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 healthcare, including its resistance to the Affordable Care Act
We’ve put together a partial list for your consideration.
Nebraska health ratings
The Commonwealth Fund’s Scorecard on State Health System Performance 2015 rated Nebraska 13th among the 50 states and District of Columbia – that’s up four positions from the last ranking in 2014. High marks for indicators related to prevention and treatment as well as healthy lives earned the state first-quartile rankings in those categories. Nebraska’s Scorecard includes more details.
The state earned a Top 10 spot in the 2014 edition of America’s Health Rankings. At 10th overall, Nebraska ranked No. 1 in the nation for high school graduation, second for its high rate of childhood immunizations, and third for both a low rate of drug deaths and a low rate of poor physical health days. Health challenges for the Cornhusker State include a large disparity in health status by education level and a high rate of binge drinking.
For more details on overall public health in Nebraska, check out the 2015 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. Sen. Benjamin Sasse has replaced Mike Johanns. Sasse voted yes in 2015 to repeal the Affordable Care Act.
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 has vowed to continue Gov. Heineman’s rejection of expanding the program.
Nebraska participates in the federally facilitated health insurance exchange.
How has Obamacare helped Nebraskans?
Prior ACA implementation, the uninsured rate in Nebraska was 14.5 percent, which was lower than the national average. By the end of 2014, the year Obamacare’s individual mandate took effect, Nebraska’s uninsured rate had dropped to 12.8 percent.
The state continued to see its uninsured rate improve in 2015. By mid-year, it had reached 10 percent, according to Gallup. The uninsured rate in other states that only expanded Medicaid, only created a state/partnership exchange, or neither was 13.4 percent, and the national uninsured rate was 11.7 percent.
Nebraska enrollment in qualified health plans
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 qualified health plans (QHPs) through Nebraska’s health insurance exchange. HHS reported that 87 percent of them received subsidies to lower their premiums.
During the 2015 open enrollment period, 74,152 people enrolled in QHPs; 53 percent were new to the exchange in 2015. As happens in every state, some individuals dropped their coverage or never made their first premium payment. As of June 30, 2015, effectuated enrollment was 63,7776, with 88 percent enrolled in plans with advanced premium tax credits and 50 percent enrolled in silver plans with cost-sharing subsidies.
Nebraska’s health insurance exchange lost one carrier, Assurant, which left the individual market nationwide, and gained two for 2016. Nebraska’s health insurance exchange will include 2016 plans from the following carriers:
- Blue Cross Blue Shiled of Nebraska
- UnitedHealthcare of the Midlands – new for 2016
- Medica – new for 2016
With new plan offerings and rate changes, Nebraskans will want to shop around and compare their coverage options during open enrollment rather than allowing their existing coverage to automatically renew with the new year.
Nebraska Medicaid/CHIP enrollment
Republicans in the Nebraska legislature filibustered a Medicaid expansion bill in 2013, and former Gov. Heineman also opposed Medicaid expansion. Current Gov. Ricketts continues to oppose it. As a result, Nebraska is one of 19 states that has not yet expanded Medicaid, leaving about 27,000 people 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).
During the 2015 enrollment period, 7,218 people had enrolled in Nebraska Medicaid through the state’s exchange, qualifying under the existing guidelines. The state’s monthly Medicaid enrollment had actually decreased 6 percent from 2013 to August 2015. Medicaid enrollment is open year-round, which means the numbers can fluctuate.
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.
Medicare enrollment in the state of Nebraska
Nebraska Medicare enrollment reached 310,666 in 2015 – 16.5 percent of its population compared with 17 percent of the population enrolled in Medicare nationwide. Historically, about 85 percent of Nebraska Medicare enrollees have qualified for coverage based on age alone, while the remaining 15 percent are on Medicare due to a disability.
Medicare pays about $9,137 per Nebraska enrollee annually, and the state ranks 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 13 percent of the state’s Medicare enrollees do so. This percentage is far lower than the 32 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, 43 percent have stand-alone Rx plans.
Nebraska’s state-based health reform legislation
Nebraska lawmakers, led by Republican Sen. John McCollister, began meeting in September 2015 to discuss moving forward with Medicaid expansion in the state. However, the state has already rejected expansion three times. Most recently, LB472 did not pass during the 2015 legislative session and will be readdressed in January 2016.
Here’s a summary of state-level Nebraska bills related to health reform: