LINCOLN, Neb. (AP) — State insurance officials assured lawmakers Thursday that Nebraska has made headway in its efforts to comply with the Patient Protection and Affordable Care Act (PPACA) health insurance exchange requirements, but one senator questioned whether Gov. Dave Heineman can fulfill the law's requirements without calling a special session.
Bruce Ramge, director of the Department of Insurance, told a legislative panel that Nebraska is "on par" with other states in its plans to create a state-based marketplace where users can comparison shop for health insurance. The state has contracted with a Chicago-based consulting firm to help design an exchange. Federal officials have said plans are due Nov. 16.
"Our planning and design process is on par with any other state," Ramge said. "Every state is in a similar situation of trying to flesh this out, design and plan. From the feedback that we've gotten from our federal counterparts, I'm confident we're as far along as any other state."
State Sen. Paul Schumacher challenged the department's claim that Heineman, a Republican who opposes the law, has the authority to move forward with an exchange by issuing an executive order. Lawmakers do not reconvene until January.
"Where do you see that responsibility lying?" Schumacher asked. "With your office or the Legislature?"
Ramge said state insurance officials have worked diligently to fulfill the law's requirements, and that federal officials have agreed that an executive order will suffice.
"We've been tasked by the governor to go forward," he said. "This is an insurance exchange, and the thinking was that the Insurance Department was an appropriate place to do this. Had we not gone forward, obtained grants and done all this studying, we wouldn't be at the place where we are now."
Heineman spokeswoman Jen Rae Hein said the Nebraska constitution allows the governor to submit the blueprint without legislative approval. She cited a provision that grants Heineman "supreme executive power" to manage the state's affairs.
"The governor has executive authority to proceed and protect the state's interest in having the option of a state-based exchange program," Hein said.
Heineman has said the state will prepare for, but not enact an exchange until after the November elections. The governor also opposes a provision of the law that would extend Medicaid coverage to more Nebraskans. The U.S. Supreme Court last month upheld a provision that could impose a tax on some people who fail to own a minimum level of health insurance, but it ruled that the federal government cannot take existing Medicaid funding away from states that fail to expand their Medicaid programs to include all residents earning up to 133% of the federal poverty level.
Martin Swanson, a health policy adviser who is leading the state's exchange efforts, said an estimated 28,400 uninsured Nebraskans would qualify for coverage if the state expanded Medicaid. If they don't receive Medicaid coverage, Swanson said, those residents would become eligible to buy insurance through the exchange and be "heavily subsidized" with new PPACA federal tax credits.
Supporters of PPACA urged lawmakers to extend health care coverage to more Nebraskans by participating in the Medicaid expansion. In a press conference after the hearing, they argued that not participating will create a coverage gap.
Many Nebraskans will be able to buy insurance through the online exchange, with federal tax credits that help pay their costs. But the credits are only available to Nebraskans who make between 100% and 400% of the federal poverty level. Without the expansion, health care advocates say some Nebraskans will have incomes too high to qualify for Medicaid but too low to qualify for the tax credits.
Bruce Rieker, a lobbyist for the Nebraska Hospital Association, said his group's 90 members provide $890 million a year in uncompensated care to patients on Medicaid, Medicare and others who can't afford treatment. Rieker said the losses account for 18% of its patient revenue, which forces the hospital to pass its costs on to insurers and insured patients.
Roughly 237,000 Nebraska residents — about 13% of the population — are uninsured, according to U.S. census data.