Nebraskans take action to prepare for Medicaid expansion vote

On Sept. 13, in York and Albion, Nebraska, dozens joined community conversations about Medicaid expansion and how it could positively impact their communities. Local residents, hospital CEOs, doctors, and legislative candidates engaged with staff from the Center for Rural Affairs to ask questions and learn more about expansion. Initiative 427, the ballot initiative to expand Medicaid, will be put before Nebraska voters in November’s election.

As shared during the meetings, voting yes on Initiative 427 would expand Medicaid eligibility to 90,000 Nebraskans according to the Insure the Good Life Campaign. Currently, these residents fall into the “coverage gap” which means they earn too much to be eligible for Medicaid and too little to qualify for subsidies to purchase health care coverage through the insurance marketplace. Many meeting attendees could identify personally with those who fall in the insurance coverage gap – often their own colleagues and employees who work in local nursing care facilities, on farms, or at the cafe on main street.

Across the nation, 34 states have adopted Medicaid expansion – yet Nebraska is one of only a handful of states that is taking expansion to a vote of the people. Rural states, like Iowa and Indiana, have expanded Medicaid coverage to those in the gap and have seen a reduction in the number of uninsured residents, state cost savings, and a healthier population. Medicaid expansion has also proven to be a lifeline for rural hospitals that struggle with the financial implications of providing uncompensated care to those without health insurance or Medicaid coverage. This year, four states – Nebraska, Montana, Idaho, and Utah – have ballot initiatives underway to expand Medicaid.

As November inches closer, Nebraskans have the opportunity to understand what Initiative 427 means for 90,000 of their neighbors. By hosting community conversations, the Center for Rural Affairs staff seeks to provide rural residents with non-partisan analysis and to answer questions.

The Center is hosting more community conversations about Medicaid expansion around the state – residents are encouraged to join us in Pender, Nebraska, on Oct. 15 at the Pender Community Center.

If you would like to request a meeting in your community, please reach out to us by emailing Your vote is important and will determine the future of our state.