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Largely overlooked in the general relief when the U.S. Supreme Court narrowly found the Affordable Care Act to be constitutional in 2012, was the Court’s holding that the Medicaid expansion wasn’t mandatory for the states. Instead, the 50 state legislatures and Governors would have to actually adopt the Medicaid expansion through the legislative process. That was the price that Chief Justice John Roberts extracted for his necessary fifth vote which found most of the ACA to be constitutional. Since that ruling was handed down, 33 states and D.C. — including several red states — have adopted the Medicaid expansion.

Unfortunately, Nebraska is one of the 18 hold out states. Despite several previous efforts to pass the Medicaid expansion through the Unicameral, a right wing Republican filibuster has blocked an up or down vote on the measure. Moreover, both Governors Heineman and Ricketts have voiced their opposition to the Medicaid expansion. This despite the fact that there has been a consistent majority in the Unicameral which supports this effort to insure 90,000 additional Nebraskans.

Despite these setbacks, the backers of the Medicaid expansion haven’t given up. Senator Adam Morfeld has spearheaded an effort that will place the Medicaid expansion on the ballot on November 6. Prospects for adoption of the Medicaid expansion are good. The measure will be well funded and the GOP has filed a lawsuit to block the referendum. GOP private polling must indicate it will pass.

Adoption of the Medicaid expansion would bring into Nebraska approximately $1.1 billion in federal money over the next five years, insure approximately 90,000 additional Nebraskans and provide a vital lifeline for many rural hospitals.

What many people don’t seem to realize is that the federal government would be paying the lion’s share of the costs of the Medicaid expansion. The federal government would begin paying 100% of the cost and that federal contribution would gradually begin to phase down to a 90% floor in 2020. The federal government would ultimately invest $1.1 billion in the Medicaid expansion.

The proposed Medicaid expansion isn’t some untested or novel idea. It has actually worked very well in the states where it has been adopted. For example, in Kentucky, the Medicaid expansion has injected more than $3 billion into the Blue Grass state’s economy in the form of payments to Kentucky doctors, hospitals and other health care providers. The bottom line result for Kentucky has been higher tax revenues, improved job creation, and overall better economic activity, in the amount of approximately $1 billion net benefit through 2021.

Despite the proven benefits of the Medicaid expansion in 33 other states and D.C. , Governor Ricketts and his band of right wing supporters in the legislature have opposed the Medicaid expansion on cost grounds. They are of the misguided belief that Nebraska can’t afford the Medicaid expansion.

Apparently, the right wing opposition to the Medicaid expansion is based upon the belief that the federal government will renege on its obligation to finance most of the costs. However, that is a remote prospect since the federal government has paid its promised 60% share of the costs of traditional Medicaid since its implementation in 1965.

What Governor Ricketts and his followers fail to recognize is that uncompensated medical care is already costing the state’s residents and health care providers. All of us pay a hidden tax in higher health care costs and insurance premiums to cover the costs incurred by health care providers who provide uncompensated care to the uninsured. According to a 2016 study by two University of Nebraska at Kearney professors: “Expanding Medicaid would reduce the amount of uncompensated care for Nebraska hospitals by $483 million by 2020.”

What this means is that refusing to adopt the Medicaid expansion won’t save Nebraska citizens and health care providers any money. Instead, all of us would continue to pay for the cost of uncompensated care through what I would term the “Ricketts tax.” Refusing to adopt the Medicaid expansion won’t make the cost of uncompensated care go away. It will still be with us and we will all be paying the price.

The opponents of the Medicaid expansion aren’t fiscal conservatives. They are all big spenders. Ricketts and his supporters have no problem with the hundreds of millions of dollars that the state’s taxpayers have spent on ineffectual corporate welfare programs that didn’t prevent Conagra from leaving Omaha and the millions of federal dollars spent on roads. As then State Senator Steve Lathrop said in 2014: ” We are being sidetracked by the discussion of bigger government. It becomes a battle cry every time we want to spend money on a poor person or sick person or elderly person. I have heard no one complain about the money we get and spend from the federal government on roads. It’s a lot. “

Ricketts and his right wing allies in the Unicameral haven’t presented an alternative to the proposed Medicaid expansion. All they’ve done is obstruct and prevent 90,000 Nebraskans from being insured. They owe the voters a serious alternative.

I believe we are in a good position to finally overcome right wing obstruction in the Unicameral and to pass the Medicaid expansion initiative. I believe this will be a good cycle for Democrats since our turnout has been up significantly across the board since the 2016 election cycle. Now let’s leave it all out on the field! Let’s get it done! We can do this!

I’m a trial lawyer, a Democratic activist and a sports fan.

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