Nelson’s Bizarre Medicaid Objection


In addition to his abortion objections, Ben Nelson has developed a late-breaking concern that health reform’s Medicaid expansion provisions could force huge new costs onto the budget of Nebraska. But Alec MacGillis points out that the authors of the legislation already thought of this:

To keep this expansion from burdening already-strapped state governments, the bills call for the federal government to pick up nearly the entire cost of covering newly eligible people — 91 percent of the cost in the House bill, and even more of it in the Senate bill.

The Senate bill would have the federal government cover all newly eligible people until 2016, at which point its share would begin to decline, to 92.8 percent by 2019 in the case of Nebraska. These terms would cover the first 10 years of the bill, then be revisited.

When you consider what a large role Senators Max Baucus of Montana and Kent Conrad of North Dakota had in crafting this legislation, there’s very little ex ante plausibility to the idea that the Senate bill would screw-over large sparsely populated plains states. Nebraska would have to be really crazy to not participate in this structure.

Let me also note that this whole process has been going on for months and Medicaid expansion has been at the core from the beginning. Nelson has had plenty of opportunity to try to come up with ideas on this score, and didn’t. The bill is also phased in very slowly, so if he wants to tweak the details of financing Medicaid expansion he could easily do so in 2010 or 2011 or 2012 or 2013 or 2014 or 2015 or 2016 before Nebraska has to pay a single cent on this. Derailing the process at this point over the idea that paying 7.2 percent of the cost (!) of Medicaid expansion in 2019 (!) will bankrupt the state reeks of someone who’s searching for reason to say “no.”