Nebraska’s uninsured rates were relatively low prior to the Affordable Care Act’s implementation. However, The Cornhusker State is one of 10 where health insurance premiums will increase by at least 30 percent in 2017. The ACA’s fourth open enrollment will reveal what, if any, impact rate hikes averaging 35 percent will have on the number of insured Nebraskans.
While consumers may pay more for coverage next year, they will have fewer options. Two companies will offer plans through the state’s federally facilitated exchange; there were four in 2016.
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.
The Cornhusker State ranked in the second quintile for all five measures: Access, Prevention & Treatment, Avoidable Hospital Use & Costs, Healthy Lives, and Equity. If Nebraska were to improve to the level of the best-performing state, then 89,988 more adults would be insured and 70,664 fewer adults would go without needed healthcare because of cost. Nebraska’s Scorecard ranked the state 18th for uninsured adults (13 percent) and 15th for the number of adults who skipped care due to cost in the past year (12 percent)
The state earned a Top 10 spot in the 2014 edition of America’s Health Rankings. At 10th overall, Nebraska ranked performed well in many measures, including poor physical and mental health days, childhood immunizations, dentists, primary care physicians, and lack of health insurance.
For more details on overall public health in Nebraska, check out the 2016 listing of Key Health Data About Nebraska, compiled by Trust for America’s Health. A county-by-county comparison provided by the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute is also available.
How has Obamacare helped Nebraskans?
Nebraska opted for a federally facilitated health insurance exchange and did not 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 14.5 percent, which was lower than the national average. Nonetheless, the state’s uninsured rate has improved since 2013, falling 3.9 percentage points to 10.6 percent in late 2015. Nationwide, the uninsured rate was 11.7 percent in late 2015.
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.
2017 health insurance rates, carriers in NE
- Medica: 38.99 percent, which is higher than its proposed average rate increase of 37.5 percent
- Aetna: 30.54 percent
In 2016, nearly 90 percent of Nebraska exchange enrollees received premium subsidies to help lower their monthly premiums. In 2017, the subsidies available to exchange enrollees who meet certain financial and household size requirements will increase with the cost of benchmark plans (i.e., the second-lowest-cost silver plan in each area).
Nebraska enrollment in qualified health plans
In November 2013, the Kaiser Family Foundation estimated that the potential market for Nebraska’s exchange 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.
By the end of 2016 open enrollment, the third ACA enrollment period, Nebraska’s exchange had enrolled 87,835 people. As of March 31, nearly 90 percent of the 80,213 effectuated enrollments were receiving subsidies that averaged $296 per month.
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.
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 4 percent from 2013 to June 2016.
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.
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.
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 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’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: