Will conservative Nebraska vote to expand Medicaid?

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• INSURE THE GOOD LIFE VOLUNTEER:

  Hi Spencer, my name is Mary. I'm calling on behalf of Insure the Good Life.

• HARI SREENIVASAN:

  At a makeshift campaign office in Omaha, about a dozen volunteers are making calls in support of Initiative 427, a ballot measure to expand Medicaid in Nebraska. The group, Insure The Good Life, is behind the expansion effort that would provide health insurance to an estimated 90,000 uninsured Nebraskans. Those who make too little to get federal subsidies under the Obama-era Affordable Care Act, or ACA

• INSURE THE GOOD LIFE VOLUNTEER:

  We're very excited about the initiative and what it can do to help those people that are caught in the coverage gap.

• HARI SREENIVASAN:

  About 10 miles away it's a similar scene, but the message is very different.

• AMERICANS FOR PROSPERITY NEBRASKA VOLUNTEER:

  We would strongly encourage you to vote "no" on ballot Initiative 427.

• HARI SREENIVASAN:

  The Nebraska chapter of the conservative political group, Americans For Prosperity, or AFP, has gathered about two dozen volunteers to encourage voters to reject the ballot measure.

• AMERICANS FOR PROSPERITY NEBRASKA VOLUNTEER:

  And their not telling the public what the whole cost of it is and all.

• HARI SREENIVASAN:

  Nebraska is one of three red states, along with Idaho and Utah, where ballot measures are attempting to do what Republican leaders have not: expand Medicaid under the ACA.

  In Nebraska, Initiative 427 expands Medicaid to cover adults who make less than 138 percent of the federal poverty line, about 17,000 dollars for a single person, and about 35,000 dollars for a family of four.

  Under the healthcare law, the federal government would cover 90 percent of the cost, but Nebraska would have to pay for the remaining 10 percent, estimated to be about $125 million dollars in the first three years.

• JESSICA SHELBURN:

  When you really truly start to look at the numbers you realize that there's no way we can afford it.

• HARI SREENIVASAN:

  Jessica Shelburn is the state director for AFP Nebraska.

• JESSICA SHELBURN:

  Medicaid was intended for the most vulnerable in our society, so the elderly, disabled, low-income children, low-income pregnant women. By expanding Medicaid we are risking the resources that we have available for those individuals because we're going to have to cover potentially 90,000 or more able-bodied working adults.

• HARI SREENIVASAN:

  Shelburn represented the vote no position in a debate this week organized by a business group in the state's capital, Lincoln.

• JESSICA SHELBURN:

  This is something that as it grows, and we see more individuals enrolling on Medicaid expansion, the state just can't afford.

• HARI SREENIVASAN:

  Her opponent was state senator Adam Morfeld, a Democrat who represents part of lincoln.

• STATE SEN. ADAM MORFELD:

  I think the better question is is how can we afford not to do this

• HARI SREENIVASAN:

  Morfeld has introduced two bills to expand Medicaid. In fact, there have been six attempts to expand the program in six years. All of them failed to pass the legislature or get the support of Nebraska's Republican governors.

• STATE SEN. ADAM MORFELD:

  I think that when it comes to affordable healthcare our constituents and Nebraskans will be eminently more reasonable than our elected officials.

• HARI SREENIVASAN:

  Morfeld says expanding medicaid would not require new taxes.

  As evidence, he points to a new study by University of Nebraska researchers funded by the State Hospital Association. It found Medicaid expansion would create nearly 11,000 jobs and generate enough state and local tax revenue to pay for itself.

  Critics dispute that would be the case. And either way, if Nebraska voters approve Initiative 427, the legislature will still need to appropriate money for the state's share of the costs.

• STATE SEN. ADAM MORFELD:

  It brings in $1.3 billion in taxpayer funds over the course of three years that Nebraskans are already paying into the federal government. But that's going to other states.

• HARI SREENIVASAN:

  Like many debates around the ACA, the initiative to expand Medicaid stirs up strong feelings.

• HEARING TESTIMONY:

  You're taking it away from the most needy people to give it to people that need to get a damn job and work.

• HARI SREENIVASAN:

  Members of the public testified about the ballot measure at a state hearing this week in Lincoln.

• AMANDA GERSHON:

  I am a good example of what not having access to healthcare can lead to.

• HARI SREENIVASAN:

  Amanda Gershon didn't have health insurance for most of her adult life, including when a chronic immune disorder flared up in 2013.

• AMANDA GERSHON:

  I had been a general manager of a restaurant putting in a lot of hours and started getting incredibly sick.

• HARI SREENIVASAN:

  Gershon says she paid cash to see her doctor when she could, and went to free clinics. But getting treatment for her chronic illness without insurance was difficult.

• AMANDA GERSHON:

  Between 2013 and the beginning, up to the beginning of 2016, I just got sicker and sicker and honestly no one thought it was going to make it at that point. I did apply for disability and was blessed to get that. But that's the only way I could have gotten health care at that point.

• HARI SREENIVASAN:

  When she became unable to work and received federal disability benefits, Gershon qualified for Medicaid in Nebraska. She underwent surgery and got medication to manage her illness. But the 36-year old says, she wishes she could still be working.

• AMANDA GERSHON:

  I really believe if I could have gotten health care in 2014 I probably would have never ended up on disability.

• HARI SREENIVASAN:

  Dr. Kristine McVea is the chief medical officer for OneWorld Community Health Centers in Omaha. It sees over 40,000 patients a year; about half of them are uninsured.

  McVea says clinics like hers have fewer resources than those in the 33 states and Washington D.C., where Medicaid has expanded, including neighboring Iowa.

• DR. KRISTINE McVEA:

  So I feel like Nebraska is really falling behind. Looking at Iowa just across the river from us they have the ability to provide services to patients who fall into this gap in a much better way than we do.

• HARI SREENIVASAN:

  Advocates for Initiative 427 also say expanding Medicaid will mean more federal and state dollars to support healthcare providers in Nebraska, including hospitals and community clinics like One World.

• JESSICA SHELBURN:

  At best it is a bandaid to fix the problem. Medicaid was not designed to be a program that would help shore up our hospitals whether it be in rural urban areas.

• ADAM MORFELD:

  The great thing about laws is they change to address changing circumstances and currently there are Nebraskans that are suffering and in many cases dying because they lack affordable healthcare

• HARI SREENIVASAN:

  If Nebraska voters approve Initiative 427, Medicaid could be fully implemented in the state by the beginning of 2020.