Officials with the Heineman Administration have attempted to assure a legislative committee that Nebraska is on track implementing provisions of the 2010 federal healthcare law.
The two-hour meeting of the Banking, Commerce and Insurance Committee provided an update on efforts to create a state health insurance exchange. State Insurance Department Director Bruce Ramge and Department Chief Policy Counsel, Martin Swanson, walked legislators through aspects of the law which they say has been made even more complicated by the Supreme Court ruling that upheld it.
Gov. Dave Heineman has said Nebraska cannot afford to expand Medicaid under the healthcare law, a point Sen. Paul Schumacher of Columbus focused on when he questioned Ramge about why the state would decline to expand Medicaid and opt, instead, to give residents access to federal tax credits to purchase their own health insurance.
“So what’s the difference between subsidizing them that way with credits and just biting the bullet and doing a Medicaid expansion?” Schumacher asked.
“Cost to the state,” Ramge replied.
Ramge explained that the federal tax credits will subsidize much, if not all, of the purchase of private health insurance for those with incomes just outside Medicaid qualification. The federal government will issue the tax credits. It will eventually pay 90% of the cost of expanding Medicaid.
The authority of the administration to move forward on creation of a health insurance exchange became another focus of Sen. Schumacher and provided a bit of humor to break up the highly detailed session.
“Where in Nebraska statute or Nebraska Constitution do you get that authority from?” Schumacher asked Ramge.
“I believe Article 1, Section 4 of the Constitution,” was Ramge’s reply
When asked to read that portion of the Nebraska Constitution, Ramge answered he didn’t have it available.
AUDIO: Sen. Paul Schumacher of Columbus questions Insurance Director Bruce Ramge [:15]
A bit later in the meeting, Schumacher returned to the subject.
“Who is the policy maker here, in this particular case? Now, I think you sited that the authority may be under executive order under Article 1, Section 4, was that correct?” Schumacher asked.
“I misspoke on that. Article 4, Section 1,” Ramge replied.
“Article 4, Section 1, ok, because Article 1, Section 4 was belief in God,” Schumacher said as the room broke out in laughter.
AUDIO: Schumacher causes laughter when questioning Ramge. [:26}
The question of authority and whether the legislative approval might be necessary persisted.
Sen. Ken Schilz of Ogallala told the officials that, at some point, the legislature needs to get involved.
“By doing this, by going forward, it seems like we’re obligating the state, at a certain point, to spend money and if the state is going to spend money then that’s always been the purview of the legislature,” Schilz said. “I just want to make sure that we’re not promising something that somebody doesn’t have the authority to do.”
Deadlines are pressing on the state. The officials said Governor Heineman will likely use an executive order to create a health insurance exchange prior to the mid-November deadline.