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Nebraska health insurance

Single insurer offers 2019 in Nebraska's individual health insurance market. Open enrollment runs through December 15.

Health insurance in Nebraska

Nebraska’s health marketplace

Nebraska uses the federally facilitated health insurance exchange, but with a marketplace plan management model, which means the state oversees various aspects of the plans available for sale in the exchange.

Open enrollment for 2019 coverage through the Nebraska exchange started November 1 and continues through December 15.

Medica will continue to be the only insurer offering coverage through the Nebraska exchange in 2019 (as well as off-exchange). Rate increases proposed for its plans were much smaller on average (Medica Insure up 3.69%, Medica with CHI Health up 2.6%) than in prior years.

In 2017, 88,213 Nebraskans enrolled in 2018 coverage through its exchange during open enrollment – a 4.6 percent increase over the previous year. For states that rely on HealthCare.gov, this was rare, as most of those states saw enrollment decrease by an average of 5 percent.

Medicaid expansion in Nebraska

Medicaid expansion will take effect in Nebraska in 2019, thanks to a ballot initiative approved by the state’s voters in the 2018 election.

Republicans in the Nebraska legislature filibustered a Medicaid expansion bill in 2013. Former Gov. Heineman had opposed Medicaid expansion and current Gov. Ricketts continues to oppose it. As a result, Nebraska was one of 19 states that had not yet expanded Medicaid, leaving about 27,000 people in the coverage gap, with no access to financial assistance with their health insurance.

The expansion will mean coverage for about 86,000 Nebraskans. By not expanding Medicaid, Nebraska was missing out on $3.1 billion in federal funding between 2013 and 2022.

Read more about Nebraska’s Medicaid expansion.

Short-term health insurance in Nebraska

Nebraska law limits short-term plans to terms of less than 12 months. That’s in line with the new federal rules on short-term health plans.

The state does, however, require short-term plans sold in state to be filed with the department of insurance, to cover state-mandated benefits and comply with the state’s internal and external appeal requirements.

Read more about short-term health insurance in Nebraska.

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, has been opposed to Obamacare and has said she supports a full repeal of the law.

Currently, all five congressional delegates from Nebraska are ACA opponents. Sen. Benjamin Sasse has replaced Mike Johanns. Sasse voted yes in 2015 to repeal the Affordable Care Act. Both Fischer and Sasse voted yes on all three ACA repeal measures that the Senate considered in July 2017: The Obamacare Repeal Reconciliation Act, the Better Care Reconciliation Act, and “skinny” repeal.

In the House, all three Nebraska Representatives supported the American Health Care Act (AHCA), an ACA repeal effort that passed the House in May but stalled when the Senate was unable to pass any of their versions of the bill.

Former Gov. Dave Heineman was also opposed to the ACA, calling it an “unaffordable, unsustainable, regulatory nightmare” Heineman ended his tenure and was replaced in January 2015 by Pete Ricketts.

Gov. 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 had vowed to continue Gov. Heineman’s rejection of expanding the program.

How has Obamacare helped Nebraskans?

Nebraska opted for a federally facilitated health insurance exchange and did not accept federal funding to expand Medicaid under the Affordable Care Act. Both tend to be indicators of reluctance to the health reform law.

However, the state was already performing better than most in the nation as far as pre-ACA uninsured rates go, and once the law’s key provisions took effect, it continued to do so.

Prior ACA implementation, the uninsured rate in Nebraska was 11.3 percent, according to US Census data. By 2016, it had fallen to 8.6, which was equal to the national average — despite the fact that the state hadn’t expanded Medicaid.

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.

Medicare enrollment in the state of Nebraska

Nebraska Medicare enrollment reached 313,703 in 2015 – 17 percent of its population, the same as the percentage enrolled in Medicare nationwide. As of 2013, about 86 percent of Nebraska Medicare enrollees qualified for coverage based on age alone, while the remaining 14 percent were eligible Medicare due to a disability.

Medicare spends $8,310 per Nebraska enrollee each year, just below the national average of $8,970. In 2009, the state ranked 36th in terms of overall spending with $2.5 billion per year.

Nebraska Medicare recipients can select a Medicare Advantage plan instead of original Medicare if they wish to gain some additional benefits, and about 12 percent of the state’s Medicare enrollees did so in 2016, up from 11 percent in 2015. This percentage is far lower than the 31 percent of Medicare beneficiaries who select a Medicare Advantage plan nationwide.

However, about 60 percent of the state’s Medicare beneficiaries are enrolled in Medicare Part D plans, which provide stand-alone prescription drug coverage. Of all U.S. Medicare recipients, 45 percent have stand-alone Rx plans.

Nebraska health insurance resources

Nebraska’s state-based health reform legislation

Here’s a summary of state-level Nebraska bills related to health reform: