Medicaid Expansion and Medicaid’s Benefits to Children

shutterstock 43866202As the Nebraska State Legislature begins its latest session, a large issue at hand is the proposed expansion of Medicaid to all adults with low incomes.  The expansion would newly include adults age 19-64 who do not have children.  Included in the passage of the Affordable Care Act, the decision to enact this expansion has been yielded to the states by the Supreme Court.

The expansion would make approximately 93,500 uninsured Nebraskans eligible for Medicaid benefits, 60-70% of which would be expected to actually take advantage of them.  Of the potentially newly insured, 500 lives could be saved per year, according to a Harvard School of Public Health study.  The income restriction will be below $14,856 for an individual or $25,390 for a family of three.

There is a lot of backing for the expansion in the state legislature, estimated at 25 votes, which would pass the expansion, but 5 additional votes would be needed to override a veto, which is expected.  Much of the support is continued from those who helped to pass the prenatal bill of last year, which provided state funded care to unborn children of illegal immigrants.  Opposition to the expansion is owed to the associated costs, which could be anywhere from $100-500 million from now until 2020.  Many advocates for the expansion argue that it would save the state a great deal of money in the long run, and that its passage would be morally responsible.

A sector of health that is greatly affected by Medicaid is pediatric medicine.  Medicaid is the single largest insurer of children in our country.  62.9% of Nebraska's Medicaid population is made up of children, who also account for only 32.2% of its expenditures.  All patients insured by Medicaid have the potential to place a financial burden on the providers who care for them, due to its low rate of reimbursement compared to other insurances.  The financial burden imposed on providers could jeopardize the access to care of children insured by Medicaid. In Nebraska, Medicaid has reimbursed pediatric services on average at a rate of 84% of that which is reimbursed by Medicare for equivalent services.  The Affordable Care Act requires that this reimbursement be increased to at least 100% of Medicare rates for primary care services beginning January 1, 2013 and lasting through 2014.  The federal government plans to
cover 100% of these increased payments.

Would the expansion of Medicaid be beneficial when a great majority of its beneficiaries are already covered and make up a only a minority of its costs? Or would it cost our state millions of dollars that would be better spent on other programs such as education or the prevention of higher taxes?  Many backers of the expansion believe that insuring individuals saves money and lives in the long run by providing preventive care in advance rather than acute or critical care when it may be too late.  The upcoming decisions of the legislators and governor will tell what the future holds for Medicaid patients and providers in our state of Nebraska.

Submitted By: Annie Mullin, PA-Student at Union College, Lincoln, NE

Sources:

Stoddard, Martha. "Battle Brewing in Nebraska Legislature over Medicaid Expansion."  Omaha World Herald. 3 Jan 2013.American
Academy of Pediatrics.  "Medicaid Fact Sheet: Nebraska." Sept 2012.

<http://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/access-to-care/Medicaid%20Fact%20Sheets/Nebraska.pdf>.

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