business side of Nebraska’s hospitals.

“We want to get as many people who are eligible to get the expanded care they need,” said Andy Hale, NHA vice president. “The problem is, it takes time to get data on health care reform and we’re still trying to figure out how exactly it will work in Nebraska.”

The NHA estimates somewhat lower costs to the state of expanding Medicaid.

“Our estimates show it would cost the state between $18 million and $20 million in the first year under expansion, and the next two through five years, it might be somewhere around $30 million,” Hale said.

Meanwhile, the federal government would spend over $300 million on expanded Medicaid in Nebraska, he said.

Nebraska Appleseed, a nonprofit organization based in Lincoln, is helping fight for accessible health care.

“We’re talking with a lot of different groups and people across Nebraska about (Medicaid expansion) and who would be impacted,” said Molly McCleery, deputy director of the Health for Access program at Nebraska Appleseed. “I think there’s a misconception about who is eligible for Medicaid currently and who would be eligible under expansion. So we want to make things clearer.”

Under Medicaid expansion, health coverage would become available to people who earn less than $17,000 per year and to “two-thirds of hard-working Nebraskans whose jobs don’t come with health coverage,” according to Insure the Good Life, an organization advocating for expansion.

Also with expanded Medicaid, the NHA -- along with Insure the Good Life -- expects close to 11,000 new health care jobs in Nebraska in the coming years. Those are not just doctors and nurses. More people enrolling in Medicaid would create a need for receptionists, maintenance workers, cafeteria staff and other support workers to enter the healthcare workforce.

Hale admits, though, hiring workers could be a problem, especially if Medicaid expansion falters in the state.

While hospitals would benefit financially from expanded Medicaid, it remains unclear just how many people would sign up. One complication is a Trump Administration initiative to set work requirements for Medicaid recipients. Recent studies have shown than most able-bodied Medicaid recipients already work, but according to published reports, Arkansas dropped nearly 4,440 people from Medicaid due to work requirements.

Before Election Day on Nov. 6, McCleery said Nebraska Appleseed, along Insure the Good Life, will host forums on Medicaid expansion, answering questions such as who would be covered, the economic impact and more. On Oct. 30, the two groups will be in Grand Island to inform the public on the impact of expansion. Most hospitals also have informational kiosks on Initiative 427.

“We want people to be informed when they go to the polls,” McCleery said. “So we’re going to be doing as much campaigning as possible.”