Medicaid expansion possible with a passive Legislature
BY WAYNE GREENE World Senior Writer
Thursday, November 15, 2012
11/15/12 at 7:33 AM
Read the Tulsa World continuing coverage of the health care law.
Oklahoma could expand Medicaid coverage under the provisions of the Affordable Care Act without any action by the Legislature, a spokesman for the Oklahoma Health Care Authority said Wednesday.
If Gov. Mary Fallin decides to go ahead with the Medicaid expansion - as seven states already have and several others are considering - the most likely scenario is that the new eligibility standards would be set through the administrative rules process by the Oklahoma Health Care Authority Board, said Carter Kimble, spokesman for the state Medicaid agency.
Under state law, administrative rules can have the effect of law, unless the Legislature takes action to prevent them from taking effect.
If rules are passed when the Legislature is out of session, they must be passed on an emergency basis with the approval of the governor and the Legislature has 30 legislative days to overturn the rules once it comes into session.
If rules are passed when the Legislature is in session, the House and the Senate have 30 legislative days to consider the rules.
If the Legislature doesn't reject the rules, they go into effect. So, the expansion could take place by the Legislature simply remaining passive, Kimble said.
No rules are going to be considered without Fallin's instructions to move ahead, and Fallin has yet to give any direction on which way the state should go on the question.
Under the Affordable Care Act, the primary means of extending health care coverage to poor people is through a significant enlargement of Medicaid eligibility.
Currently, Oklahomans have to fall in specific categories - such as children, pregnant women or the elderly - to be eligible for Medicaid. Under the Affordable Care Act, the state could broaden that eligibility and would be extended to anyone who lives in a home with up to 133 percent of the federal poverty level - currently $30,657 a year for a family of four.
The federal government would pay for 100 percent of the newly eligible Medicaid patients for 2014-16 and then a portion of the costs would be transferred to the states. State cost would cap at 10 percent in 2020 - an estimated $48.8 million for the newly eligible Medicaid clients assuming a 75 percent enrollment.
Fallin has said she thinks the Affordable Care Act is unconstitutional, unworkable and unaffordable, but she has not joined other GOP governors, such as Rick Perry of Texas and Bobby Jindal of Louisiana, who have said they would block Medicaid expansion in their states.
Initially, Fallin said she wanted to wait until after the presidential election to make a decision because the prospect of a Mitt Romney election would make the issue moot. After President Barack Obama won re-election, Fallin's staff said she was still considering the issue and that she wanted to make the right decision for the state, not necessarily a quick one.
The list of states that have accepted the Medicaid funding have largely mirrored the electoral college map - with Obama states generally accepting the funding and Romney states rejecting it, but there has been movement in some states since the election.
Florida's Republican Gov. Rick Scott, who ran for office on a platform of fighting against "Obamacare," told The Associated Press earlier this week that he is dropping his opposition to the health law, including the Medicaid expansion.
Florida voters chose Obama over Romney in the election and struck down a constitutional amendment aimed at making it harder to implement the Affordable Care Act.
"I don't think anyone involved in trying to improve health care should say, 'No, no, no,' " Scott told the AP. "Let's have a conversation."
In Idaho, a state that went for Romney, a panel of community and state leadership urged this week that Republican Gov. Butch Otter and the Idaho Legislature accept Medicaid expansion but wants to tie the expansion to a benefit program that improves care, boosts personal accountability and reduces costs.
One of the concerns Fallin and others have voiced about the prospects of accepting the Medicaid expansion is the possibility that the federal government won't abide by the 10 percent cap on state costs for the newly eligible patients.
Rep. Glen Mulready, R-Tulsa, one of the chairmen of a 2011 joint legislative committee that investigated the state's response to the federal health law, said that is a valid concern for lawmakers.
"I would think that we would be leaning away from expanding an entitlement program where funding is in an unsure place," Mulready said. "There's great concern about that."
Because of the cost concerns and other problems with the federal law, Mulready predicted that any attempt to expand Medicaid coverage wouldn't go through the legislative process passively.
"That would not be rubber-stamped," Mulready said. "That would not be an easy decision on the Legislature's part."
While the Affordable Care Act plans to shift costs to the states through 2020, advocates of the Medicaid expansion point out that because of savings to the state Health, Mental Health and Corrections departments and increased tax revenue from new medical professionals, Oklahoma's net costs could be quite small.
Those calculations don't include the possibility of the federal government increasing the state's share, but they also don't include increased productivity of state businesses that could result from a healthier work force.
Advocates also point out that Oklahoma could redirect state tobacco tax revenue currently used to fund the Insure Oklahoma program, which would largely become redundant with Medicaid expansion, to pay for its costs. In fiscal year 2011, Insure Oklahoma received $46 million in tobacco tax money.
Meanwhile, Ginny Webster, Oklahoma regional organizer for Moveon.org, has created an online petition urging Fallin to accept the expanded Medicaid funding. The petition is available at tulsaworld.com/medicaidpetition
Special session request
State Rep. Joe Dorman, D-Rush Springs, has filed a petition to call the Oklahoma Legislature into session to consider establishing a health insurance exchange to comply with the Affordable Care Act.
Republican legislative leaders didn't deal with the issue during the regular legislative session, leaving the state with no plan for dealing with the federal mandate, Dorman said.
An exchange is an electronic marketplace for consumers to shop for health insurance. Under the Affordable Care Act, an exchange would route eligible people onto Medicaid and provide federal subsidies for private insurance purchases to people who don't get coverage through their employers but earn too much for Medicaid.
Subsidies would be graduated according to income with people earning up to 400 percent of the federal poverty level - currently $92,200 for a family of four - eligible for subsidies.
Dorman said for his petition to result in a special session, it would have to get the signatures of two-thirds of the members of both the House and the Senate, which he doesn't expect is likely.
"I don't think anything will happen with this, but I think the conversation needed to come up," Dorman said. "Hopefully, I started the conversation by doing this today."
Gov. Mary Fallin is expected to announce her decision on how the state should address the exchange issue later this week.
Original Print Headline: Medicaid solution option is outlined
Wayne Greene 918-581-8308
Gov. Mary Fallin: Although an opponent of the Affordable Care Act, she is trying to decide whether to accept the law's Medicaid expansion.