The decision has also left many lower-income Nebraskans in a “coverage gap” – making too much to qualify for Medicaid and too little to qualify for tax credits in the new health care insurance marketplace. Because of the health insurance they buy in the individual market, lower- and middle-class Nebraskans may suffer some of the greatest consequences of this decision, Bailey explained.

According to Bailey, in three of the four health plan levels (all except the Platinum level), Nebraskans in border counties have higher health insurance premiums than Iowans just across the border. In general, premium cost differences between the two states increase as consumers get older, and premium cost variations are greater for the lower level (Bronze and Silver) health plans. When age and health plan level are combined, the annual cost difference can be significant. For example, a hypothetical 60 year old Nebraska couple would pay nearly $500 more annually for a Bronze plan.

Read or download a full copy of the report at: http://files.cfra.org/pdf/Tale-of-Two-States.pdf

The report examines the ten Nebraska counties and six Iowa counties along the Missouri River that form the border between the states. These bordering counties form the core of two major metropolitan areas – Omaha, Nebraska, and Sioux City, Iowa. Outside of the metropolitan areas these counties are rural, made up of small towns and farms. These border counties share common backgrounds and history, have common economic environments, demographics, and have numerous other similarities.

“The cost variations for Bronze and Silver plans are important because those are the plans most people are purchasing on the health insurance marketplace, particularly lower- and middle-income consumers, continued Bailey. “The most recent data from the U.S. Department of Health and Human Services show that 83 percent select a Bronze or Silver plan in the federal-facilitated health insurance marketplace.”

“Most border county Nebraskans, therefore, are selecting plans with the greatest cost variations compared to Iowa border county residents,” Bailey concluded.