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Ben Nelson's Medicaid concerns questioned


Sen. Ben Nelson (D-Neb.) talks with reporters after a Senate Democratic caucus meeting at the U.S. Captiol. (Chip Somodevilla/Getty Images)

By Alec MacGillis
Nebraska Sen. Ben Nelson, the final Democratic hold-out on health-care reform legislation, said Thursday that his opposition to the bill extends beyond the use of federal subsidies for abortion-covering plans to the impact that expanding Medicaid will have on the finances of his home state.

A Medicaid expansion would "create an underfunded federal mandate for the state of Nebraska," Nelson told a Nebraska radio station. Instead of mandating that Medicaid cover everyone up to a certain level, as the House and Senate bills now do, he argued that states should be permitted to "opt out" and find other means of covering their poorest residents.

Health-care policy experts say that Nelson's concerns have little basis -- and that, in fact, Nebraska could make out better at the end of the day than many other states.

As it now stands, states and the federal government share the cost of Medicaid on a scale based on their wealth, with richer states paying half and poorer states paying a quarter or less. Nebraska pays 40 percent. States have widely varying levels of eligibility for their residents.

Under the legislation, much of the extension of coverage would be accomplished by raising the threshold for Medicaid eligibility to a uniform level across the country -- to 133 percent of the poverty level in the Senate bill, and 150 percent of the poverty level in the House bill.

To keep this expansion from burdening already-strapped state governments, the bills call for the federal government to pick up nearly the entire cost of covering newly eligible people -- 91 percent of the cost in the House bill, and even more of it in the Senate bill.

The Senate bill would have the federal government cover all newly eligible people until 2016, at which point its share would begin to decline, to 92.8 percent by 2019 in the case of Nebraska. These terms would cover the first 10 years of the bill, then be revisited.

To be sure, any added cost to state governments is nothing to sneeze at in a time of strapped budgets, notes Chris Whatley, director of the Council of State Governments. "It's not going to break states, but it's going to be a significant cost factor," he argues.

But others note that representatives of other states have far more justification to be outraged at the terms of the legislation than does the senator from Nebraska.

Many states are already covering people below the 133 or 150 percent of poverty threshold, at great cost to their taxpayers. Under the legislation, states that have been stingy -- Nebraska covers parents to only 58 percent of poverty, and does not cover childless adults -- will be able to cover their low-income residents with the feds picking up more than 90 percent of the cost. Meanwhile, many more generous states -- mostly those in the Northeast and Upper Midwest -- will still be paying as much as 50 percent of the cost to cover people at the same income level.

States like Nebraska "have to come up with the extra money, so you can view it as a burden, but on the other hand, a ton of federal dollars are coming in to pay for these people, so it's an economic gain in that sense," said John Holahan of the Urban Institute. "This is a really ridiculous thing for anybody to complain about... The bottom line is, Nebraska comes out great on this."

By Web Politics Editor  |  December 18, 2009; 2:55 PM ET
Categories:  44 The Obama Presidency , Health Care  
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Comments

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Posted by: fozzy13mailbox-ler | December 23, 2009 5:01 AM | Report abuse

I watched Senator Ben Nelson's statement on Saturday morning and the body language was awful. He looked like a political prisoner who had been forced to recant his beliefs. He looked down and rarely made eye contact while speaking in an unenthusiastic monotone. He has kind of disappeared since then.

I took an undergraduate course in constitutional law and know only enough to be dangerous but it seems that granting one state an exemption from the costs of a federal program and not giving it to the other states might create problems under the Equal Protection clause.

Posted by: danielhancock | December 21, 2009 12:03 PM | Report abuse

Ben Nelson, There can't be a reason NOT to allow every single American to read, examine, and discuss with out senators and Congressmen any concerns with the bill.

It is MY job as an American to find the pork and to squawk and try to trim the fat. We have to do it in our own homes...why not now with pork barrel spending that makes us working stiffs sick to our stomachs.

Where is the bill? I need to pull it up online and get to reading it! WHERE IS IT?

Posted by: easttxisfreaky | December 21, 2009 1:46 AM | Report abuse

Ben Nelson, There can't be a reason NOT to allow every single American to read, examine, and discuss with out senators and Congressmen any concerns with the bill.

It is MY job as an American to find the pork and to squawk and try to trim the fat. We have to do it in our own homes...why not now with pork barrel spending that makes us working stiffs sick to our stomachs.

Where is the bill? I need to pull it up online and get to reading it! WHERE IS IT?

Posted by: easttxisfreaky | December 21, 2009 1:46 AM | Report abuse

"As it now stands, states and the federal government share the cost of Medicaid on a scale based on their wealth, with richer states paying half and poorer states paying a quarter or less."

Of course the people in those richer states pay greater federal taxes that pay for the fed's share of Medicaid. So they, in effect are paying for their own lesser federal share as well as the greater federal share of other states. Furthermore in many of the "poor" states, 150% of poverty buys an almost middle class existence relative to the "wealthy" states where that amount of income, after taxes, won't pay the rent. At least the federal subsidies for health insurance will now lessen the perverse world where government policy makes the "poorer" actually richer than some officially considered as such, that is if accounting reflecting reality is done on the question.

Posted by: jskdn | December 19, 2009 11:08 AM | Report abuse

"

Clearly, Nelson's hemming and hawing over Nebraska's "extra burden" of providing for its Medicaid population means one of two things: either he's trying to extort more than his state's fair share of federal largesse (so much for his "concern" about the impact of health-care reform on the US budget) or this is just one more smokescreen for his real aim--which is to protect the interests of the health insurance companies for which he is a gopher. That's probably the same reason he's in such a snit over abortion.

Make one concession to him, and he'll think up another reason to play hard to get.

What a pious old skinflint! We really do need to pull the rug on these horsetraders and impose serious restrictions on the filibuster rule.

Posted by: jm91"

The thought that those oppose Obama, Reid and Pelosi's vision of health care "reform" as hired hands of insurers would be a powerful argument. IF IT WEREN'T FALSE!
Senator Ben Nelson has received 5 times less in contributions from the industry than Senator Reid or ultra-liberal Senator Schumer. If you review the campaign contributions from insurers (and every segment of health care distribution), you notice the list is heavy on Obama and Democrats.
http://www.opensecrets.org/industries/recips.php?ind=H03&cycle=2010&recipdetail=S&mem=Y&sortorder=U

Posted by: cprferry | December 18, 2009 11:50 PM | Report abuse

I'm just a near 85 year-old man wondering why this strange looking senator from Nebraska is holding the health care reform legislation captive, even in the face of the column pointing out that Nebraska will not be hurt if the legislation is enacted.

Also, Nelson and other pro-lifers have turned reform into a campaign against abortion.

However, when I learned that Nelson at one-time served as an executive with the insurance industry, I scratched my head and asked, "Is it possible that abortion and Medicare are merely stalking horses for Nelson, whose primary interest lies in protecting the insurance industry, say like Mutual of Omaha?"

I'm thinking of taking up a collection to buy this selfish, egotistical lacky for the insurance industry a decent wig. Where did Nebraska voters discover this character. Now I know why so many citizens want term limits for members of congress

Posted by: fgerard | December 18, 2009 9:38 PM | Report abuse

Nelson is the servant of three masters: the Vatican, the insurance companies by which he's paid millions, and BIG PHARMA, which contributes heavily to his campaigns.

The exact figures are readily available on the web via Google. As for his Vaticanism, he's repeatedly said he would sign of on nothing of which the "bishops" did not approve.

There would seem, then, to be massive conflicts of interest. An investigation into Nelson's Vatican, insurance co., and Big Pharma connections should be launched and his arse removed from the Senate.

Posted by: Farnaz1Mansouri1 | December 18, 2009 9:25 PM | Report abuse

Cracks me up to see you all call people from farm states 'rednecks'!! You have no clue!
About the rodents: I wouldn't want to meet your eastern RATS!

Posted by: houston123 | December 18, 2009 8:19 PM | Report abuse

Another grandstanding dork from a state with more rodents than voters. Forget getting rid of the filibuster. How about a unicameral legislature.

Posted by: douglaslbarber | December 18, 2009 7:54 PM | Report abuse

Further proof, that the jingoistic, uber-patriotic rhetoric by the republicans is just that, empty rhetoric. The republicans/conservatives don't care about human lives, concerning military operations nor domestic welfare. How can anyone support a party whose ultimate goal is political gamesmanship to keep the status quo? Democrats are not much better, being to spineless to hold up to their ideals. Negotiating like a bunch of dithering do-nothings.
People who support this type of buffoonary need to really look at what they are contributing too. This is the type of crap that makes government so inefficient, in particular the Senate. At least this debate on health care opens the eyes of the aveage lay person to realize how Senators have become the House of Lords and that this so-called aristocratic bunch believe they can play games while people are dying here and abroad. They have totally forgotten that they are supposed to be representatives of the people.
I suggest starting a movement for a total recall of the Senate of both Republicans and Democrats.

Posted by: FeComments | December 18, 2009 7:24 PM | Report abuse

This guy needs to go. Besides, he may need abortion services if the choir girls or altar boys makes that special call to him. This man is as low as the obstructionists from the fringe GOP party.

Posted by: revbookburn | December 18, 2009 7:06 PM | Report abuse

Nelson wants to gut the health are bill--to see it cover even fewer of the uninsured than it will now.

He, like so many others Senators with Cadillac health care, has little concern for the truly hurting.

Posted by: tinyjab40 | December 18, 2009 5:26 PM | Report abuse

How could a man with such a poor toupee hold an entire nation hostage?

Posted by: rugspotter | December 18, 2009 5:24 PM | Report abuse

Sirius2: The American taxpayer takes the hit for farm welfare, of which Nebraska gets boatloads.

Will Nelson filibuster the round of farm welfare for Elmer Fudd? Or is socialism bad only when it goes to working Americans?

As for reading the bill, Congress had only had only 3 days to read the USA Patriot Act. It was introduced in the House on Oct. 23, 2001, brought to the floor that day, and passed the next day, Oct. 24. The Senate passed it on Oct. 25. W signed in on Oct. 26.

Where were the complaints from the conservatards then about not being able to read the bill? Ooops, shredding the Constitution just isn't important to the conservaturds. Denying the American pubic health care and all that mumbo jumbo liberal socialism stuff Jesus Christ talked about is important to the right.

Posted by: Garak | December 18, 2009 5:23 PM | Report abuse

If the GOP hasn't read the bill then why do they oppose it unanimously? For all they know it could say that Democrats will be banned from Government.

Posted by: JRM2 | December 18, 2009 5:15 PM | Report abuse

"McCain complained that while "every single major reform bill that's been passed in the history of this country has been bipartisan ... there's no bipartisanship here. There's no negotiation. There's no conversation."
---
What a croc, they have had 10 months and have done nothing but obstruct.

Medicare?, Social Security?, all these benefits that these jerks enjoy were passed with virtually NO help bi-partisanship from Republicans.

Bi-partisanship is a two way street John.

McCain is getting worse every day with his lies.

Posted by: JRM2 | December 18, 2009 5:14 PM | Report abuse

Here we go again, "no one has read the bill", how idiotic is that. Just because you choose to NOT read does not mean it has not been read. I mean, let us wait until every republican reads the bill? gimme a break. This bill could be as short as one page or as long as the bible, the republicans would still vote NO, these republicans are blindlessly and mindlessly voting NO. READING NOT REQUIRED.

Posted by: MikeQ2 | December 18, 2009 5:04 PM | Report abuse

sen ben nelson-- a true profile in courage

dem sen ben nelson's lone stand against obamacare has riveted the pro-life community

all the other dems have either backed obamacare,

or been bought off with he appropriate amount of landrieu

except

sen ben nelson (d. neb)

who, alone, stands against obamcare's mandatory abortion coverage as

a matter of HONOR--which of course puzzles and confuses team obama who have grown accustomed to landrieu

so obama summons ben nelson to the white house repeatedly for "consultations"

and ben nelson still stands for unborn babies

if sen nelson stands for unborn babies he will have a living legacy that will bless america long after all the dem pro abortion hacks are

dust


and republicans-- you should stand with ben nelson and protect him from any thug team obama's threats

Posted by: ProCounsel | December 18, 2009 4:41 PM | Report abuse

Here is the filibustewr rule: You must filibuster! Stand there and talk endlessly, day in and day out. The way it sits now all Lieberman or Nelson or Lincoln or Landrieu has to do is get all the perks of the majority, democrat caucus, then threaten to join the republicans on a procedural vote, mind you now, just a procedural vote, and BANG everything comes to a halt. TAKE THE VOTE and let the filibuster with the republicans. Oh, by the way, when you come back from filibustering, you are considered lower than a cockroach, certainly not a chairman.

Posted by: MikeQ2 | December 18, 2009 4:40 PM | Report abuse

Dear Mr. MacGillis,

Thanx for doing the work on this.

Posted by: piniella | December 18, 2009 4:39 PM | Report abuse

Ben Nelson MIGHT have had a valid point -- if he had raised it months ago.

But the reality is that his number 1 and number 2 concerns, not necessarily in that order, are serving the interests of his lifelong friends in the insurance industry and pandering to the religious zealots.

Clearly, Senator Ben Nelson, former CEO of an insurance company and regulator of insurance companies, has no honest interest in promoting access to health care to the public at large. If he had, he would have contributed something to the discussion, and would have done so a lot earlier.

It is also worth noting that while he may hold a strong personal belief opposing choice, he is a Methodist, and over 35 years ago the United Methodist Convention declared officially, in writing, and has reiterated that women should have the right to choose.

Of course, both Ben Nelson and Joe Lieberman, another religious fraudster, can take comfort in knowing that they, personally, have been doing their level best to keep tens of millions of Americans from improving the quality of their lives -- like, in many cases, KEEPING their lives.

But if there is a God, then I don't think that she will be merciful to people who go out of their way to cause physical harm to thousands of people.

Posted by: edallan | December 18, 2009 4:37 PM | Report abuse

So, steveandshelley, your argument is that politicians KNOW BETTER than their constituents what is best for them?????

As I understand it, no one even KNOWS what's in the bill, as Harry Reid hasn't allowed anyone to see the Manager's Amendment yet (because to do so would require the CBO to make their findings public...this way, if the news is bad (and Harry must expect that it will be, to keep everything so hush-hush)he can keep it to himself.

I remember there was a time when Bill Clinton suggested that he knew better than the people how best to spend their money...I don't recall that going over really well.

For the first time that I can recall, people actually are engaging and educating themselves on this topic of health care, and they DO GET IT....they do understand its implications.


Posted by: boosterprez | December 18, 2009 4:34 PM | Report abuse

People in Nebrasaka oppose this bill by a margin of 2 to 1 because two out of three Nebraskans don't have a friggin' clue what's in the bill and they're swallowing the standard Republican line. (I say that as a Nebraskan.) And for Nelson to vote according to the opinion polls is mostly definitely NOT in the "the best interest of his constituents." It might be in the best interests of his re-electablity. But he'd be selling out the best interests of this constituents.

Posted by: steveandshelley | December 18, 2009 4:27 PM | Report abuse

I wish Nelson would grow a pair and acknowledge the REAL reason he opposes this bill: Because, by a margin of 2 to 1, people in Nebraska oppose this bill, and therefore he's acting in the best interest of his constituents.

Isn't that what our elected officials SUPPOSED to be doing???

Posted by: boosterprez | December 18, 2009 4:17 PM | Report abuse

The following statement is so nonsensical, I can't believe anyone would take it seriously. Here it is:

"States have to come up with the extra money, so you can view it as a burden, but on the other hand, a ton of federal dollars are coming in to pay for these people, so it's an economic gain in that sense," said John Holahan of the Urban Institute.


So it will be an extra burden for the states, but it won't because the federal government is giving the states money, only they aren't covering everything, thus the states will have to cover the extra burden that the guy I quoted specifically states will exist before he dismisses it as no big deal. Furthermore, even if it won't effect Nebraska, it is explicitly mentioned that other states will be drastically affected by new Medicaid guidelines, so in essence there will be an added burden no matter how you cut it. And this is supposed to be a piece that argues that Nelson is odd for opposing the new Medicaid expansion? What an epic failure. If anything it is a case as to why more Senators aside from Nelson should be opposing such a terrible bill.

And as the individual above me pointed out, even if the money is provided overwhelmingly by the federal government rather than the states, it doesn't change the fact that this is an additional burden on the taxpayer. And I thought this was supposed to decrease costs. Those who are arguing in favor of this bill would be wise to keep their "defenses" to themselves because the more people read them, the more unpopular an incredibly terrible bill becomes.

Posted by: Bob65 | December 18, 2009 3:51 PM | Report abuse

Clearly, Nelson's hemming and hawing over Nebraska's "extra burden" of providing for its Medicaid population means one of two things: either he's trying to extort more than his state's fair share of federal largesse (so much for his "concern" about the impact of health-care reform on the US budget) or this is just one more smokescreen for his real aim--which is to protect the interests of the health insurance companies for which he is a gopher. That's probably the same reason he's in such a snit over abortion.

Make one concession to him, and he'll think up another reason to play hard to get.

What a pious old skinflint! We really do need to pull the rug on these horsetraders and impose serious restrictions on the filibuster rule.

Posted by: jm917 | December 18, 2009 3:34 PM | Report abuse

So what if states do not take the hit - the Federal government does and that means more taxes from hard-working Americans!

We cannot continue to give, give, give to those who represent themselves as "poor" -
because they rape the system for every penny they can from US taxpayers.

Stop the hand-outs! Send the poor into jobs in agriculture and other industries.

Make them work for a change - stop stealing from hand-working taxpayers.

Posted by: Sirius2 | December 18, 2009 3:12 PM | Report abuse

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