A push to expand Medicaid in Nebraska will try again. It's the fourth legislative effort to find coverage for more than 77,000 Nebraska left without health insurance.
While both sides say it's needed, they disagree on how to pay for it. Medicaid expansion is one of many topics ready for debate on the legislative floor this session.
"Nebraska is going to be at a disadvantage if we choose not to embrace the expanded Medicaid," said Omaha Sen. John McCollister.
Sen. McCollister part of a group of senators introducing a bill called the Transition Health Insurance Program to provide more health coverage to more Nebraskans.
"It embraces free market principles and uses private insurance," said Sen. McCollister.
The difference with his proposal, it's a private-market alternative to Medicaid expansion which Sen. McCollister said will help more than 77,000 Nebraskans falling in a coverage gap, "They are the people that work at fast food restaurants, farming occupations, personnel services so those folks will have health insurance just like all, most of us have".
However the Platte Institute said the state simply can not afford to have this type of expansion and it said the plan doesn't cover intended recipients in the coverage gap.
"So what they are doing is coming onto the state's program at the cost of the state at the cost to the taxpayers and they are getting a pretty generous insurance program in the private market and it's breaking the banks of states," said Platte Institute CEO Jim Vokal.
Vokal also said this expansion would be a disincentive for Nebraskans to find better paying jobs.
"They want this insurance and so they are making too much money at their job, they will quit their job they get stuck in the cycle then at the expense of taxpayers," said Vokal.
But Sen. McCollister said the state will only pay for 10-percent of the coverage and the Federal government will pay the other 90-percent. If that doesn't happen, this bill falls flat.
"We aren't burdened by a program that's no longer funded full levels," said Sen. McCollister.
Sen. McCollister pointed out that this bill would help two-thirds of the working poor, 50-percent are rural Nebraskans. McCollister feels the bill get out of committee and debated on the floor but advancing after that could be an uphill battle.
This bill is written similarly to the one Arkansas has. Vokal said 41-percent of Arkansans are now on Medicaid after the state expanded that program in 2012.
Vokal said for an alternative Nebraska should get a waiver from the Federal governement and use some existing Medicaid dollars available under the Affordable Care Act and provide a means test for people to buy insurance.
The estimated cost of Medicaid expansion to the state would be $2-5 million dollars a year if enacted.
The bill already faces a lot of opposition, Nebraska Governor Pete Ricketts asked lawmakers during the state of the state address to reject proposals like this calling them unsustainable.
Currently 31 states and the District of Columbia have some form of Medicaid expansion.
Groups for and against this Medicaid expansion will speak at the state Capitol on Tuesday.