Medicaid Expansion: Bring Our Tax Dollars Home

Update June 7, 2018: Since 2014, the Medicaid scene has changed, the information in the blog below was determined prior to the federal match reduction. For updated Medicaid information, please visit our Rural Health page and check out Rural Health notes near the bottom of the page.


Nebraska is leaving a lot of money on the table. So are other states that haven’t expanded their Medicaid program for low-income residents as the Affordable Care Act provided.

Since Jan 1, 2014, Nebraska has been forfeiting $930,096/day in federal funds that could provide health insurance for around 59,000 low-income families and individuals. As of Oct 28, 2014, the amount of forfeited federal funds amounted to over $280 million.

The results and consequences are severe.

About 59,000 Nebraskans are left in the “coverage gap.” They can’t afford private health insurance because they are unable to receive premium assistance. They aren’t eligible for traditional Medicaid coverage. And they likely work for an employer that doesn’t provide health insurance.

Those in the “coverage gap” are often unable to obtain needed medical services, checkups, and prescriptions. Their health often worsens until they become extremely ill and costly.

Hospitals and other providers are left with significant uncompensated care for the uninsured. The University of Nebraska Medical Center estimates through 2019 Nebraska will have more than $1 billion in uncompensated care without Medicaid expansion. That causes expenses for those with insurance to rise.

About 300 rural hospitals across the US are on the verge of closing due to financial issues, with a lack of Medicaid expansion as one major cause, according to the National Rural Health Association. In addition to compromising the health of rural people, a hospital closure causes job losses, lost economic activity, and lost community vibrancy in rural communities. A rural community hospital closure costs about $1,000 in per capita income. Every man, woman, and child in a rural community loses when the hospital shuts down.

Our research has shown that insurance premiums are higher in Nebraska compared to Iowa, an expansion state. Again, the decision not to expand Medicaid is costly for all Nebraskans.

Forfeiting nearly $1 million per day means Nebraskans are helping to pay for the health insurance of residents in 28 states and the District of Columbia who have chosen to implement the Affordable Care Act and provide coverage for their low-income residents. Nebraska taxpayers are paying the bill for New Yorkers, Californians, Coloradans, Iowans, and others with none of the benefits. 

Please check out medicaidcounter.org to view how much Nebraska is losing every second, and how some other non-expansion states compare. It is time for Nebraska to bring our tax dollars home!