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Grace: Columbus, Nebraska’s Medicaid vote was a battle of ‘people need help’ vs. ‘get off your butts’

November 12, 2018

COLUMBUS, Neb. — Finishing her beer at Nebraska’s oldest still-running tavern, a place that had been in her family for years, 74-year-old Cathy Hoops considered the state’s recent vote to expand Medicaid. And her own vote no.

Cathy says she’s not against helping, not unsympathetic to hard luck. But after 44 years of working in the kitchen of Scotus Central Catholic Junior Senior High School, Cathy can’t shake the feeling that circumstances are tied to elbow grease.

“Maybe a lot of us aren’t fully understanding of this whole thing,” she said Thursday night at Glur’s as she pored over this newspaper’s stark front-page map. It showed the counties where Medicaid passed (just eight, including population centers in Douglas, Lancaster and Sarpy) and where it did not (85 Nebraska counties, including hers: Platte).

“There’s just so many jobs!”

Husband Milt, who at 74 is still working — he makes car seats at the Camaco factory, one of several manufacturing plants in this blue-collar town — put it more directly: “There’s no work ethic. It’s all, ‘Give me.’ ”

This was the prevailing attitude among people I met in Columbus on Thursday, two days after a near-record number of Nebraskans went to the polls in part to decide whether to expand a federal-state safety net program that provides health insurance for the poor. Medicaid expansion means 90,000 more Nebraskans could get health insurance.

It applies to those earning no more than 138 percent of the federal poverty level, or $16,753 annually for a single person and $34,638 for a family of four. Noncitizens would not be eligible.

For years, Nebraska’s lawmakers rejected the idea, declining millions of federal dollars to pay for the expansion allowed under the Affordable Care Act.

This time around, the issue was brought directly to voters through a ballot initiative called 427. On Tuesday, 53 percent of Nebraska voters said yes to Medicaid expansion. Majorities were especially pronounced in Douglas and Lancaster Counties, where Initiative 427 passed by 62 percent in both places. It passed even in beet-red GOP Sarpy County with 54 percent of voters saying yes.

But if you look at Thursday’s World-Herald map, it’s clear that outside Omaha, Lincoln and just a handful of other places, most Nebraskans not only said no, but hell no.

To better understand those no votes, I drove 90 miles northwest of Omaha to Columbus, encountering a “rural” Nebraska place that feels hardly rural at all, with its 22,000 people. The city has a mix of old buildings (a still-intact charming downtown bedecked for Christmas with wreaths and light-up candles on street lamps) and new ones (plenty of retail including a Panda Express, a new high school and a shiny YMCA-rehab facility jam-packed with families at 5:30 p.m.).

Columbus sits in Platte County, which is “not that rural by Nebraska standards,” said David Drozd, demographer at the University of Nebraska at Omaha. Pulling from census data using 2016 figures that take into account a five-year average, Drozd painted a picture of a place that has lower poverty than the state as a whole, 8.7 percent to the state’s 12.4 percent; a lower rate of uninsured people, 8.9 percent to the state’s 9.7 percent.

Unlike the rural Nebraska narrative of shrinking population, the county has enjoyed stability despite a decrease in its white population. Hispanics now make up one out of every five residents.

Platte County has remained a GOP stronghold, and the Medicaid vote hews somewhat to party divisions — though not by as much as might be expected. While nearly 8 out of 10 Platte County residents voted to re-elect Republican Gov. Pete Ricketts, about 6 out of 10 voted against the Medicaid expansion.

Platte County voters echoed familiar conservative themes: Too expensive. Too much government. Too much opportunity for the wrong people to get help while the right ones never catch a break. And when does individual responsibility kick in? If one job isn’t enough, try two.

Chad Van Cleave, vice president of finance at the 47-bed Columbus Community Hospital, said he stayed neutral on the subject but offered two thoughts: One, the hospital strives to work with people struggling to pay their bills. But at some point, the person should chip in, too, he said.

He cited the case of an uninsured woman contesting her $4,500 maternity bill. (The tab excludes care the newborn got that Dad paid for through his insurance.) He said the woman balked at a payment plan and declined a health insurance option that would have meant a monthly premium well under $100.

Secondly, Van Cleave described a caring community that takes care of people.

“I think you’d find we’re very generous. We care,” said the married father of two. “What we do expect is if you have the means, to get up and put your boots on and get to work.”

But State Sen. Paul Schumacher of Columbus said people misunderstand who would benefit from Medicaid expansion.

“There are very few lazy people just laying around,” he said, pointing to Nebraska’s low unemployment of 2.8 percent. “The vast majority of those are working people who have jobs that do not provide health insurance. There’s just a lot of people who make too little to qualify for federal programs and can’t afford to pay 100 percent of the bill. They do without.”

But their care eventually catches up to everyone because when they get sick, they go to hospital ERs, which must treat them under federal law. The cost of charity care gets passed along to paying customers. He called this inefficient and costly.

“Somebody pays for it. Santa Claus doesn’t pick up the tab,” he said.

You didn’t need to tell that to three 20-somethings, one on Medicaid and two without health insurance, and all working.

Rebecca Johnson, 21, works two part-time jobs at Glur’s and a dance studio and gets Medicaid in part because she had a baby seven months ago. She said she can’t imagine what the hospital bill would have been without insurance.

She said her fiancé, who just started his own business and has no health insurance, refused to get medical treatment for a recent allergic reaction to shellfish. He was too afraid of what it would cost.

How’d she vote on Medicaid expansion?

“I didn’t get around to it,” she said, flushing.

Briana Closser, who works at Glur’s and a restaurant in Lincoln, voted for it. She described her politics as “not socialist, but help each other out.” She had benefited from Medicaid as a child but now falls into a gap. She goes without health insurance “because I don’t have the money.”

Plenty of people in Columbus saw value in Medicaid expansion and voted for it.

One was Ben Beller, who emailed to say he’s a registered Democrat, a father of four with a fifth child due in February. He’s 31, works as an environmental specialist at Nebraska Public Power District and said he saw a common good in expanded Medicaid. He said he understands the argument about cost but “can’t see how that worry alone justifies excluding low-income folks from health care.”

A man reading at the Columbus Public Library also voted yes. Marvin Sidel, 81, said his needs are met but not everyone’s are.

“People need it,” he said.

Even as they shared their own stories of struggle, others were firm in their beliefs that the onus was on the individual, not the community and certainly not a government that didn’t inspire confidence. Many voters were reluctant to give their names or be photographed.

One man having a beer at Dusters restaurant works in telecommunications and described his age as in his 60s. He said he’s a registered Democrat who voted against expansion because he’s not sure how the state is going to pay the bills it already has.

A table of women playing cards at the senior center stopped their game and nodded as one of them, who is 70, said firmly:

“I’m not afraid to say I voted against it. You hand them another freebie when they could be sitting on the couch. The ones who really need it won’t get it. Others who are getting it should get off their butts and be getting a job.”

An out-of-town banker dining at the Picket Fence in Columbus shared that view and took it a step further.

“Nobody thinks about this country being a lifeboat,” said the man.

What happens when “you put too many people in the lifeboat?” he asked.

It sinks?

“Everybody drowns,” he answered. “You’ve got to work. Or you starve.”

Back at Glur’s, I met owner Todd Trofholz, who said he was surprised that Medicaid expansion passed so easily.

“It’s nice to see this clarification,” he said, studying the color-coded map of the county-by-county breakdown of the vote.

Trofholz had voted against it, putting him with the majority of Platte County. But he said he understands the need and why the issue was successful.

“It does pull at your heartstrings,” he said.

Cathy Hoops was torn about her “no” vote, too.

“I definitely want to help people,” she said.

But her husband stuck to his guns.

“I’m tired of paying for people who don’t want to help themselves,” he said. “Everyone wants to be given. No one wants to earn.”

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