Nebraska’s health marketplace
Nebraska uses the federally facilitated health insurance exchange, but with a marketplace plan management model, which means the state oversees various aspects of the plans available for sale in the exchange.
Open enrollment for 2020 health plans has ended, although Nebraska residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
Medica is no longer the only insurer offering coverage through the Nebraska exchange. Bright Health joined the exchange statewide for 2020. Medica had proposed an average rate decrease of 5.3 percent for 2020, but later revised it to a 6.9 percent average decrease.
Medicaid expansion in Nebraska
Voters in Nebraska approved a Medicaid expansion ballot initiative in the 2018 election. So the state is in the process of expanding Medicaid, with the specifics submitted to the federal government for review in late 2019. But enrollment won’t begin until August 2020, and the earliest available effective date will be October 2020 — nearly two years after voters approved the expansion ballot initiative.
The expansion will mean coverage for about 86,000 Nebraskans, and the federal government will pay 90 percent of the cost.
Read more about Nebraska’s Medicaid expansion.
Short-term health insurance in Nebraska
Nebraska law limits short-term plans to terms of less than 12 months. That’s in line with the new federal rules on short-term health plans.
The state does, however, require short-term plans sold in the state to be filed with the department of insurance, to cover state-mandated benefits and comply with the state’s internal and external appeal requirements.
Read more about short-term health insurance in Nebraska.
Nebraska and the Affordable Care Act
Nebraska’s current senators, Republicans Ben Sasse and Deb Fischer, were not in the Senate in 2010 when the ACA was enacted. But both voted yes on all three ACA repeal measures that the Senate considered in July 2017: The Obamacare Repeal Reconciliation Act, the Better Care Reconciliation Act, and “skinny” repeal.
In the House, all three Nebraska Representatives supported the American Health Care Act (AHCA), an ACA repeal effort that passed the House in May 2017 but stalled when the Senate was unable to pass any of their versions of the bill.
Former Gov. Dave Heineman was also opposed to the ACA, calling it an “unaffordable, unsustainable, regulatory nightmare” Heineman ended his tenure and was replaced in January 2015 by Pete Ricketts.
Gov. Ricketts is also opposed to the ACA, and favors many of the reforms preferred by the GOP: tort reform, expanded HSAs, and tax credits to help purchase insurance. He is opposed to Medicaid expansion and had vowed to continue Gov. Heineman’s rejection of expanding the program, but voters circumvented the state legislature with a Medicaid expansion ballot initiative. And although Heineman’s administration is implementing a more complicated version of Medicaid expansion, and taking a long time to get it done, the process is moving forward.
How has Obamacare helped Nebraskans?
Nebraska opted for a federally facilitated health insurance exchange and did not accept federal funding to expand Medicaid under the Affordable Care Act. Both tend to be indicators of reluctance to the health reform law.
However, the state was already performing better than most in the nation as far as pre-ACA uninsured rates go, and once the law’s key provisions took effect, it continued to do so.
Prior ACA implementation, the uninsured rate in Nebraska was 11.3 percent, according to US Census data. By 2018, it had fallen to 8.3 percent, which was a little lower than the national average — despite the fact that the state hadn’t expanded Medicaid.
Does Nebraska have a high-risk pool?
Before the ACA, individual health insurance was underwritten in nearly every state, which meant that pre-existing conditions could prevent a person from obtaining a policy, or could result in significantly higher premiums or policy exclusions. The Nebraska Comprehensive Health Insurance Pool (NCHIP) was created to give people an alternative if they were unable to obtain individual health insurance because of their medical history.
Now that the ACA has been implemented, all individual major medical health insurance plans are guaranteed issue, making high-risk pools largely obsolete, and NCHIP closed on December 31, 2013. The program is now only available for people who are under 65 and on Medicare due to a disability.
Medicare enrollment in the state of Nebraska
Nebraska Medicare enrollment reached 347,400 as of late 2019. Medicare beneficiaries in Nebraska can select a Medicare Advantage plan instead of Original Medicare; there are pros and cons with either choice. About 15 percent of the state’s Medicare enrollees did so in 2018, which was well below the national average.
About 59 percent of the state’s Medicare beneficiaries are enrolled in stand-alone Medicare Part D plans, which provide prescription drug coverage.
Nebraska health insurance resources
Nebraska’s state-based health reform legislation
Here’s a summary of state-level Nebraska bills related to health reform: