If you live in Nebraska – or you’re considering living there – you should be aware of issues that impact the overall health of the state’s residents. There are numerous factors that might affect your own perception of the state’s attitudes toward providing health coverage and health care.
We’ve put together a partial list for your consideration.
Nebraska health ratings
The Commonweatlh Fund’s Scorecard on State Health System Performance 2014 rated Nebraska 17th among the 50 states and District of Columbia – the same score it received in 2009. Nebraska’s Scorecard includes details on how the rankings are determined.
The most recent edition of America’s Health Rankings (2013 edition) also measured the state’s “healthiness” and ranked Nebraska 11th of the 50 states. Nebraska’s rating is buoyed by a low incidence of drug deaths and low birth weights, and relatively good physical and mental health. It’s lowered by factors that include high rates of binge drinking, moderate rates of obesity, and significant health disparity based on education level.
For more details on overall public health in Nebraska, check out the 2014 listing of Key Health Data About Nebraska, compiled by Trust for America’s Health.
Nebraska and the Affordable Care Act
In 2010, Nebraska’s U.S. Senators were split on the health reform law. Mike Johanns voted no, while Ben Nelson voted yes. All three members of the House voted no – Jeff Fortenberry, Lee Terry, and Adrian Smith.
Ben Nelson is no longer in the Senate, and his successor, Deb Fischer, is opposed to Obamacare and has said she supports a full repeal of the law. Currently, all five congressional delegates from Nebraska are ACA opponents. Gov. Dave Heineman is also opposed to the ACA, calling it an “unaffordable, unsustainable, regulatory nightmare”
Heineman will end his tenure at Governor in January 2015, when Governor-elect Pete Ricketts will take over. Ricketts is also opposed to the ACA, and favors many of the reforms preferred by the GOP: tort reform, expanded HSAs, and tax credits to help purchase insurance. He is opposed to Medicaid expansion, and has vowed to continue Gov. Heineman’s rejection of expanding the program.
How did the ACA help Nebraskans?
Prior ACA implementation, the uninsured rate in Nebraska was 14.71 percent, which was lower than the national average. Various studies have projected an average post-Obamacare uninsured rate of 13.69 percent, for a reduction of just 1.02 percentage points. This puts Nebraska 24th among the 50 states and District of Columbia in terms of overall uninsured rate after ACA implementation.
Nebraska enrollment in QHPs
In November 2013, the Kaiser Family Foundation estimated that the potential market for the exchange in Nebraska was 239,000 residents, and that 122,000 of them would qualify for premium subsidies to lower the cost of their coverage. By mid-April 2014, when the first open enrollment period ended, 42,975 people had finalized their enrollment in the Nebraska exchange, and HHS reported that 87 percent of them received subsidies to lower their premiums.
Four carriers are offering health insurance plans through the Nebraska exchange: Blue Cross Blue Shield of Nebraska, Coventry Health, CoOportunity (a newly-created CO-OP based in neighboring Iowa), and Health Alliance Midwest.
Nebraska Medicaid/CHIP enrollment
Republicans in the Nebraska legislature filibustered a Medicaid expansion bill in 2013, and Governor Heineman also opposed Medicaid expansion. Nebraska is one of 24 states that has not yet expanded Medicaid, leaving about 32,570 people – 20 percent of the state’s uninsured population – in the coverage gap, with no access to financial assistance with their health insurance.
They would be eligible for Medicaid if the state were to use federal funds to expand coverage under the ACA. But for now, there is no financial assistance available for people with incomes below the poverty level who do not qualify for Medicaid under the state’s existing guidelines (Medicaid is not available in Nebraska for non-disabled childless adults, and is only available for parents of dependent children if their household income is under 57 percent of poverty).
The ACA would have provided Medicaid for all Nebraska residents with incomes up to 138 percent of poverty, but a Supreme Court ruling in 2012 allowed states to opt out of Medicaid expansion, and Nebraska is one of the 24 states that has not yet expanded Medicaid coverage. As a result, only 9,879 Nebraska residents had enrolled in Medicaid through the exchange by mid-April, qualifying under the existing guidelines. More information on Nebraska’s Medicaid and CHIP coverage and eligibility is available here.
Does Nebraska have a high-risk pool?
Before the ACA, individual health insurance was underwritten in nearly every state, which meant that pre-existing conditions could prevent a person from obtaining a policy, or could result in significantly higher premiums or policy exclusions. The Nebraska Comprehensive Health Insurance Pool (NCHIP) was created to give people an alternative if they were unable to obtain individual health insurance because of their medical history.
Now that the ACA has been implemented, all health insurance plans are guaranteed issue, making high-risk pools largely obsolete, and NCHIP closed on December 31, 2013. The program is now only available for people who are under 65 and on Medicare due to a disability. NCHIP can be reached at 855-247-5201.
State-based health reform legislation
Here’s a summary of recent Nebraska bills related to healthcare reform: