Nelson’s Nebraska To Receive Extra Medicaid Funds Under Senate Bill

by Igor Volsky
Wonk Room

This morning’s managers amendment to the merged Senate health bill goes a long way towards satisfying the demands of Democratic hold-out and all-important 60th vote Sen. Ben Nelson (D-NE).

Nelson has recently complained that the proposed expansion of Medicaid to those earning below 133% of the Federal Poverty Line (FPL) would burden his state of Nebraska and suggested that states should be able to opt-in to the program.

Under the current merged legislation (the version unveiled on November 18th), the federal government fully finances care for the expanded population for two years and increases its matching funds (known as FMAP) thereafter. Page 98 of the managers amendment specifically identifies Nebraska for higher federal matching funds, fully funding its expansion for an additional year:

‘‘(3) Notwithstanding subsection (b) and paragraphs (1) and (2) of this subsection, the Federal medical assistance percentage otherwise determined under subsection (b) with respect to all or any portion of a fiscal year that begins on or after January 1, 2017, for the State of Nebraska, with respect to amounts expended for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be determined as provided for under subsection (y)(1) (A) (notwithstanding the period provided for in such paragraph)

Subsection (y)(1)(A) refers to page 399 of the original merged Senate legislation which fully funds state Mediciad expansions for the first two years. The manager’s amendment also provides 2.2% increase in FMAP to help states finance their existing Medicaid programs.

UPDATE from Betsy’s Page:

Abortion might have been the issue that got the headlines for Ben Nelson’s wavering on the health bill, but what he was really negotiating for was more federal money for Nebraska to cover additional Medicaid payments that would come about because of this bill. And Republicans are already pointing out the exceptions to the abortion language that Nelson was supposedly so adamant on getting. Who knows what is in a bill that was written so quickly and in such secrecy? We’ll be finding all sorts of errors, contradictions, and special provisions as people have time to digest it. Of course, then it will be too late because of this artificial hurry to get the thing passed by Christmas Eve. Wonkroom at Think Progress has the language of the special provision that bought Ben Nelson’s vote…

We’ll see whose vote cost more – Mary Landrieu’s or Ben Nelson’s. All the other senators are pansies for going along and not getting special carveouts for their states. When every single Democratic vote is crucial, why not hold them up. Of course, we may be finding those special provisions after people have had time to pore over the bill and figure out what all these subparagraphs are referring to.

Nelson was right to be concerned. As Paul Mirengoff at Powerline points out, this bill is a mammoth unfunded mandate that burdens the states to be on the hook for additional Medicaid payments…

…Probably, we’ll be hearing calls for a new federal law to force the doctors and hospitals to take the Medicaid patients.

And if you want to know what politicians’ words are worth, just having this vote on Saturday mere hours after the Reid Manager’s Amendment has been released violates the demand of eight Democratic senators that the health care bill be posted for 72 hours before a vote is taken. I guess Senators Lincoln, Bayh, Landrieu, Lieberman, McCaskill, Ben Nelson, Pryor, and Webb are happy to posture for the public, but when push comes to shove, they’ll do what the party asks of them.

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