Nebraska’s interests have become the nation’s interests as the health reform debate reaches a critical stage in Washington, D.C., and U.S. Sen. Ben Nelson is one of a handful of key players who will determine whether the legislation helps or harms the state and the nation.
While some senators, such as Louisiana’s Mary Landrieu, have shown they are willing to sell their votes for $100 million or so, others are focusing on the big picture and not on small favors tucked inside the 2,074-page bill.
They know their vote on health reform may well be the most important they cast in their entire political careers. Their vote will impact one-sixth of the economy, the quality of health care for 300 million Americans and the financial health of our nation for dec- ades to come. The stakes could not be higher.
Sen. Nelson voted to allow the debate to proceed, giving Senate Majority Leader Harry Reid the 60th vote he needed to bring the measure to the floor.
Sen. Nelson’s next crucial vote will be deciding whether to close the debate. That is where the 60th vote counts. If Sen. Nelson votes yes, then President Barack Obama’s sweeping reform plan very likely will become law.
Here are some of the considerations that are crucial to Nebraska — and the nation:
— Health costs: Sen. Nelson says legislation must cut the costs of health care for Nebraskans and all Americans — a top priority for struggling families and businesses.
But the Congressional Budget Office released a report showing the Senate bill fails that test. It says health insurance premiums would continue to rise for people in the individual market. They would pay $2,100 more by 2016 than if no bill were passed.
While some would receive subsidies, Nebraskans would be faced with a barrage of new mandates requiring them to purchase government-designed health poli- cies or pay a tax penalty. Additionally, young people would be forced to pay disproportionately more for their insurance, causing some premiums to almost double in price.
— Cuts in payments to hospitals: Hospitals nationwide face at least $135 billion in cuts over the decade but still would be required to treat millions of uninsured people.
Sen. Mike Johanns, who opposes the Senate bill, reports that cuts to Nebraska hospitals would total $910 million over 10 years, hitting rural hospitals hardest because of their tight operating margins.
The bill would cut an additional $93 million from Nebraska nursing home payments over 10 years. And more than two-thirds of Nebraska’s home health programs would be losing money by 2016 because of $120 million in cuts.
— Unfunded mandate: Nebraska would have to add all citizens to Medicaid who earn up to 133 percent of poverty, about $30,000 for a family of four. While the federal government would pay the added costs for three years, the state could face millions of dollars of added Medicaid costs in the future.
With Nebraska’s Legislature having to make painful cuts in government spending to balance its budget under current obligations, this would surely require new taxes or more cuts to other essential programs.
— Losing your current coverage: About 60 percent of health insurance policies in Nebraska would have to be rewritten because they would not meet federal tests for the generous benefits Washington would require them to cover.
Nearly 9 million senior citizens nationwide would be faced with losing the private health coverage they have through Medicare Advantage as the program faces $118 billion in cuts. This would impact the majority of the 35,000 Nebraska seniors who have chosen these programs.
— Budget gimmickry: Sen. Reid boasts that his bill would cost “only” $848 billion over 10 years, but that is only because the bill would start collecting taxes four years before subsidies begin.
Budget expert James Capretta says actual spending for the first 10 years after implementation would be $2.5 trillion. Pulitzer Prize-winning journalist David S. Broder calls the legislation a “budget buster.” All this for a bill that would increase taxes by $500 billion, cut Medicare by $400 billion and create 118 new programs and government agencies.
Sen. Nelson could well determine whether this huge expansion of government moves forward or whether he forces his colleagues to go back to the drawing board to develop more sensible, affordable reform that works for Nebraska and the nation.
Published in the Omaha World-Herald, December 6, 2009.