Highlight on Nebraska: Mumps outbreak spreads as college students head home for summer

A mumps outbreak centered at Midland University in Fremont, Nebraska, has spread to six counties as university students went home for the summer before developing symptoms. The school of 1,300 students reported 10 cases of mumps to the Nebraska Department of Health and Human Services (DHHS) in May, all affecting students enrolled at Midland. Health care providers in the state received a health advisory about the outbreak, and were asked to report suspected new mumps cases to their local health departments.

By the end of May, the number of mumps cases had more than doubled to 21 reported cases, spreading from Fremont in Dodge county to Cass, Douglas, Hall, Madison and Platte counties as Midland students returned home for the summer and began experiencing symptoms. DHHS’ State Epidemiologist, Dr. Tom Safranek, said that due to the highly contagious nature of the mumps virus, there is potential for the outbreak to continue to spread. He noted the importance of “aggressive isolation” of individuals exhibiting mumps symptoms for a period of five days after the onset of symptoms.

Mumps is caused by the mumps virus, and is an acute viral illness. Its best-known symptom is swollen salivary glands, but also commonly causes fever, headache, muscle aches, tiredness, and loss of appetite. Complications can include swelling of the testicles or ovaries, deafness, inflammation of the brain and/or tissue covering the brain and spinal cord (encephalitis/meningitis) and, rarely, death. According to the Centers for Disease Control and Prevention, there has been a 99 percent decrease in mumps outbreaks in the United States since the introduction of the MMR vaccine, which inocculates against measles, mumps, and rubella (German measles). The vaccine is typically given to children in two doses, with additional vaccinations given to university students and adults who do not have evidence of protection.

The Nebraska DHHS said that the mumps virus is most contagious for the three days before and five days after their symptoms begin; symptoms can appear 12 to 25 days after infection, with most appearing after 16 to 18 days .To prevent the spread of mumps:

  • Always cover your nose and mouth when you cough or sneeze
  • Wash hands frequently
  • Dispose of used tissues and other similar objects appropriately
  • Do not share glasses, eating utensils, water bottles, etc.

Individuals who are not sure of their immunity should contact a physician to determine whether they are protected and, if necessary, arrange for vaccination. The vaccine will not cure mumps in an individual who has already contracted the virus, but can prevent its spread. It is particularly important for individuals who attend Midland University or have been in contact with Midland University students to check their health status. Health care workers should also check their protected status to avoid additional transmission of the virus as they tend to infected individuals.

Nebraska Governor Requests Public Input for State Health Insurance Exchange

Last week, Nebraska Governor Dave Heineman announced a series of public meetings that will be held over the next month regarding the state’s decision whether to and how to establish its own health insurance exchange. Under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), each state must have an exchange, which is an online marketplace for health insurance plans, in place and operating by January 1, 2014.  November 16, 2012 is the deadline for states to submit to the federal government their decisions whether to design their own exchanges and their plans for implementing the exchanges. If a state elects not to design its own exchange, it will be required to implement a default exchange designed by the federal government.

The eight planned meetings will be held statewide beginning August 27th and will be hosted by Governor Heineman and Bruce Ramge, the director of state insurance. Over 30 advocacy groups, health care associations, and insurance representatives have been asked to attend and speak at the meetings about the exchange option they recommend and how it should be funded. The public will be able to participate in a question-and-answer period at the end of each session with Nebraska’s exchange-planning team.

Unlike many other states, which are establishing their exchange plans through their legislatures, the governor intends to issue an executive order to submit Nebraska’s plan to the federal government. He contends that his administration is granted the authority under Nebraska’s constitution in order to protect the state’s interests. State Senator Jeremy Nordquist has indicated his support for an executive order establishing the exchange as long as the administration keeps the process transparent to the public and “…not behind closed doors by bureaucrats.” To ensure transparency, Nordquist stressed the need for a public board to govern the exchange and stated that he would propose legislation to create such a board if the governor did not create one in his plan.

Governor Heineman made it clear that these meetings will address the health insurance exchange only and not include discussion of Medicaid expansion. After the U.S. Supreme Court’s June ruling that states are not obligated to expand their Medicaid programs under PPACA, the governor has indicated that Nebraska will opt out of expansion because it cannot afford to add to the program’s rolls.

State Governors Elect Not to Implement Parts of PPACA

After the United States Supreme Court’s ruling last week that states cannot be forced to expand their Medicaid programs to receive federal funding, states are given the tough decision to make whether they will indeed expand their Medicaid rolls as suggested by the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148).

Thus far, five states have made it clear that as a result of last week’s decision, they do not plan to expand their Medicaid programs: Florida, South Carolina, Louisiana, Mississippi and Wisconsin.

All of those five states, which have Republican governors, participated in the lawsuit against the bill, which was the subject of last week’s ruling. In addition, six states have publicly raised doubt as to whether they will participate: Iowa, Missouri, Nebraska, Nevada, New Jersey and Texas. Currently, only ten states have affirmatively pledged to participate in Medicaid expansion, which leaves nearly two-thirds of the states in question.

Wisconsin Governor, Scott Walker issued a statement on the same day the Supreme Court released their decision on PPACA, indicating, “Wisconsin will not take any action to implement ObamaCare.” (Obama Care is a casual term commonly used to refer to PPACA and its provisions.) Walker emphasized his concerns that the bill would cost his state’s tax payers to “pay more money for less healthcare” and that both quality of and access to care would be reduced under the bill. He expressed his hope that this year’s elections would ultimately result in the repeal of the bill at a federal level.

Governor Bobby Jindall of Louisiana announced that his state will not be expanding its Medicaid program in response to PPACA; nor will it be setting up private health insurance exchanges called for by the bill. Under the provisions of PPACA, if Louisiana or any other state fails to establish a fully operable exchange by January 1, 2014, the federal government will implement an exchange for that state. Jindall agreed that reform of the health care system is necessary, but that an “expensive, unsustainable entitlement program is not the solution to our problems.”

In Florida, Governor Rick Scott similarly announced that his state will neither set up exchanges nor expand its Medicaid rolls to comply with PPACA. Approximately 20 percent of Florida residents are uninsured, however, Scott pointed out that it would cost Florida taxpayers $1.9 billion to add those residents to the Medicaid program. He raised concern over the rapidly increasing Medicaid program in the state, which he said is growing “three and a half times as fast as Florida’s general revenue.”

South Carolina Governor Nikki Haley declared that her state will opt out of expanding its Medicaid program and that block grants, which offer flexibility to states as to how they will use the money, offer the best solution to state-specific problems. She referred to PPACA’s changes as a “broken system that further ties our hands.”

Lt. Governor Tate Reeves of Mississippi “is not inclined to drastically expand Medicaid” as called for by PPACA. He explained that such an expansion, which would add nearly 400,000 residents to the program, would cost the state nearly $1.7 billion over ten years. He maintained that “(t)rue health care reform should look at reducing costs for services not increasing the burden on taxpayers.”

Nebraska to Continue Provision of Prenatal Care for Illegal Immigrants

Until 2010, Nebraska was one of 15 states that funded prenatal care for illegal immigrants through its Medicaid program. That year, the federal government prohibited the state from using federal Medicaid funds, limiting such coverage to the Children’s Health Insurance Program (CHIP). This ban resulted in the loss of prenatal care for 870 women illegally residing in the state. However, Nebraska lawmakers took a stand last week, voting 30 – 16 to override Governor Dave Heineman’s veto of a bill that would reinstate prenatal care for illegal immigrants at the cost of Nebraska taxpayers.

Governor Heineman and other opponents of the bill point out that during the past two years, in which the state was not paying for the prenatal care, illegal immigrants were obtaining low-cost or free care from charities and churches. The Governor maintains that charity care should remain the status quo, and that “providing preferential treatment to illegals while increasing taxes on legal Nebraska citizens is misguided, misplaced and inappropriate.” Senator John Nelson agreed, stating, “No on is being turned away…They’ve been finding a way.”

Other Senators raised concerns that passage of the bill will make Nebraska a magnet for illegal immigrants who are seeking free prenatal care–especially since no other states surrounding Nebraska provide such services. Additional concerns include opposition from state residents who grapple financially to pay for their own health care and find it unfair to have their tax dollars stretched further to provide health care for illegals.

Strong supporters of the bill included “pro-life” advocates who contend that the measure will protect the interests of unborn babies, which have no control over their circumstances and will be legal citizens upon their birth. Other supporters included professionals in the health care field, who testified that $4 dollars will be saved for every dollar spent on prenatal care since the care will prevent easily avoidable complications upon birth, when the child would be covered by government programs anyway.

Advocates of the bill included the Nebraska Right to Life organization and the Nebraska Appleseed Center for Law in the Public Interest, bringing together some uncommon political allies. Appleseed Center’s public policy director argued that illegal immigrants are “…in our communities and they’re helping contribute to our communities…so we believe providing this kind of prenatal coverage to their children is appropriate.”

Governor Heineman advised lawmakers that they will suffer long-lasting political consequences for voting to override his veto of the bill.

The bill, which is expected to provide care for 1,100 illegal immigrant women and their babies, goes into effect in three months. Lawmakers estimate that the cost will be $1.9 million in federal funds and $560,000 in state tax money.