Higher Incomes For Childcare Subsidies Advanced; Emergency Room Bills, YRTCs Discussed

Lincoln Sen. Kate Bolz is sponsoring the bill to increase the income limits for people to receive child care subsidies. In the debate Tuesday, Bolz said it addresses a real need.

“The cost of childcare in our state is very expensive. In fact, Nebraska is one of the least affordable states in the US for childcare. The annual cost of $12,480 for family childcare for an infant would take almost 15% of income for a median income, two-parent family. But let me remind you the families that are receiving childcare assistance are not median income families. They are low-income families,” Bolz said.

Currently, people with household incomes below about $28,000 for a family of three are eligible for subsidies. If their income goes up, those subsidies go down, but they can continue for another two years. The subsidies end once that same family’s income reaches about $40,000. Under Bolz’s bill, LB329, that cutoff point would be raised to just over $43,440.

Sen. Steve Erdman, who represents a 10-county district in the largely rural Nebraska panhandle, suggested that’s too high.

“In my district, $43,440 is a pretty good wage. So maybe we should just remove all limits and just have everybody eligible. I guess what I’m trying to say is at some point in time, we have to draw a line and say ‘This is enough.’ So I’m not in support — I’m not standing up in support of 329. I’ll be voting ‘no,’” Erdman said.

Nebraska requires people who get child care subsidies to pay 7 percent of their income first. That would be just over $250 a month for a family at the proposed limit of $43,440 dollars, with the state paying the rest of the cost. Bolz estimated the bill would cost taxpayers $250,000 the first year and $400,000 the second.

The bill got the first of three approvals it would require on a vote of 25-7, the bare majority required. It won’t come up for a final vote until the main budget adjustments are voted on this spring.

In a public hearing Tuesday afternoon, senators heard a proposal by Sen. Adam Morfeld that tries to ensure people are not surprised by huge bills after an emergency room visit.

Morfeld said patients may be unconscious when they’re brought in, or may not know which providers their insurance company considers “in-network” or “out of network.”

“You show up, see several providers, the ER doctor, radiologists, maybe an anesthesiologist. A few months later you get a bill for thousands of dollars and the realization hits you that the ER doc and hospital is in-network, but maybe the radiologist or anesthesiologist was out of network. This is often known as a balanced bill, or more commonly a surprise bill. This happens more often than you think, to my constituents, people I know, and quite frankly, one or two of our fellow senators have brought up to me that has happened within their family or to them themselves,” Morfeld said.

Lobbyist Andy Hale, representing the Nebraska Hospital Association, said the hospitals agreed with one of the bill’s goals.

“We want to make sure that our patients are held harmless in surprise billing situations. We want to make sure that the patient is taken completely out of the equation, and not placed in the middle of reimbursement disputes between insurers and providers in out of network billing,” Hale said.

But Hale objected to a part of the proposal that would set a benchmark for paying disputed charges at 175 percent of the Medicare rate, saying it should be closer to 225 percent. Morfeld said he would continue to negotiate and hopes to make the bill a priority.

And Sen. Sara Howard went before the Appropriations Committee to ask for $3 million to create private rooms and showers at the Youth Rehabilitation and Treatment Center, or YRTC, in Kearney. Currently, the center uses dormitory-style housing for boys ages 14 to 19 who can be sent there by juvenile courts for offenses ranging from theft to assault.

Last week, four boys disassembled their metal beds and used the pieces to attack staff members. Howard said reconfiguring the housing would help prevent that.

One of the challenges with the dorms, if you look at where the dorms are, the staff is stationed in between two separate dorms. The only way for the staff to get in or out is to go through the dorms and down a set of stairs. So if a staff member wanted to leave — if something was happening, if there was an altercation — they would have to walk through the altercation in the dorms in order to get out,” Howard said. “And so when we’re talking about switching from dorms to single rooms, we’re not talking about it because ‘Oh, these kids should have their own rooms and that’s something for them.’ It’s really about safety for staff,” she added.

The YRTC in Kearney currently houses girls as well as boys, after a separate YRTC for girls in Geneva, Nebraska was emptied last summer following a staffing and facility crisis. Howard said the girls are currently in a separate building in Kearney and have their own rooms, but they still have to use communal showers.

“The thing I hear the most from the girls is (about) the communal bathing. It’s a different situation for boys versus girls I can imagine. But for girls who are menstruating, for girls who have maybe been sexually assaulted or had an issue of sexual trauma, having to bathe communally is really difficult for them,” she said. “And so when we consider their journey, and we consider that the YRTCs are meant for rehabilitation and treatment, we really want to make sure that the facilities are aligning with those aims.”

Sen. John Stinner, chair of the Appropriations Committee, asked Howard where the $3 million costs came from. Howard said when she was writing the bill, she thought of it as a vehicle to spark discussion for action in the future, and $3 million was just her best guess. But she said things are getting to the point where the action is needed now. And Howard said the state needs to reconsider how it treats young people who are sent to the facility.

“I think that we have seen the youth rehabilitation and treatment centers move into a more corrections-focused mindset, away from a rehabilitation mindset. And that has brought to us a whole host of problems. And so the more we clamp down, the more likely it is kids are going to try to escape,” she said.

Several legislative committees are considering other bills to establish standards and plans for the YRTCs, and the Department of Health and Human Services is working on a long-term plan.

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