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“No man’s life, liberty or property are safe while the Legislature is in session.”

~ Gideon J. Tucker, 1866 ¹

Wednesday, June 5, was the final day of the 103rd Unicameral, 1st Session. I wish I could say: “At ease Nebraskans, the Legislature is out of session!” Unfortunately, I can’t.

I also wish I could join in the chorus of celebrations (sent via mass emails) about the alleged victory in stopping the Medicaid expansion bill, LB577.

It is true, LB577 encountered resistance – it didn’t pass this year – and, of course, that is good. But, celebrations are premature. Actually, they are unwise, based on the problems outlined, below.

1. The Nebraska Legislature is never really totally out of session anymore. Between official sessions, much is decided through Interim Studies – this practice will directly impact Medicaid expansion and health care law implementation.

GiN’s considered opinion ² of Interim Studies: Think of Interim Studies as a constitutionally unauthorized, unscrutinized extension of the Legislative session, which occurs without votes. It’s the secret negotiations in “the smokey back room”, so to speak. The subject, of course, is more complicated than that, but we will have more to say about Interim Studies in the future.

• Some of this process will be accessible to the people of Nebraska, but much of it will not.

• Specifically, regarding Medicaid expansion and health care law implementation: There were multiple Interim Studies introduced on these subjects.

• There was a special “partnership” project created by Senator Kathy Cambpell’s LR22; “Partnership Towards Nebraska’s Health Care System Transformation” to “make policy recommendations” during the Interim.

SO…

• When the 2nd Session of the 103rd Unicameral officially opens in January, 2014, very much of what is going to happen there will be a foregone conclusion. (See number 4, below; near the end of the radio segment, statements from a State Senator support my assertion.)

2. Proponents of Medicaid expansion (and the health care law, generally) will not rest.

• Senators Kathy Cambpell, Bob Krist, Jeremy Nordquist, Steve Lathrop, and others, have repeatedly pledged to pursue support for Medicaid expansion – in some form – since the bill stalled during two days of debate in April.

• Several State Senators pulled a variety of maneuvers after it stalled, including attempts to end-run the State Constitution and Legislative Rules in hopes of getting LB577 passed; procedures were manipulated to use floor debate to bully Senators who were opposed or on the fence and to ensure media would keep covering the issue.

• Key proponents coordinate their efforts with one another, with members of the media, and with a reliable, loyal network of organizations and groups.

• Remember prenatal care for illegal immigrants and other ineligibles? That was a three year fight, won by Campbell, Nordquist & Co. Remember CIR “reform”? That was Steve Lathrop’s victory.

3. The executive branch administrative machine never stops. State agencies, including the Nebraska Department of Health and Human Services, will make decisions and take important actions, during the Interim.

This means, specifically, that NEDHHS will continue activities associated with implementing the health care law. Some of this is happening without Legislative authorization ³ (this is part of number 5, below). In addition, NEDHHS has some big problems – see number 6.

4. Nebraska Republican resistance – especially among State Senators – to expanding Medicaid is so weak, it’s…scary…perhaps, non-existent.

• Just one, recent example: Senator Colby Coash – a Republican – indicated on Drive Time Lincoln on June 4 formerly , that a good number of Senators, including himself, were “open” to “more information” about expanding Medicaid. He also said he thinks the Interim Study (the “Partnership”, introduced by Kathy Campbell) will be “fact based”, a dubious assumption considering the number of myths, falsehoods, and skewed statistics proponents have introduced thus far in support of their proposed boondoggle. See Linda’s series on Medicaid expansion (see bottom of article at this link) and recent “Myths and Facts” document. (Senator Coash’s contact information can be found HERE.)

• A number of Republicans, led by Senator Beau McCoy, have expressed interest in some kind of “compromise” formerly/http://www.omaha.com/article/20130428/LIVEWELL01/704289874, such as “the Arkansas plan”. MAKE NO MISTAKE: There is NO COMPROMISE when it comes to Medicaid expansion, and anyone who says there is, is not telling the truth or doesn’t know what they are talking about. (Senator McCoy’s contact information can be found HERE.)
  

• Finally, a few of the Senators who privately say they are opposed to expanding Medicaid, and even the implementation of the health care law itself, have been reluctant to make forceful, reasoned public arguments against either. It appears they are literally afraid of attacks from the media, so, they won’t make any direct or explicit statements in public.

5. Medicaid expansion is inextricably intertwined with the health care law, so Medicaid is NOT the only health care law issue about which Nebraskans should be worried.

While anyone who IS paying any attention at all to their state government is focused on Medicaid expansion, a long list of other problems in Nebraska associated with health care law implementation are being totally ignored. That list is way too long to get into here, with the exception of what’s mentioned in number 3, detailed in the document linked to the image (right), and number 6, immediately below.

6. The Nebraska Department of Health and Human Services, which would be responsible for overseeing and administering the huge expansion of Medicaid if LB577 were to pass, is literally in a shambles.

A pair of federal Inspector General reports and a pair of audits by Nebraska State Auditor Mike Foley, revealed shocking, multiple instances of multi-million dollar improper reimbursement requests and inappropriate expenditures.

• The IG report asserts that Nebraska must reimburse millions to the federal government.

• The State Auditor is going to turn information over to criminal investigators, and perhaps the Attorney General ⁴ and he’s recommended a comprehensive audit of NEDHHS.

NEDHHS currently consumes more than 40% of our annual budget. Does it seem prudent to even consider further expansion of this Department’s authority and responsibilities?

HINT: If you think it’s absurd to further empower the IRS at this point…

Celebrations are clearly premature, clearly unwise.

But, if there’s any doubt, due to lack of supporting information, I don’t intend to leave my explanation as is. I stated that I would list the reasons in brief. Because we’ve been too busy doing to write (see footnote ⁵ for a little explanation) I’m going to have to back up the reasons I listed by playing “catch up”. Meaning, this article was an outline. Now, as time allows, I’ll fill in the gaps.

Besides anything else we’ve done related to this subject, we’ve spent no small amount of time pondering and discussing what we’ve discovered along the way. Our deliberations were especially focused on what to do, what to write – or what not to write – and what might be wise to recommend.

We realize it’s quite trendy to do something, do anything, and do it right now, rather than be still, but we try to refrain if we lack clarity. “Fools rush in where angels fear to tread ⁶“ is a familiar and enduring phrase for good reason.

I hope my effort will be worth your time and attention. In the meantime, if you have any questions about anything in this article, I encourage you to use the comment box, which you’ll find by scrolling below this article a bit.

Nebraska Capitol: Rotunda, S. Dawdy; Doorway, Tarah Dawdy – attribution required

Senator Steve Lathrop: Unicameral Update

“Mystery Man”, original image from clker.com, edited by S. Dawdy