LIBA forum features state Sen. Morfeld, Americans for Prosperity director

JOANNE YOUNG – Lincoln Journal Star




A state senator and an Americans for Prosperity director in Nebraska, each on different sides of the Medicaid expansion ballot issue, debated Tuesday in fromt of business owners and members of the Lincoln Independent Business Association.

Jessica Shelburn, state director for Americans for Prosperity, and Lincoln Sen, Adam Morfeld answered questions proffered by a media panel on the pros and cons of expansion and what would happen if it didn’t pass.

The expansion, Nebraska Initiative 427, would insure about 90,000 adult Nebraskans who don’t now have health insurance. Medicaid now covers children, elderly, blind, disabled and certain other low-income Nebraskans.

The two disagreed on the effect on the health of recipients in other states that have expanded Medicaid.

Morfeld said one study has shown identification of new diabetes cases in Mdicaid expansion states increased by 23 percent. In non-expansion states, diagnosis of new cases increased by 0.4 percent. In addition, preventative care went up dramatically in Medicaid expansion states.

Enrollees receiving breast, colorectal and cervical cancer screening rose by 88 percent to 111 percent in various expansion states, he said. And people getting physical exams rose by 187 percent.

That “is going to decrease our costs long-term and allow people to more work-force ready,” Morfeld said.


But Shelburn said new Medicaid enrollees in Oregon did not show better physical outcomes compared with those who were uninsured. California was sued last year because some people believed care for people enrolled via Medicaid expansion was substandard.

The suit alleged patients had a harder time finding doctors, waited longer for appointments, ended up in the emergency room more often and had their diseases diagnosed later than those in other insurance programs, according to the Los Angeles Times.

“Just because you have a Medicaid card doesn’t mean that you are going to have access to quality health care,” Shelburn said.

Sixty-three percent of the state of Nebraska is in a provider shortage, she said. Providers who will take on Medicaid patients have to be available.

Morfeld said provider shortages would worsen with hospitals closing. That’s why the Nebraska Hospital Association and rural hospitals support Medicaid expansion. With uninsured Nebraskans going to emergency rooms and clinics with no ability to pay because they’re making $12,000 to $17,000 a year, hospitals are closing and will continue to close, he said.

Shelburn said Medicaid expansion is not a universal win for hospitals. Some analyses have shown that across the board, hospital finances have not necessarily improved with expansion.

“Medicaid was not intended to prop up our hospitals,” she said.

If expansion doesn’t pass, Shelburn said, the state would need to look at direct primary care options, in which patients pay a flat monthly fee to have preventative care.

Morfeld siad if it doesn’t pass, people would continue to go to emergency departments in hospitals, continue to suffer in some cases and could die an early death without the basic care they need.

He said the online sales tax – the Nebraska Department of Revenue plans to give online retailers until 2019 to start collecting taxes on sales within the state – would pay the costs needed for expansion. Shelburn said that money would not come in immediately.

A new study by University of Nebraska at Kearney business and economics professors conducted on behalf of the Nebraska Hospital Association found Medicaid expansion would generate more in combined local and state revenues than it would cost the state.

Recent estimates from the legislative fiscal office envision $1.3 billion in federal funding flowing into the state during the first three years of Medicaid expansion, with state matching funds totaling 90.8 million over that period.

Lincoln Journal Star – October 17, 2018