By Louise Norris
February 4, 2014
14,464 people had finalized their private plan selections in the Nebraska exchange by December 28. In addition, 6,873 applicants had been found to be eligible for existing Medicaid in Nebraska by December 28 (Nebraska has not expanded Medicaid under the ACA, a decision that disproportionately impacts the large rural population in Nebraska). 26% of the private plan enrollees in the exchange are between the ages of 18 and 34 – higher than the national average of 24%. 84% of the enrollees qualify for premium tax credits.
Although Nebraska has not yet expanded Medicaid, there is a bill in the legislature that would expand Medicaid to cover the 33,000 Nebraska residents who have fallen into the coverage gap – they aren’t eligible for current Medicaid, but they have incomes too low to qualify for subsidies in the exchange. The Nebraska Department of Health and Human Services held a public hearing on LB887, the Wellness in Nebraska Act, on January 29, and the issue is still very contentious in the state.
HHS is running the exchange in Nebraska via HealthCare.gov. As of December 1, the site was working well for the majority of users, and was vastly improved from where it was at the beginning of open enrollment. Residents who need enrollment assistance can contact Community Action of Nebraska or the Ponca Tribe of Nebraska - both received federal grants to hire navigators, who can answer questions and assist with the enrollment process. Community Action of Nebraska has a toll free number (1-800-318-2596) that people can use if they want to enroll over the phone. Residents who want in-person help can also visit one of Community Action’s offices to meet with a navigator.
In a memo to insurance carriers on November 22, Nebraska’s Director of Insurance, Bruce Ramge, informed carriers that they could opt to renew existing policies into 2014 instead of terminating them at the end of 2013, but that all renewals would have to be processed by December 31 – per federal law, policies that are not ACA-compliant may not be sold or renewed starting January 1, 2014. Blue Cross Blue Shield of Nebraska had previously sent out termination notices for policies that cover 88,000 Nebraska residents, but the carrier opted in late November to allow those policies to renew for another year if the insureds wished to do so. Policy-holders who qualify for subsidies in the exchange are likely financially better off switching to an exchange plan, and their coverage will also be more comprehensive.
Despite work completed by the Nebraska Department of Insurance (DOI), Gov. Dave Heineman announced in November 2012 that the state would not operate a health insurance exchange. In rejecting a state-run exchange, Heineman said it would be much more expensive for the state to run its own exchange. He also expressed doubt that even a state-run exchange would give Nebraska much authority over exchange operations. Governor Heineman has also refused to expand Medicaid, but state Senator Jeremy Nordquist is pushing for Medicaid expansion and called on Heineman in December to forfeit his own health insurance until all Nebraskans are able to have coverage.
Before Heineman’s final decision, he had expressed some support for a state-run exchange, and the DOI had studied that option. The DOI gathered input from stakeholders, developed a set of working assumptions around policy and operations, and issued a number of requests for information and requests for proposals to engage subcontractors in developing an exchange.
While the federal government manages most functions for the new marketplace, Nebraska oversees participating health plans. The Nebraska legislature also authorized a workgroup, called the Nebraska Exchange Stakeholder Commission, to provide input to state and federal officials on how the marketplace should operate.
Four companies are selling policies through the federal marketplace in Nebraska: Blue Cross Blue Shield of Nebraska, Coventry Health Care, CoOportunity (a new health care cooperative), and Health Alliance Midwest. Preliminary rates were posted on the Nebraska Department of Insurance website in August, although consumers will need to compare plans at Healthcare.gov in order to see official rates and the impact of subsidies for eligible enrollees.
The Nebraska Department of Insurance estimates that 135,000 people will obtain health insurance through the marketplace in 2014. About 13.3 percent of Nebraska residents are uninsured, a lower percentage than the national average, and lower than most of the midwest states.
The federal government will operate the exchange in Nebraska; enrollment begins Oct. 1, 2013
State Exchange Profile: Nebraska
The Henry J. Kaiser Family Foundation overview of Nebraska’s progress toward creating a state health insurance exchange.
Nebraska Department of Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Nebraska.
(877) 564-7323 / Toll Free: (800) 833-7352
Nebraska DOI’s overview of the exchange
An in-depth document published in September 2013 that details how the exchange will work for individuals and small businesses.
Advocacy group working to raise awareness about the Nebraska exchange.