Nebraska Medicaid backers turn to those who didn't qualify

Less than a year after lawmakers rejected Medicaid expansion in Nebraska, supporters are turning to a new group of allies: Low-income people who now realize they don't quality for coverage.

While signing up for healthcare on the federal website, many learned that although they're poor, they aren't poor enough to qualify for coverage. Now, they're coming forward and preparing to push for a rewritten Medicaid proposal along with advocacy groups and supportive state lawmakers.

On Wednesday, the Legislature's Health and Human Services Committee will hear from people who would have qualified for Medicaid under the expansion proposal. The hearing sets up another debate in the Legislature, with supporters, made up of Democrats and some moderate Republicans, facing opposition from conservative lawmakers and Republican Gov. Dave Heineman.

In his State of the State message, Heineman assailed the Medicaid proposal as unaffordable and urged lawmakers to reject it.

"When we debated this last year, it was an abstract concept for legislators, just hearing about big numbers and the federal poverty level," said Sen. Jeremy Nordquist, of Omaha. "Sometimes that doesn't resonate. But when you hear about the individual stories of people who are impacted, it often drives policy more than statistics and data."

The measure that stalled last year would have insured about 54,000 residents — most of them adults, ages 19 through 64, who don't have minor children and who make less than 138% of the federal poverty level.

That includes Oksana Kling and her 19-year-old son, Cody Thornley.

Kling, of Omaha, suffers from severe arthritis that has kept her from working outside her home for the last seven years. She injured her knee while walking down a flight of stairs in August, and business at her home daycare plummeted because she wasn't able to carry children or take them to an upstairs bathroom.

Kling, 49, said she made $1,200 a month when her business was in full swing — enough to cover all her bills — but she now collects less than $700 from the parents who kept their children enrolled. Without coverage, virtually all of her money goes toward prescription medications for her and her son. She received a shut-off notice from her power company in December, and she's now three months behind on her rent.

"I'm in this Catch-22," Kling said. "I can't get better and go back to work until I have my knee replacement surgery. But I can't have the surgery because I was denied Medicaid."

Her son, Thornley, suffered from a painful cyst that required surgery. Kling said his doctor went ahead with the procedure on the assumption that the teen would qualify for adult Medicaid within 90 days, so the surgery would be covered. But Thornley was denied, and he aged out of a state children's health program when he turned 19. His unpaid medical bills have risen to more than $10,000. Kling said complications from the surgery have prevented him from finding work, and he still has problems with the cyst.

"I understand that the governor wants to give money back to taxpayers, and that's a good thing," Kling said. "But we could also use that money so that people in this gap, like me, aren't stuck in the system. Because let me tell you: Until I'm able to work again, I'm going to have to keep drawing food stamps and energy assistance. If we get evicted, we're going to be using homeless shelters."

Denise Dickeson of Lincoln said she relies on Medicaid to treat her post-traumatic stress disorder, the result of abuse by her ex-husband. But the 57-year-old said she only qualifies because she spends $150 a month on "redundant insurance," which reduces her $1,000 monthly income enough to let her collect the benefit. If Medicaid were expanded, she said, she could qualify without having to reduce her income.

Dickeson said the extra money would help cover repairs for her 1997 Plymouth Voyager, and allow her to buy healthier food. Dickeson said she's frustrated that the state hasn't acted on the Medicaid proposal.

"I know it's not personal, but it feels personal," she said. "It's really tough to get along."

The measure would still have the federal government paying 100% of the cost until 2016. The federal contribution would then decrease gradually to 90% by 2020. The legislation includes a requirement that lawmakers re-evaluate the program if federal reimbursement ever drops below 90%.

The measure will still face opposition in the Legislature. Sen. Bill Kintner of Papillion said the proposal would tether the state financially to the federal government, making it politically difficult to withdraw if the federal contribution declined below 90 percent.

Kintner pointed to a recent study of Oregon's Medicaid expansion program, which found that low-income adults covered by government health insurance visited emergency rooms more often than other adults.

"You still have a problem with the federal government saying they're going to pick up 90 percent of the cost," Kintner said. "There isn't anyone who thinks we won't eventually get a Congress and a president who are serious about addressing the deficit. They're going to say, we can't afford 90% — and that will cost us greatly."