What A 60th Vote Costs…

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We suspect it can be found in this language on page 98 of the manager’s amendment to the health care bill:

‘‘(3) Notwithstanding subsection (b) and paragraphs (1) and (2) of this subsection, the Federal medical assistance percentage otherwise determined under subsection (b) with respect to all or any portion of a fiscal year that begins on or after January 1, 2017, for the State of Nebraska, with respect to amounts expended for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be determined as provided for under subsection (y)(1) (A) (notwithstanding the period provided for in such paragraph)

Translation: The feds are going to pick up Nebraska’s share of the tab for the expansion of medicaid, which as we have noted here before, is a major means by which this health care bill gets close to universal coverage. But it is also going to be a big new burden on already-strapped states.

In his news conference a few minutes ago, Senate Majority Leader Harry Reid said this provision for Ben Nelson’s home state was “a minor part of the issues” that brought him aboard. Maybe so. But I’m betting there are at least 49 governors out there who wish their own Senators had been able to win that kind of minor concession.

Reid also says that, as we read the bill, we will find “a number of states are treated differently from other states. That’s what is legislation is all about.”

It is, indeed.

UPDATE: What this means to Nebraska

was summed up in this recent Omaha World-Herald article:

An analysis of the Senate bill completed by the Nebraska Department of Health and Human Services indicated that while the state’s increased Medicaid costs would be covered in the first three years after the law takes effect, Nebraska would have $45 million in extra expenses after six years, or from fiscal year 2014 through fiscal year 2019.

The state’s total budget this year is $3.37 billion.

But Igor Volsky has noted over at Wonk Room that Nebraska would be far from the state hardest hit by the expansion of Medicaid:

The Medicaid expansion would “have the biggest impact in states with high numbers of poor uninsured people and tight Medicaid eligibility standards.” Nebraska has the 23rd highest number of uninsured residents with incomes below 133% of FPL. Since the federal government would cover the first three years of Medicaid expansion, Nebraska would be required to insure some 80,000 Americans through its Medicaid program and spend “$45 million in extra expenses after six years, or from fiscal year 2014 through fiscal year 2019.”

In other words, Nebraska is not at the front lines of the Medicaid expansion controversy. Expanding the program wouldn’t come cheap but it wouldn’t overwhelm the state either.