Lawmakers at odds over Medicaid expansion in Oklahoma
BY WAYNE GREENE World Senior Writer
Wednesday, November 14, 2012
11/14/12 at 7:13 AM
Read the Tulsa World continuing coverage of the health care law.
Two Republican physicians in the Oklahoma House of Representatives disagree on whether Gov. Mary Fallin should accept federal funding to expand Medicaid and decrease the number of uninsured Oklahomans.
Rep. Mike Ritze, R-Broken Arrow, says the state can't afford to accept the money.
Rep. Doug Cox, R-Grove, says the state may not be able to afford not to.
The primary means for reducing the number of poor people without health coverage under the Affordable Care Act is a massive increase in the Medicaid program.
Currently in Oklahoma, only people in certain categories are eligible for Medicaid - children, pregnant women and indigent elderly in nursing homes, for example.
Under the federal law, anyone in a household that earns up to 133 percent of the federal poverty level - currently $30,657 for a family of four - would be eligible for Medicaid coverage.
The U.S. Supreme Court ruling that found the federal law is constitutional also determined that its Medicaid expansion mandate was unconstitutionally coercive, essentially making each state's inclusion into the program optional.
Gov. Mary Fallin has yet to say whether Oklahoma should accept the Medicaid money, at first putting a decision off until after the presidential election and subsequently saying that she is continuing to study the issue.
Cox says the state needs to take the money, at least for now, and it's his experience as a physician that drives him that way.
"I deal with the system every day, and it is very broken," Cox said. "We do have to change it."
Under the Affordable Care Act, the federal government will pick up 100 percent of the costs of newly eligible Medicaid patients for three years starting in 2014 and gradually shift costs to the state with the amount capping in 2020 at 10 percent.
Oklahoma can afford that price, but Cox said he is concerned with the possibility that Congress won't stick with that deal.
"My great concern like everyone else is the feds steadily increasing costs over to the states, and I'm not sure we can accept that," he said.
The state's Medicaid match rate for people not brought into the system by the Affordable Care Act is about 36 percent.
But for now, at the current federal match rates and with the state's problems getting its citizens covered with health insurance, Oklahoma needs to be very careful about walking away from the offer, Cox said.
"Bottom line at this point, we should think about taking it because the feds are going to pick up the expense," he said.
Ritze, an osteopathic physician, sees things very differently.
He says Fallin should stay away from the Medicaid money and anything else that would tie the state to Obamacare.
Ritze is inalterably opposed to the federal health-care law and says the Medicaid funding is a back-door approach to accepting it into the state.
He urged Fallin to follow the path of Republican Louisiana Gov. Bobby Jindal, who - like about a dozen other GOP governors - has turned down Medicaid expansion money.
"He's pretty stern about it," Ritze said.
One of the biggest concerns about accepting the Medicaid funding is what happens in the future, he said.
There has been talk in Washington of changing the policy of how much of the cost the federal government will pick up and shifting more of the costs to the states.
Further, Ritze pointed out there is the possibility that people who are currently insured will drop their coverage to take Medicaid, driving up the potential costs well beyond anticipated levels.
Oklahoma has a decent system for accommodating those who are uninsurable because of pre-existing conditions and other issues, but the better solution to those who simply choose not to carry insurance is to allow the free market to resolve issues, Ritze said.
As a physician, Ritze said he has discovered that he can get much better prices for lab work and testing for his patients who would rather pay cash for their services than work with insurance companies. The labs get immediate payment and avoid the hassles of dealing with insurance bureaucrats, and the patients get a better price, he said.
"I've actually seen that it's much cheaper to go the cash route," Ritze said.
Wes Glinsmann, lobbyist for the Oklahoma State Medical Association, said the group, which represents allopathic physicians in the state, has not taken a position on the proposal to expand the Medicaid program.
Earlier this year, the association attempted to poll its members on the issue but didn't get a strong consensus and found there were more questions about how the program would work than there were answers.
"Any time you're dealing with federal government agencies, the devil's in the details," Glinsmann said. "There's still so many variables in terms of what expansion would look like that we don't have enough information to make an informed decision yet."
Now that the national election has made it clear that Obamacare isn't likely to go away soon and Fallin faces a deadline to make a decision on the Medicaid expansion, Glinsmann said the association will likely take up the issue again soon.
Uninsured Oklahomans and Medicaid
More than 693,000 Oklahomans - 18.7 percent of the state population - do not have health insurance, according to the U.S. Census Bureau.
State officials estimate by expanding Medicaid eligibility to 133 percent of the federal poverty level, some 200,000 newly eligible Oklahomans would be eligible for coverage. Estimates vary on how many of the newly eligible clients would actually enroll in Medicaid.
The federal government has put the estimate at 57 percent, about 114,000 Oklahomans, but state officials think the number would be higher.
At the same time, the state estimates that another 57,000 people who are already eligible also would sign up for Medicaid.
Based on a the current population, if 75 percent of the newly eligible population enrolls and 57,000 currently eligible people enroll, the total number of uninsured Oklahomans drops to about 13.1 percent.
Original Print Headline: Lawmakers at odds over Medicaid
Wayne Greene 918-581-8308
Rep. Mike Ritze (left) and Rep. Doug Cox: Both lawmakers are physicians and Republicans, but Ritze says the state shouldn't accept federal funding to expand Medicaid, and Cox disagrees.
Gov. Mary Fallin: She had said she would put off the decision on whether Oklahoma would accept federal funding to expand Medicaid until after the election. Now that the president has been re-elected, Fallin says she is continuing to study the issue. About a dozen GOP governors have turned down Medicaid expansion money.