Why talks with Nelson go poorly

WHY TALKS WITH NELSON GO POORLY…. To hear Sen. Ben Nelson (D-Neb.) put it, if even a small number of American women are able to get indirect subsidies for their reproductive choices, he’ll have to kill health care reform. But as of yesterday, Nelson has other concerns, too.

Sounding suspiciously like someone who’s read a few too many Republican talking points, Nelson added that a Medicaid expansion would “create an underfunded federal mandate for the state of Nebraska.”

Alec MacGillis reports today that Nelson has it backwards — under proposed Medicaid expansion, his home state stands to do very well.

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.

John Holahan of the Urban Institute told MacGillis states 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. This is a really ridiculous thing for anybody to complain about… The bottom line is, Nebraska comes out great on this.”

In the larger sense, the problem is not just that Nelson is a conservative Democrat, resisting a progressive policy goal. It’s also the fact that Nelson has developed a reputation for ignoring substantive policy details. This makes it extremely difficult to explore compromise solutions with him — Nelson tends not to understand what other senators are offering. When he raises a concern that troubles him, Nelson hears the explanation of why that concern isn’t really a problem, but doesn’t really believe it because he doesn’t really understand it.

This is a classic example. Nelson probably heard a Republican tell him Nebraska would be hurt by Medicaid expansion. He believed it. When he raised the point with proponents, Nelson didn’t understand that Nebraska would benefit from the Medicaid changes.

For what it’s worth, Nelson huddled privately with Senate Majority Leader Harry Reid (D-Nev.) earlier today. After their meeting, Nelson told reporters, “Hopefully we’re making progress. As I said, there’s always a lot of room which you have to have between the bid and the ask, and we’re seeing if we can close the gap.”