Nebraska Gov. Dave Heineman came down firmly against expanding the state's Medicaid program under the Affordable Care Act (ACA), which is now voluntary for states after the Supreme Court's ruling at the end of June.

Heineman sent a letter Wednesday to Nebraska legislative leaders, declaring that: "Nebraska cannot afford an unfunded Medicaid expansion." He pointed to the state's impending $620 million budget shortfall and argued that the state would spend "hundreds of millions of dollars" expanding Medicaid eligibility to 133 percent of the federal poverty level, as dictated in the ACA.

According to data compiled by Governing from the Urban Institute and the Kaiser Family Foundation, Nebraska would add up to 110,000 people to its Medicaid rolls under the expansion and spend up to $106 million in state dollars by the end of the decade.

Heineman stated immediately after the Court's decision that, while opposed to increasing taxes or cutting spending for other priorities to fund a Medicaid expansion, he was "reviewing the decision in a detail, thoughtful and responsible manner." Wednesday's letter appears to be an update of his position.

Heineman asserted that the state would have to make cuts to K-12 schools and its higher education system to pay for the Medicaid expansion. “My priorities are the education of Nebraska’s children and job creation for Nebraska’s families," Heineman wrote in the letter. "Cutting funding for the education of Nebraska’s children and increasing taxes on Nebraska’s families are not my priorities."

The governor indicated that he had been asked by state legislators interested in exploring the Medicaid expansion to send Medicaid Director Vivianne Chaumont to a July 12 meeting to discuss the idea. Heineman said in his letter that Chaumont would not attend.

According to the Advisory Board Company, which is tracking state reactions to the Supreme Court's decision to essentially make the Medicaid expansion optional, five other states (Florida, Louisiana, Mississippi, South Carolina and Texas) have definitively said they won't participate in the expansion. Another five (including Nebraska) are leaning in that direction.