There has been a tremendous amount of media spent on the fact that Nebraska has not expanded Medicaid. Now first of all, there are only two letters that separate Medicaid and Medicare but the differences are worlds apart. Medicaid is the safety net that protects those individuals that are low income and has little to do with attaining a certain age. I mention that because many times I hear people mix the two programs. Medicaid is a state based system that is in place to provide assistance to individuals who for one reason or another, are financially challenged. So why expand Medicaid? Those in favor have a belief that individuals in this category are not able to afford to purchase health insurance and that the Medicaid system should provide these coverages. The truth is that there are many Nebraskans who for one reason or another, let’s call it pride, don’t want to be in the Medicaid system but on the other hand, can’t afford to pay the health insurance premiums on their own. These individuals are willing to pay a small premium to have private coverage. This was evident to me as I sat in our RV’s and listened to people. Many would come in and when asked how much they earned, would give a number that was obviously that would qualify them for Medicaid. When told that was the case, they would ask how much they would need to earn next year to avoid Medicaid and be able to purchase a private plan with subsidies. Many of these individuals, when told that the income threshold was a couple of thousand dollars higher, would state that they planned on working more this year and expected their income to rise to the stated level. They would then find that with subsidies, both premium and plan, the cost would require very little out of their pocket. They would then apparently call others they knew who were in the same financial situation and in a few hours, everyone coming in would ironically state that their projected income was nearly identical. I wish all marketing efforts went as smoothly as theirs did. Since these subsidies all come out of the federal coffers, doesn’t it make sense for Nebraska to allow these individuals their pride and assist them in obtaining private coverage. If Nebraska were to expand Medicaid, these same individuals would automatically fall into Medicaid or they would have to earn even more money next year to avoid that stigma. I believe that most Nebraskans would rather pay a small amount to avoid falling under a program like Medicaid that they feel is for the very poor. I once heard it said by my friend KP that the poor was anyone who makes less than me and the rich is anyone who makes more than me. Nebraskans don’t like to think of themselves as poor no matter what their incomes are. By not expanding Medicaid, our Governor has done the right thing and yet, our people are able to obtain coverage in a manner that they choose. I have also heard it said that the State is giving up Federal dollars that would have paid for this expansion. Not sure, but federal, state or local dollars still come from the same ultimate pocket, yours and mine. I don’t like the fact that in some people’s minds, getting Federal dollars is somehow a great thing. Even the subsidies, paid for by the Federal regime, are truly just yours and my tax dollars being redistributed to others. Might I ask why we just didn’t leave things alone and let my premium dollars continue to pay for those who chose not to get coverage? Too late now, cats out the bag, but let’s don’t invite more people to live under Medicaid. Let’s try to elevate everyone to stay out of Medicaid and leave it for the truly needy.