The need for health care reform in Nebraska.

This paper has identified some of the major health care problems in Nebraska. Although Nebraska does not face as many serious challenges as some other states, there is clearly a need for reform. For example, the health of our population is generally good, but many serious gaps exist, particularly for minority population groups. Per capita health care costs in Nebraska are only slightly below the national average, and out-of pocket costs for the average Nebraska family rank among the highest in the nation. In addition, Medicaid costs are exploding and create serious challenges to balancing the state's budget. Nearly 140,000 Nebraskans lack health insurance coverage and at least 90,000 others are underinsured. Many insurance policies limit or deny coverage to individuals with pre-existing medical conditions, deny coverage to individuals employed in certain occupations, and limit coverage for preventive services. "Cost shifting" continues to become more widespread, which significantly increases the number of small businesses that drop or reduce health insurance coverage for their employees. Finally, rural areas face some unique challenges related to their ability and capacity to provide services. There is a serious shortage of primary care physicians, mid-level practitioners, and many other allied health professionals. As a result, individuals, including a large elderly population, must travel long distances to obtain care. Many rural hospitals are under severe financial stress and some will close during the next five years. There appears to be an adequate supply of nursing home beds in rural areas, but many communities lack adequate in-home services.