Elections force nation's governors to face reality on Obamacare
BY JANET PEARSON Associate Editor
Sunday, November 18, 2012
11/18/12 at 3:31 AM
Gov. Mary Fallin is facing perhaps the most difficult decision of her political life: whether to expand Oklahoma's Medicaid program, as called for in the historic federal health-care reform law known as Obamacare.
She has lots of company. According to one recent survey, the governors of at least two dozen states also are undecided on the matter; so far only about a dozen governors have embraced the expansion. Thanks to President Obama's re-election, it's expected there will be considerable waffling on the issue in the months to come.
The expansion provision of the new law would enable states to use Medicaid to cover adults earning at or less than 133 percent of the federal poverty level. Currently, working-age adults who don't have children do not qualify for Medicaid.
In Oklahoma, it's estimated that as many as 200,000 uninsured adults would be eligible for coverage if Medicaid is expanded.
The federal government would pay all the cost of the expansion for the first three years, with the state over time picking up at most 10 percent of the costs.
Opponents have raised a litany of criticisms and concerns, mostly about the costs to the state.
That is among the issues bedeviling Fallin, who faces political fallout whether she opts for expansion or not. But there are some developments and trends that could make her job a little bit easier.
One obvious development is the likelihood that, thanks to the election outcomes, Obamacare now has the aura of inevitability. Even ardent conservatives now admit that. That being the case, Fallin and her counterparts can actually breathe a little easier. After all, if it's going to remain the law of the land, then the question becomes how best to live with that reality.
Who says Obamacare is here to stay? "Repeal of the whole thing, I just don't see now how that's possible," Grace-Marie Turner, president of the Galen Institute, a conservatiave health-care think tank, told The Hill's health-care blog, Healthwatch, after the election.
Dean Clancy, vice president for health-care policy at FreedomWorks, sounded a similar theme: "Implementation is going to go forward. You'll see a raft of regulations go through now." He also told The Hill that critics "still have every reason to oppose the government takeover," and predicted they'll look for ways in future legislation to "chip away" at the health law.
Turner noted that the "further we got in time from the original passage, the more that anger becomes dissipated. ... It becomes not a major issue."
These observers make salient points. The nation's five decades of experience with Medicare prove the points. While it was also highly controversial at first, with tweaking year after year after year it has become arguably the federal government's most popular and jealously guarded service.
It's also true that as time passes and a controversial program becomes a fixture, opposition softens. A poll done after the election by the Kaiser Family Foundation found that the level of support for full repeal of Obamacare is at its lowest point since passage. Only 33 percent of those polled favored repealing or replacing Obamacare, while 49 percent favored keeping it or even expanding it.
So what are Fallin and other undecided governors to do, given that Obamacare is here to stay and becoming less controversial as time goes by? One approach would be to spread the decision-making around a bit, which seems to be working in Idaho.
In fact, reaching out for knowledgeable help in a public, formal way - through a blue-ribbon panel, for example - not only would help the public understand and perhaps eventually embrace what's coming, it also could give the governor some political cover.
After spending three months and $195,000 on two in-depth studies, a 15-member panel appointed by Idaho Gov. Butch Otter last week unanimously agreed to recommend that the governor go along with expanding Medicaid. But the group added a few caveats, also agreeing that the expansion program be designed to include incentives for new enrollees to take responsibility for their own health, according to a report in the Nov. 10 Spokesman-Review.
"We aren't just signing a blank check," said a Republican state representative who was a member of the panel. "That's not what we're about. We're about doing it right or we're not going to do it."
Like Oklahoma, Idaho is one of the most heavily Republican states in the country. Idaho provided John McCain with his fourth highest percentage in 2008 with 61 percent of the vote. Republicans control the statehouse and have held the governor's post since 1994.
Yet, this red state seems to have come up with the evidence that can convince even extreme doubters. One consultant told the working group the state would save $6.5 million over 10.5 years if the expansion were approved, compared to added costs of $284 million if it is not approved.
Other analyses have shown Idaho could save between $380 million and $407 million in the near term if expansion is approved.
Similar findings are popping up in other states. Arkansas - not exactly a liberal outpost either - estimates that state could save $372 million in the first six years of the expansion program. The Washington Post described Arkansas' analysis as "one of the most detailed by a state so far, probing just about every way that Medicaid impacts state budgets."
"It's worth looking at to get a more complete understanding of the costs and savings a state accrues from participating in the program," the Post declared.
And over in Arizona - another Republican stronghold - a nonpartisan report found that expanding the Medicaid program could help save Arizona $1.2 billion and create more than 20,000 jobs in the state over the next four years.
Even here in Oklahoma, some ciphering has shown some savings would accrue from Medicaid expansion, notably in the area of mental health treatment.
Our governor owes it to all Oklahomans to exercise all due diligence. All indications are that is what she is doing. While no projections are ever iron-clad, there is enough evidence and data accumulating to arrive at an informed, reasonable decision that's in the state's best interests.
Original Print Headline: Medicaid: To expand or not?
Janet Pearson 918-581-8328
This Tulsa infant received care in 2009 at a pediatric clinic in Tulsa thanks to Medicaid. Gov. Mary Fallin is weighing whether to accept federal money to expand Medicaid to cover some working adults. CORY YOUNG/Tulsa World file