In November, Nebraska voters will get the opportunity to vote on whether or not the government should provide more low-income residents health insurance. But a new lawsuit from Republican lawmakers is trying to deny voters their say.

Should Nebraska residents vote to expand Medicaid eligibility to 138 percent of poverty level, an estimated 90,000 people statewide will gain health care.

Nebraska is one of four states aiming to expand Medicaid insurance this fall. The others are Utah, Idaho, and Montana (Montana already participates in Medicaid expansion under the Affordable Care Act, but the expansion is set to end in 2019). Maine was the first state to expand insurance by will of the voters, but Gov. Paul LePage (R) has done everything in his power to prevent implementation. Nebraska lawmakers are now similarly following suit.

State Sen. Lydia Brasch of Bancroft (R) and former Sen. Mark Christensen of Imperial (R) filed a lawsuit in a federal court on Tuesday after Medicaid expansion supporters collected more than 133,000 signatures — well above the required minimum of 85,000 — to put the issue before voters in the November ballot.


Medicaid expansion campaign manager Meg Mandy called the lawsuit “a desperate attempt to block the people’s ability to voice their opinion on this issue.”

(3/3) This is clearly a desperate attempt to block the people’s ability to voice their opinion on this issue and ensure affordable healthcare for 90k Nebraskans. 135k Nebraska voters demanded this be on the ballot in November and we will fight for their right to vote and be heard https://t.co/7bX32wlGT3 — Meg Mandy (@megmandy) July 10, 2018

One of two plaintiffs, Brasch believes that expanding Medicaid will have a “negative impact” on property taxes. And Mark Christensen — who once introduced a bill to allow teachers to carry concealed guns after a local high school shooting — is concerned expansion will reduce or alter his son’s existing Medicaid benefits.

“The allegations upon which their standing is based are undermined, if not contradicted, by the facts associated with Medicaid expansion,” said Director of Health Policy for the National Health Law Program (NHeLP) Leonardo Cuello.


The federal government pays for the bulk of Medicaid expansion, unlike regular Medicaid — and so saves money by covering the uninsured. In Nebraska, the state pays roughly 47 cents for every $1 spent on regular Medicaid, compared to just 7 cents for every $1 spent on Medicaid expansion in 2019. The plaintiffs are speculating that once residents vote for Medicaid expansion, state spending will go up as the public program will become a budget buster. But that’s not necessarily true and runs contrary to states that expanded Medicaid and saw a budget boost as a result.

The lawsuit also tells the judge to block the ballot measure for a host of constitutional and regulatory reasons, suggesting plaintiffs are just trying to see what sticks. For example, the lawsuit contends the ballot violates the state constitution by asking voters to decide on two separate issues: expand Medicaid and maximize federal funding. But in reality, what the ballot says is that Nebraska is leaving federal dollars on the table by not expanding Medicaid, so lawmakers should expand. In other words, the second issue plaintiffs are referring to simply describes what Medicaid expansion actually does.

Nebraska lawmakers’ actions resemble Maine’s, where the governor has resisted to start the process to give health care to 70,000 residents, even after 59 percent of voters cast their ballots for Medicaid expansion. The Maine Supreme Judicial Court will take up a lawsuit next week on the matter, where the LePage administration will argue the state cannot implement Medicaid expansion without the legislature appropriating funding.

The funding issue may not be a problem for Utah and Montana, as the ballot measures include specific funding sources to pay for the state’s share of expansion.

“The fact that we now have at least 4 states seriously considering expansion through ballot initiatives is proof positive that health care has become a political football,” Cuello told ThinkProgress. “Instead of doing what is good for the health of Nebraskans and the state of Nebraska, politicians are playing politics — and so the people are forced to take matters into their own hands because their leaders have failed them.”

The Supreme Court ruled in 2012 that states don’t have to implement the ACA’s Medicaid expansion. Seventeen states have declined to do so thus far. Nebraska’s Republican-dominated legislature rejected six previous attempts to expand insurance largely for people of modest means and with disabilities.