Number of Nebraskans with health insurance declined in 2016, but expert says it could be a blip

The number of Nebraskans without health insurance rose slightly last year for the first time since the Affordable Care Act became law, according to data from the U.S. Census Bureau.

After three years of decline, Nebraska’s uninsured rate grew in 2016, from an estimated 8.2 percent in 2015 to 8.6 percent last year, the Census Bureau said. That increase amounted to about 6,800 more uninsured people in the state, the bureau indicated. In the three years since the Affordable Care Act became law, only South Dakota in 2015 and Washington, D.C., in 2016 saw their rates increase in any year.

The numbers come from a survey of a sampling of the population, and a local census expert cautioned that the shift is too small to be statistically significant.

Still, the data suggest certain groups are having a harder time getting insurance in Nebraska: young adults, middle-class individuals and people with disabilities.

All three groups tend to fall into what some call “the Medicaid gap” — meaning they might earn too much to qualify for Medicaid but not enough to receive federal subsidies in the health insurance marketplace.

According to Amy Behnke, CEO of the Health Center Association of Nebraska, a nonprofit association of federally qualified community health centers, the problem may have been compounded by Nebraska’s decision not to expand Medicaid.

“(It) could be the ones who remain uninsured are difficult to insure,” Behnke said. “Maybe they fall into the gap because we haven’t expanded Medicaid and there isn’t a way to insure them in the current system we have.”

While 32 states have expanded Medicaid since the ACA went into effect, proposals to do so in Nebraska have been rejected by the Legislature, and many Republicans remain opposed.

“Medicaid expansion would preference able-bodied individuals over our most vulnerable citizens in our existing Medicaid program, and it would also expose our state budget and Nebraska taxpayers to great, long-term financial risks,” Gov. Pete Ricketts said in a statement.

The rising cost of health insurance continues to be an issue.

“I would tell you that this is a trend that we’ve seen coming ever since the Affordable Care Act was passed,” said State Sen. Mark Kolterman of Seward, a former insurance agency owner.

“I think the reality is that health insurance is unaffordable.”

According to Raina Gulbrandson, a social worker at Easterseals Nebraska, there are many gaps in information regarding health insurance programs, and many people never find the programs they qualify for.

“People who might be eligible or at least should be evaluated for the program are often not even referred to the right personnel,” Gulbrandson said.

Said Brad Meurrens, policy director at Disability Rights Nebraska: “For a lot of people I know with disabilities, it’s not easy for them in terms of insurance.”

David Drozd, research coordinator for the University of Nebraska at Omaha’s Center for Public Affairs Research, urged caution in interpreting the survey numbers. He noted that the state’s uninsured rate had fallen by significant margins every year since the ACA became law, dropping from 11.3 percent in 2013 to 8.2 percent in 2015.

The 2016 uptick in uninsured could be more of a blip, Drozd said, than an indication of significant growth in the state’s uninsured population.

There are signs that the uninsured rate could continue to rise. Open enrollment begins Nov. 1 and ends on Dec. 15, more than a month earlier than the previous deadline of Jan. 31.

Besides the shorter enrollment period, Nebraska’s lone health insurer, Medica, plans average premium increases of 31 percent.

And the Trump administration has moved to halt payments to insurers that offset the cost of covering lower-income people.

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