Banking, Commerce and Insurance Committee
February 24, 2025
Committee Chair: Sen. Mike Jacobson | Bills Heard: 4 | Full Transcript (PDF)
LB253: Require coverage for biomarker testing by state-regulated insurers
Introduced by: Sen. Eliot Bostar | Testimony: 5 proponents, 2 opponents, 0 neutral | Read bill text (PDF)
Biomarker testing mandate faces pushback over scope and cost concerns. Sen. Bostar's LB253 would require insurers to cover biomarker testing for diagnosis and treatment when supported by medical evidence, but insurers and committee members raised questions about whether the bill is too broad and whether mandates are necessary.
Why it matters: Biomarker testing enables precision medicine and can improve cancer outcomes while reducing unnecessary treatments. But over 600 CPT codes exist for biomarker tests, and insurers worry about covering tests lacking clinical utility.
What they're saying: - Proponents: Studies show $8,500 monthly savings per patient; 20 states have passed similar laws; Medicaid patients face 30% higher risk of not benefiting from precision medicine. - Opponents: Blue Cross approved $110 million in biomarker testing in 2024 but denied $5 million lacking clinical utility. Mandates remove negotiating leverage and create cost creep. Scope should be narrowed to cancer and Alzheimer's.
By the numbers: 24 proponent letters, 1 opponent letter, 1 neutral letter. Over 600 CPT codes for biomarker tests exist. Blue Cross data: $110M approved, $5M denied in 2024.
What's next: No vote taken. Sen. Hallstrom suggested narrowing scope and adding clinical utility standard. Insurance Federation offered to work on language amendments.
Committee sentiment: Supportive: Sen. Bob Hallstrom Skeptical: Sen. Brian Hardin, Sen. Merv Riepe, Sen. Mike Jacobson
Sentiment estimated from questions and comments — not stated positions.
LB68: Allow 12-month supply of self-administered hormonal contraception coverage
Introduced by: Sen. Jane Raybould | Testimony: 5 proponents, 2 opponents, 0 neutral | Read bill text (PDF)
Contraception access bill draws minimal opposition but raises wastage concerns. Sen. Raybould's LB68 would require insurers to cover 12-month supplies of hormonal contraception when prescribed, but insurers argue most women prefer 3-month refills and worry about medication waste.
Why it matters: One-third of contraception users miss doses due to supply gaps, increasing unintended pregnancy risk. Studies show 12-month supplies reduce unplanned pregnancies by 30-35% and save money overall, even accounting for wastage.
What they're saying: - Proponents: 23 states plus D.C. have passed similar laws. California Medicaid study showed cost savings despite pill wastage. Continuous access especially helps rural women and abuse survivors. - Opponents: Blue Cross data shows only 7 women chose 6-month option versus 12,000 choosing 3-month. Wastage and prescription changes create cost concerns. Mail-order already available for rural access.
By the numbers: 80 proponent letters, 9 opponent letters. Fiscal note: negligible cost to general funds (under $10,000/year). Blue Cross: 7 women chose 6-month fill vs. 12,000 chose 3-month in last 6 months.
What's next: No vote taken. Fiscal note shows minimal state cost. Insurance Federation indicated willingness to work on compromise language, potentially reducing to 6-month supply.
Committee sentiment: Supportive: Sen. Patrick Dungan Skeptical: Sen. Mike Jacobson Unclear: Sen. Brad von Gillern, Sen. Merv Riepe
Sentiment estimated from questions and comments — not stated positions.
LB64: Allow Medicare supplement (Medigap) coverage for under-65 ESRD patients; establish birthday rule
Introduced by: Sen. John Fredrickson | Testimony: 3 proponents, 5 opponents, 1 neutral | Read bill text (PDF)
ESRD Medigap bill splits committee over birthday rule's cost impact. Sen. Fredrickson's LB64 would allow under-65 dialysis patients to buy Medicare supplements and establish annual open enrollment, but insurers warn the birthday rule will spike premiums and push seniors to Medicare Advantage.
Why it matters: About 400 Nebraska ESRD patients under 65 cannot access Medigap, blocking transplant eligibility. Transplant centers require financial clearance; without supplemental coverage, patients face $16,000/year out-of-pocket costs. Kidney transplant doubles life expectancy versus dialysis.
What they're saying: - Proponents: HMA actuarial study shows only $0.40/month premium increase. 33 states allow this; nearby states all require it. Patients resort to GoFundMe and bankruptcy without coverage. Could save state $300,000-$500,000 over 5 years through Medicaid avoidance. - Opponents: Birthday rule causes adverse selection; Missouri saw 30-50% premium increases. ESRD claim costs 6-10 times higher than aged; small carriers especially vulnerable. Will push seniors to Medicare Advantage with networks and cost-sharing.
By the numbers: 13 proponent letters, 1 opponent letter, 2 neutral letters. ~400 non-dual ESRD patients under 65 in Nebraska. HMA study: $0.40/month increase; $300,000-$500,000 state savings over 5 years.
What's next: No vote taken. Sen. Fredrickson indicated willingness to remove birthday rule if that's primary opposition driver. Committee members suggested bifurcating bill into ESRD and birthday rule components.
Committee sentiment: Supportive: Sen. Patrick Dungan Skeptical: Sen. Mike Jacobson Unclear: Sen. Brian Hardin
Sentiment estimated from questions and comments — not stated positions.
LB252: Ensure non-opioid pain treatments not disadvantaged versus opioids in insurance coverage
Introduced by: Sen. Eliot Bostar | Testimony: 2 proponents, 2 opponents, 0 neutral | Read bill text (PDF)
Non-opioid pain treatment parity bill faces premature timing objection. Sen. Bostar's LB252 would require insurers to treat FDA-approved non-opioid pain medications equally to opioids, but opponents argue the legislation is premature since the primary alternative drug (Journavx) isn't yet on market.
Why it matters: Opioid epidemic kills tens of thousands annually; even short-term use increases addiction risk. Safer alternatives exist but insurers often impose higher barriers (prior auth, step therapy, cost-sharing) on non-opioids versus opioids.
What they're saying: - Proponents: 75% of 2021 overdose deaths involved opioids. Many addiction cases start with prescribed opioids. Similar legislation passed in Louisiana, Oklahoma, Tennessee in 2024. Voluntary non-opioid directives empower patients without limiting prescribing. - Opponents: Journavx approved January 30, not available until March with limited distribution. Costs ~$15/pill versus $0.50 for opioids. Insurers already evaluating for formularies. Holistic approach needed addressing entire supply chain.
By the numbers: 113 opioid-related deaths in Nebraska in 2021; 256 from synthetic opioids in 2022. Journavx cost: ~$15/pill vs. $0.50 for other acute pain drugs.
What's next: No vote taken. Sen. Bostar noted drug already being prescribed despite March availability date. Opponents suggested monitoring developments over next 10 months before mandating parity.
Committee sentiment: Unclear: Sen. Merv Riepe
Sentiment estimated from questions and comments — not stated positions.
Session Notes
Committee Chair Sen. Mike Jacobson opened with procedural instructions regarding testifier sheets, sign-in sheets, three-minute light system, and written position comment deadline (8:00 a.m. day of hearing via Legislature website). Committee members introduced: Sen. Merv Riepe (Omaha/Ralston), Sen. Brad von Gillern (District 4, west Omaha/Elkhorn), Sen. Eliot Bostar (District 29), Sen. Bob Hallstrom (District 1, southeast Nebraska), Sen. Brian Hardin (District 48, panhandle), Sen. Dave Wordekemper (District 15, Dodge/western Douglas County). Committee counsel Joshua Christolear absent due to illness. Committee clerk Natalie Schunk present. Pages: Ayden Topping (second-year psychology student, UNL) and Kathryn Singh (third-year environmental studies student, UNL). Hearing conducted February 24, 2025. Four bills heard: LB253 (biomarker testing), LB68 (contraception supply), LB64 (Medigap/ESRD), LB252 (non-opioid pain treatment parity). No votes taken on any bills during hearing.
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