Supreme Court Preserves Health Insurance Marketplaces

By John Crabtree,, Center for Rural Affairs

The Supreme Court recently announced their decision upholding tax subsidies to help people purchase individual health insurance plans through a federal health insurance marketplace.
The Supreme Court made the right decision, preserving provisions of the Affordable Care Act that have been so crucial in providing access to more affordable health care coverage to millions of Americans. The court focused on interpreting the intent of Congress to create a health insurance marketplace for every eligible American, either through state exchanges or a federal exchange. Incentives for low- and moderate-income families to help make their insurance coverage more affordable was part of that intent.
The decision protects the progress we have made as a nation in providing affordable health insurance coverage for the millions of Americans who were uninsured prior to passage of the Affordable Care Act – 6.5 million Americans received tax credits to make their health coverage more affordable as of this year.
Clearly the ACA’s health insurance marketplaces are working, making health insurance more affordable for families that use the marketplace. Those individuals would have seen their premiums increase by nearly 500% in the federal exchange states if the Supreme Court decision had gone the other way.
Now it’s time to get on with providing affordable healthcare coverage for everyone and finishing the job of expanding Medicaid for the nearly 4 million low-income uninsured adults who fall into the “coverage gap” resulting from state decisions not to expand Medicaid.

For Pete’s Sake

By Jon Bailey,, Center for Rural Affairs 

The Legislature recently voted to delay LB 472, the Medicaid Redesign Act, until the 2016 session. While the bill is still alive, this means another year without access to health insurance for up to 77,000 Nebraskans, another year of health consequences that inaction will demand of them, and another year our rural hospitals are in financial jeopardy.


What’s more discouraging is the absolute lack of a reasonable alternative plan to provide access to health insurance for these Nebraskans.


Governor Ricketts has suggested two alternatives to the health care access issue facing thousands of modest income, hardworking Nebraskans. First, we should rely on “community health clinics” (we assume he’s referring to Nebraska’s seven Federally Qualified Health Centers). Unfortunately, this is placing a small bandage on a major wound. These clinics exist in Omaha, Lincoln, Norfolk, Columbus, Grand Island, and Gering. A look at a map shows there are vast areas of Nebraska where these services are unavailable. A Valentine resident without insurance would live 200 to 300 miles away from these clinics, for example.
Second, the Governor says we should just create better jobs with health insurance. Unfortunately, no plan is offered on how to accomplish this. In recent years, in fact, Nebraska has one of the lowest rates of employer-sponsored health insurance in the nation. The health insurance access challenges facing thousands of Nebraskans still exists, no matter what a majority of the Legislature and Governor say. We challenge them to work with us on a reasonable, practical solution.

Medicaid Redesign Won’t Bust Budget

By Jon Bailey,, Center for Rural Affairs 


Other states have found their initiatives to expand Medicaid similar to Nebraska’s LB 472, the Medicaid Redesign Act, have produced significant budget savings. Providing health insurance for low-income, working Nebraskans will result in state budget savings and economic growth.


Kentucky estimates their expanded Medicaid program will result in net state budget savings of $820 million from state fiscal year 2014 to state fiscal year 2021. And Arkansas estimates savings of $370 million during that time.


The savings Kentucky and Arkansas realized are available to all states. Providing health insurance coverage in LB 472 through private premiums and federal contributions will result in less need for state-funded mental and behavioral health programs. Other current specialized Medicaid programs would be to initiatives where the federal government is providing a greater contribution. Nebraska’s corrections program would achieve savings from released inmates receiving needed mental health and substance abuse treatment resulting in fewer reoffenders.


Research found that Connecticut, New Mexico, and Washington also realized budget savings in the first year of expanded Medicaid programs.


A recent University of Nebraska-Kearney study finds that over the next 10 years LB 472 would result in $1.5 billion savings in state spending (a conservative estimate; the experiences of other states argues it may be more) while bringing in more than $2 billion in federal Medicaid funding to Nebraska. LB 472 is estimated to result in $5 billion in economic activity to Nebraska.


LB 472 is not a budget buster and will result in economic growth to Nebraska.

Insurance Premiums in Iowa and Nebraska Border Counties

Lyons, Nebraska – Today, the Center for Rural Affairs released a new report examining how Nebraska’s decision not to participate in the Medicaid expansion program as provided by the Affordable Care Act (ACA) has contributed to higher health insurance premiums compared to Iowa.“Nebraska’s decision not to expand Medicaid as allowed under the ACA has changed its health insurance marketplace pool,” said Jon Bailey, Director of the Rural Public Policy Program at the Center for Rural Affairs and author of the report. “That changed pool has resulted in higher health insurance premiums for most Nebraskans.”

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:

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.

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