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The article about Medicaid coverage for prenatal care in Nebraska that was published in the Sunday, July 24th, Lincoln Journal Star is so full of bias, unsupported conclusions, and half-baked analysis it’s difficult to know where to begin to respond.  I’m going to take a stab at it anyway over the next few days.  But here’s the bottom line: What is described in that article is a solution in search of a problem and an elected official determined to “sell” the public on that solution, come Hades or high water.

Senator Campbell embarked on this crusade well over a year ago when some 1600 pregnant women were notified by Nebraska Medicaid authorities that the program would no longer pay for their prenatal care. About half of these women were illegal aliens. A portion of the women failed to comply with Medicaid rules, one of which requires a pregnant woman seeking Medicaid assistance to identify the father of her child to assist the state in holding him financially responsible for medical expenses and child support. Another portion of the women affected by the rule change were incarcerated. The remainder simply did not qualify for coverage because they didn’t meet the financial criteria — in other words, they either made too much money or failed to provide information about their income that is required to determine eligibility.

It’s important to note that the Nebraska Medicaid authorities did not discontinue prenatal coverage as a cost-saving measure or in an attempt to balance the state budget on the backs of the needy. The state was informed by the federal Department of Health and Human Services that the Medicaid program was never intended to cover these women. “The state apparently has been granting coverage to pregnant women based on the wrong criteria for perhaps decades.”

Senator Campbell immediately swung into action, seeking leave from her fellow senators to introduce LB1110 after the cutoff date for the introduction of new legislation. When it became clear that LB1110 lacked enough support to pass (and Governor Heineman promised to veto the measure even if it did), Senator Campbell and some of her colleagues made a rather dubious effort to “piggyback” it on an abortion bill that had wide support and pass it that way.  That plan also failed.   Down but not out, Senator “Do-or-Die” Campbell retreated, regrouped, and introduced LB599 the following legislative session to remedy the “problem.”  It failed to pass as well, but — wait for it — Senator Campbell promises to revisit the issue in the upcoming legislative session this fall.  I have to ask, Senator Campbell, what part of NO don’t you understand?

LB599 was questionable on its face.  Through that bill, Campbell proposed to spend $6.5 million dollars to cover prenatal care for the affected women. That’s approximately $4062.50 for prenatal care for each of the 1600 women involved.  That is an interesting figure given that the average cost of prenatal care for women covered by private insurance is around $1900, and, for women covered by Medicaid, the average cost is $2100. At clinics in the Lincoln area that provide prenatal care at reduced prices, the cost of prenatal care can be as low as $30 per visit or a total of $420 for an average of 14 visits typically scheduled during a normal pregnancy.

Why the steep price tag for LB599, you may ask? The answer is unclear. Perhaps, Senator Campbell’s bill would expand coverage to a broader population than the state was covering before the feds told them to stop.  Perhaps the anticipated cost of the program includes a generous advertising budget so the state can attract more “customers,” like a private company trying to drum up business.  (If you think I’m joking, you’ll be reading more about this trend right here in the very near future.)

Either way, more people covered = more cost to the taxpayer.  AND, it’s the gift that keeps on costing. LB599 would provide coverage to people making up to 185% of federal poverty guidelines.  In contrast, when the health reform law goes into effect in 2014, its provisions require every state to cover persons making up to 138% of the federal poverty level. BUT, Obamacare prevents any state from changing its existing laws and/or regulations to disqualify people who are already eligible for Medicaid in that state even if the state program covers people making over 138% of the federal poverty guidelines and even if the state can no longer afford to pay for such coverage.

So, if Senator Campbell succeeds in expanding Medicaid coverage now, we’re essentially locked in to providing such coverage into the foreseeable future.  Of course, when the state budget is bleeding red and the legislature’s back is, once again, against the wall because of its free-spending ways, I predict Senator Campbell’s voice will be among those wailing and moaning about “federal mandates.”  But we will know better.  In this instance, the federal government opened the door by allowing states to elect whether or not to cover persons making over 138% of federal poverty guidelines, but it was Senator Campbell’s choice to walk through that door and slam it behind her.  Too bad she’s dragging all of us along with her.

• Should Nebraska provide Medicaid coverage that is broader and more inclusive than that required under federal law?
• Should Nebraska use Medicaid funds to pay for the prenatal care expenses of a population that other states don’t currently cover?
• If a pregnant woman refuses to provide enough information about her income to prove she’s eligible for Medicaid, or if she refuses to identify the father of her child so the state can hold him responsible for the support of the child he helped to create, should we waive those rules and give her Medicaid benefits anyway?

If so, WHY, Senator Campbell? Inquiring minds want to know.

NOTE:  Due to the Unicameral’s redistricting, I’m no longer in Senator Kathy Campbell’s legislative district.  I have to admit, though, that I voted for her when she ran for her present office.  My sincere apologies, folks.  I didn’t know.  Honestly.  Anyway, in the spirit of goodwill, I want to dedicate the following song to Senator Campbell.  No hard feelings — much.

DOA or Resurrecting the Dead? Nordquist One World & LB1110

Strange But True: The UN is Interested in Nebraska Prenatal Care

Nebraska Deem & Pass: LB1110 Proved Shenanigans Not Limited to Federal Government

Nebraska Appleseed Not Happy: Judge Refuses Injunction

LB1110: Another Conundrum Caused By Federal Government