Supporters are considering a sunset date for the bill sometime around 2020, at which time lawmakers would have to reauthorize the program. It also could include a "trigger mechanism," which would require lawmakers to review the program or withdraw if federal payments were to drop unexpectedly.
"I think the proponents are willing to put that on the table," Nordquist, a co-sponsor of the Medicaid expansion bill.
The bill was introduced in the wake of a U.S. Supreme Court decision that struck down part of the federal health care law, one of President Barack Obama's top domestic achievements in his first term. The court upheld most of the law, but ruled that the federal government cannot withhold funding from states that choose not to expand their Medicaid programs.
Bill supporters remained cautiously optimistic Friday that they have at least 25 votes needed to pass the bill through the Legislature, but a veto-proof majority of 30 is less certain.
The program's cost and federal budget pressures have remained sticking points on the Medicaid expansion debate. State officials predict the bill would extend coverage to between 54,000 and 80,000 uninsured Nebraskans by 2015. Some insured residents would switch from their current plans.
The federal government has agreed to pay 100 percent of the cost for newly insured Medicaid recipients from 2014 to 2016, and then ratchet down its contribution to 90 percent. Supporters say the federal money would reduce the number of uninsured residents who are already seeking care, an expense that health providers pass along through higher premiums to those who are insured.
Rieker said lawmakers and other supporters were considering the sunset provision to calm some lawmakers' concerns about the cost uncertainties. His group endorses the expansion.
"We're not trying to get in front of them," Rieker said. "But we do think it is a very realistic possibility that, in order to expand Medicaid, it's going to require those of us who are proponents to put something into the law that sunsets it. That's not to say (lawmakers) wouldn't extend it in the future. But they'd have to revisit the issue."
Critics of the Medicaid expansion hadn't seen the sunset proposal on Friday, but they argued the bill as-written would only add more cost to the existing requirements of the federal health care law. The state's current two-year budget proposal calls for an additional $133 million in Medicaid spending even without the expansion.
Sen. Bill Kintner of Papillion said the federal government has front-loaded the Medicaid reimbursement in an effort to entice states. Those that participate would face enormous political pressure if they later tried to withdraw from the program, he said.
"It's free government cocaine for the first three years," Kintner said. "Once you've got 50,000, or 80,000, or 90,000 people on a new entitlement program, just try to take it away from them. They'll be storming the Capitol with pitchforks."
Kintner said Nebraska doesn't have enough primary care physicians to handle the likely influx of new Medicaid recipients. He also argued it would pull money from schools and education.
"We have got to get people to see that all of these other programs that they like are threatened if we can't put a stake to this beast," he said. "Do you really want to live in a state with one in five people on Medicaid? Is that the kind of welfare state that people want?"
If Medicaid is expanded, Nebraska would receive an estimated $2.3 billion in federal money through 2020. Nordquist said the expansion could save an estimated 500 lives a year by allowing mammograms, colonoscopies and other preventive care.
Nordquist said the federal health care law by itself would save the state an estimated $29 million per year in behavioral health services, by requiring private insurers to cover services that are now paid for by the state. The Legislature's Fiscal Office has also projected that the state would see an additional $6 million in behavioral-health savings if Nebraska was to expand Medicaid, and Nordquist said that estimate was conservative. Such programs help people with mental illness and those who abuse drugs and alcohol.
However, the fiscal office also warned that the state faces "a great deal of uncertainty" in estimating the legislation's total cost. "The Medicaid expansion covers a population that has never been covered by Medicaid," the fiscal office said in a memo to lawmakers.
