Medicaid Myth Buster #2: Source and Quality of Care

By Jon M. Bailey, Guest Writer

A constant complaint about Medicaid is that fewer healthcare providers take patients on public insurance programs, and the resulting quality of care suffers.
The facts, however, tell a different story. According to the Commonwealth Fund Biennial Health Insurance Survey nearly all Medicaid (95%) and private coverage patients (94%) have a regular source of health care. The quality of care (rated excellent or very good) is higher for Medicaid patients (55%) than for those with private insurance (53%).
Unfortunately, uninsured people are severely disadvantaged in both respects. Only 77% of those without insurance have a regular source of health care. And only 40% of uninsured rate their care as excellent or very good, compared to 55% of those with Medicaid.
Those with private insurance are slightly better able to schedule a same day or next day medical appointment (58%) compared to those on Medicaid (53%) or uninsured (43%). But those on Medicaid have physicians and physician staff who know their medical history; 86% for those on Medicaid compared to 84% for those with private insurance and 77% of the uninsured.
Those who oppose expanding Medicaid, as provided in the Affordable Care Act, use these myths to support their arguments. But the facts tell us that the right choice, the only moral choice, is to extend Medicaid coverage to the hundreds of thousands who fall into the Coverage Gap, where working Americans who don’t currently qualify for Medicaid and whose income is too low to participate in the new health insurance marketplace.

Jon M. Bailey is a rural policy and research expert and former Center for Rural Affairs Policy and Research Director. Contact him at

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.

Reviewing the Legislative Session, tax relief and agriculture

By Senator Lydia Brasch

With the legislative session completed for over a week now, the Capitol is a much quieter place mostly populated by visitors from near and far on hourly tours of this magnificent institution and structure. The hallways are no longer filled with the voices of student visitors from across the State with exception of Boys and Girls State and Unicam Youth Legislature students. Lobbyists are not watching the legislative chambers attentively from the rotunda or walking the hallways in search of a senator to discuss their interests on specific legislation. Most Senators living a distance from Lincoln are working remotely with out-of-session business. Trips to Lincoln for us include scheduled meetings, office needs, or interim hearings. Our District 16 office staff continues to keep busy with constituent services and research for next year’s legislative proposals.


This first interim update provides a brief overview of some key legislation debated during session worth repeating or received little or no coverage during session. Other updates will follow leading into what issues we may expect to see in 2016.


As this year was the beginning of the biennium (two-year period), the Legislature’s priority was the constitutional duty to pass a budget. The budget passed with an average 3.3 percent increase in annual spending over the next two years which is the fifth lowest increase over the last thirty years. Most of the spending goes toward education, Medicaid, university/college system, health and human services, corrections, and special education. The budget also leaves a projected $718 million in the cash reserve or “rainy day fund.”


Regarding tax relief, the Legislature granted two forms of tax relief, added an additional tax burden, and left unaddressed a number of other areas. The Legislature provided relief by increasing the property tax credit relief fund. As well, businesses and farmers will receive a partial property tax break on machinery, computers, and other personal property. However, the gas tax will increase 6 cents a gallon over the next four years. Unfortunately, the Legislature did not address the property tax burden shouldered by our farmers and ranchers which I attempted to address with LB350.


As for agriculture, the Legislature ended the session by addressing the issue whether to allow meatpacker ownership of hogs (LB176). The bill had significant opposition from some rural senators arguing this would be a death blow to small, independent hog producers and eventually lead to loss of independent cattle producers. The bill did not survive a second-round filibuster as it fell two votes short of cloture.


Next week’s column will continue covering legislation from criminal justice, the death penalty, education, health and human services.


As always, please contact me, administrative aide, Katie Wattermann, or legislative aide, Tom Venzor, with questions or thoughts at (402) 471-2728 or e-mail at


Keeping the Good Life Growing in Nebraska,

Senator Lydia Brasch, District 16

Redesigning Medicaid in Nebraska

By John Crabtree,, Center for Rural Affairs 

Nebraska’s failure to participate in the new Medicaid program under the Affordable Care Act has, for two years, allowed low-income, working Nebraskans to fall into a health care coverage gap that has left them economically and medically vulnerable. At least 54,000 of our friends, family members and neighbors do not qualify for Medicaid, cannot afford private insurance, and have incomes too low to qualify for tax credits in the new health insurance marketplace. Yes, you read that right… with incomes too low to qualify for coverage in the healthcare exchange.


The Medicaid Redesign Act, LB 472, would help redesign Nebraska’s Medicaid program, creating a Nebraska-specific plan for better, more cost-effective health coverage while also closing the coverage gap and providing coverage to working Nebraskans with low incomes who cannot afford insurance under the current system.


LB 472 sets out a framework to redesign Medicaid and close the coverage gap, providing the Governor and Department of Health and Human Services broad latitude to design and implement a plan for Nebraska.


Moreover, through 2016, 100% of the cost will be covered by the federal government. The federal share will then gradually settle to 90% in 2020 where it will then remain. And most enrollees would be required to contribute up to two percent of their income to the cost of their coverage.


The Medicaid Redesign Act – LB 472 – is a responsible, commonsense Nebraska solution to closing the health care coverage gap. Let’s get this done.

Medicaid Expansion Life and Death Issue

By Jon Bailey,, Center for Rural Affairs
Charlene Dill was a 33 year old mother of three in Orlando, Florida. She worked three jobs to support her family. She had a treatable heart condition. Charlene also fell into the “coverage gap” – she made too much money (a whole $9,000 per year) to qualify for Medicaid in Florida, too little to qualify for a subsidy to purchase insurance on the new health insurance marketplaces, and none of her jobs provided health insurance. She was uninsured. Florida decided not to expand their Medicaid program as allowed under the Affordable Care Act to cover low-income working people like Ms. Dill. On March 21, while working one of her jobs, she collapsed and died on a stranger’s floor from the preventable condition for which she could not get treatment.

Let us pray there are no Charlene Dills that suffer the same fate in Nebraska. But there likely are. Research shows that there will be at least 500 preventable deaths in Nebraska due to the Legislature’s failure to expand Medicaid to our low-income working friends and neighbors.

State Senators Bloomfield, Brasch, Coash, Garrett, Janssen, Kintner, Larson, McCoy, Murante, Scheer, Schilz, Seiler, Smith and Watermeier opposed attempts in both the 2013 and 2014 Legislature to expand Medicaid to those in the “coverage gap.” They would not even allow a vote to provide health insurance coverage for these working adults. They may all be back serving in the Legislature in 2015. Let’s hope they can figure out this is a life and death issue, not a political game.

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