Nebraska’s medicaid expansion: An interesting rural-urban divide

H. Jason Combs, Paul R. Burger

Research output: Contribution to journalArticlepeer-review


Initially established in 1965, Medicaid was expanded in 2010 to include the working poor. The U.S. Supreme Court in 2012, however, ruled that the provision of the Affordable Care Act requiring states to expand Medicaid was unconstitutional. This made it a state option whether or not to expand Medicaid. In Nebraska, the approved expansion is projected to cover approximately 90,000 Nebraskans who are 19 to 64 years of age with annual incomes 138 percent of federal poverty level. In conjunction with current Medicaid expenses, expansion is expected to make the program the second largest general fund appropriation in the state. The spatial aspects of Nebraska’s Initiative 427, the measure regarding expansion in Nebraska, are noteworthy as well. The measure passed with 356,891 in favor compared to 309,533 against. Only nine Nebraska counties, however, voted in favor of Initiative 427 and eighty-four voted against the measure. A similar rural-urban divide also appeared at the legislative district level. Nebraska has forty-nine legislative districts and twenty-eight voted in favor of the measure. Although, simply stating the number of districts for and against hides a sharp rural-urban divide. Twenty-four of the twenty-eight districts that supported Initiative 427 are located in the Omaha and Lincoln metropolitan areas, with only four legislative districts favoring expansion located outside Omaha and Lincoln. A similar pattern was witnessed in the 2018 gubernatorial election in Nebraska as well. Ricketts-R carried the state by a significant margin, winning 59.0 percent to the Democrat challenger’s 41.0 percent, yet a pronounced rural-urban divide was evident.

Original languageEnglish (US)
Pages (from-to)29-36
Number of pages8
JournalGeographical Bulletin - Gamma Theta Upsilon
Issue number1
StatePublished - 2020


  • Medicaid Expansion
  • Nebraska
  • Vote Patterns

ASJC Scopus subject areas

  • Geography, Planning and Development
  • General Earth and Planetary Sciences


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