Agricultural Economics Department


Date of this Version



J. David Aiken, Initiative 427: Nebraska Medicaid Expansion, Cornhusker Economics, October 31, 2018.


Copyright 2018 University of Nebraska.


This article summarizes information regarding Initiative 427–the Medicaid expansion question on the November 6, 2018 ballot. It reprints the actual ballot language and the Nebraska Secretary of State’s summary of arguments for and against Initiative 427.

Background. Originally Medicaid covered the elderly, the disabled, children in low-income families, and low-income pregnant women. In 2010 Medicaid coverage was expanded by Congress to include the working poor. In 2012 the U.S. Supreme Court ruled that the provision of the Affordable Care Act (ACA) requiring states to expand Medicaid was unconstitutional. This made it a state option whether or not to expand Medicaid. Currently 33 states and the District of Columbia have adopted Medicaid expansion. Seventeen states (including Nebraska) have not expanded Medicaid. Three of those states, including Nebraska, are currently considering expanding Medicaid.

Several bills to adopt Medicaid expansion in Nebraska have been proposed but none were enacted. So Medicaid expansion proponents circulated a ballot initiative petition and successfully placed Initiative 427 on the November 6, 2018 ballot. If approved by Nebraska voters, Initiative 427 would amend Nebraska’s existing Medicaid statutes to require Nebraska officials to apply to the federal government for Medicaid expansion. Then the Medicaid expansion statutes could be modified only by a super-majority of 33 votes in the Nebraska Unicameral (very unlikely to occur). The Medicaid expansion, if federally approved, could go into effect beginning in 2020.