Nebraska healthcare system punishes the working poor for the crime of getting sick


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Phil Brown

What’s the answer to providing healthcare for the 79,000 Nebraskans currently in the “coverage gap”; the Nebraskans currently ineligible for Medicaid and unable to afford private options?

According to Nebraska governor Pete Ricketts, it’s “leveraging current workforce development programs.” In a statement released by Ricketts on his website, the governor invoked the “Soviet rule of Russia” to describe his objections to expanding Medicaid access to more Nebraskans. Of course, the governor’s plan to leverage “current workforce development programs” ignores the reality that most of the Nebraskans in the coverage gap are already working, have already experienced the governor’s “programs” and have already found them wanting.

Regardless, the rhetoric used by Ricketts to explain away the need for Medicaid expansion worked, as Nebraska lawmakers rejected expansion for the third time this legislative session. Objections to the bill were along the traditional lines of fiscal conservatism, with the implication that the Medicaid expansion would cost the taxpayers money and put a greater financial burden on the state. However, those objections were wholly untethered to practical reality.

Funds for Medicaid expansion have already been allocated by the federal government, who will cover 100 percent of the cost of the expansion initially, and 90 percent after 2020. No additional taxes would be levied initially, and even after 2020, would be negligible. Indeed, the only “waste” of taxpayer money is occurring through Nebraska law-makers’ refusal to expand Medicaid, as the tax money being paid by Nebraskans that has gone and will go into the federal program in any case is going unused. Far from being practical, lawmakers that have opposed expansion are operating purely on emotion and prejudice. The most blatant example is the governor’s laughable McCarthyite invocation of the “Soviet rule of Russia” to oppose the measure.

The legislature’s indulgence of paranoia and meaningless platitude will have disastrous effects on the real lives of Nebraskans across the state. The Nebraska Appleseed group found that lack of health insurance was driving medical bankruptcy around the state, and forcing hospitals and local small businesses to bear the cost of medical debt. Particularly for rural hospitals, the refusal to expand Medicaid is resulting in economic hardship and risk of closure.

To those who can’t afford their medical bills and don’t have coverage, the state is brutal.

According to a detailed report released last week by ProPublica, Nebraska makes it very easy for collections agencies to sue over medical debt. With cheap court fees and loose rules, the state encourages hospitals to sue over even the smallest medical debts, and collections agencies make little discrimination over whether their target have the means to pay. In 2013 alone, 79,000 medical debt collection lawsuits were filed in the state, a number that far outstrips states with similar populations, like New Mexico. ProPublica found that many of the suits were directed at those who couldn’t afford to pay at all, which didn’t stop collections agencies from garnishing pay checks and removing funds from bank accounts, sometimes both at once from families struggling to put food on the table.

In a truly pernicious way, Nebraska continues the problem of health insurance coverage deficiency for low-income citizens by refusing to use already-spent taxpayer dollars on Medicaid expansion, and at the same time allows and encourages the most aggressive and indiscriminate use of collections lawsuits against those who can’t pay for healthcare. The state perpetuates the problem with one hand and punishes it with the other in a vicious cycle.

Nebraska legislators and governor Pete Ricketts must move beyond prejudice and paranoia to alleviate the suffering of Nebraskan citizens. The solutions are both simple and obvious, and neither will cause an undue financial burden on the state. First, Medicaid must be extended, and the pointless waste of Nebraskan taxpayer money with the stubborn refusal to do so, stopped.

Second, legal fees for collections lawsuits must be increased and more regulations added to prevent further victimization of the poor. The ability to end the vicious cycle is well within the power of our state, it only remains for the citizens to hold state lawmakers accountable to do so.


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