Medicaid expansion still an issue in state
BY JANET PEARSON Associate Editor
Sunday, December 09, 2012
12/09/12 at 2:56 AM
Gov. Mary Fallin has spoken on the Medicaid expansion issue. But that doesn't mean the debate is over - far from it.
And with good reason. This issue is far from resolved.
No doubt Fallin hoped the controversy would go away when she announced Oklahoma will not participate in the Medicaid expansion program called for in the Affordable Care Act, known as Obamacare. But she probably knew better, because so much is at stake here, stakeholders are not going to keep quiet.
A predictable and well-founded response to the governor's decision arose from the left-leaning Oklahoma Policy Institute, which is still arguing the case for participating in the expansion. OK Policy, as it's known, took the governor to task for her contention that the proposed Medicaid expansion would cost Oklahoma as much as $475 million between 2014 and 2020. OK Policy Director David Blatt said in a Nov. 27 blog that the governor's claim is "greatly exaggerated and misleading." Her cost figures are based on "unrealistic assumptions" of how many people would participate in the expansion and include costs the state faces even if Medicaid isn't expanded.
The governor's conclusion also ignores savings and new revenues that would accrue from expansion. "When we consider benefits of increased coverage for the health of our citizens and financial well-being of our health-care providers, Medicaid expansion is clearly affordable and urgent," wrote Blatt.
Blatt cited figures developed by the Oklahoma Health Care Authority putting the state's cost of Medicaid expansion at only about $17 million to $22 million a year, based on the more realistic assumptions used by health industry experts.
Fallin also did not take into account any cost savings and new revenue the expansion would generate. Some mental health and corrections programs currently funded by the state would be covered by the expansion, relieving existing budgets. And new tax revenue generated by expansion - new employees, new businesses, etc. - could range as high as $30 million a year, according to one estimate.
Let's get tweaking
It's no surprise Fallin and OK Policy are on opposite sides of this issue. But one well-respected GOP leader also has taken her to task. In a recent column published in grandlakenewsonline.com, state Rep. Doug Cox, who is a physician, took a courageous stance against the governor.
Pointing to the unpopularity of Obamacare in Oklahoma, the Grove Republican wrote, "I have no doubt that Gov. Fallin made the right decision from a political standpoint."
But he added, "the fact is, now it is the law, whether we like it or not."
"I would have made the opposite choice from the governor. But then again, my decision would not have been made based on politics, but rather on the predicament many of my constituents find themselves in," he continued. "Most people who would have been affected by the expansion of Medicaid are not deadbeats, but hard-working Oklahomans trying to raise their children and make a better life for themselves. They have lower wage jobs, without employer-provided insurance."
Cox came up with another estimated range of costs to the state - $27 million in 2017 up to $56 million in 2020 - new spending that he called "doable."
"With the governor's decision, our money will now be used to expand the program in other states, while our own citizens continue to be uninsured and lack access to care," he noted.
Cox also detailed another problem the governor's decision creates that has received little attention: the loss of funding to hospitals for uncompensated care that will occur due to Medicaid expansion. Obamacare calls for this supplemental funding to hospitals, known as disproportionate share funding, to be cut back to help pay for the Medicaid expansion.
"Presently Oklahoma hospitals receive supplemental Medicare money ... to offset the cost of caring for the uninsured. These payments are going to be decreased or eliminated as a way to finance the federal share of the health plan. Since the governor chose not to participate, Oklahoma hospitals will still lose (this funding), and not be able to recoup the loss through the Medicaid expansion. Hospitals will have to choose between closing, raising prices on those with insurance or paying with cash to make up for this lost revenue," Cox explained.
He concluded: "I respect Gov. Fallin's decision, but I deal on a daily basis with good people who need, but cannot get, access to medical care. Right or wrong, my compassionate heart overrules my political mind."
Cox later elaborated on the thoughts expressed in his column. "As a state legislator I am powerless to change what the feds send down. Although I can make my opinions known - as can any citizen - to our federal legislators, I see my role as trying to work with whatever they have sent our way to the best advantage for my constituents.
"I will be the first to say that the ACA may not do much, if anything, to control cost. However, I may also be the first to say that our present system is broken and we have to start looking at ways to improve it. Like many bills we pass in Oklahoma City, the ACA is far from perfect. I think it will continually be tweaked - just as our Medicare system has been since 1965."
As it stands now, these are the stakeholders who stand to be hurt by the governor's decision: the 180,000 uninsured people who could get health insurance under the Medicaid expansion; the 381,000 uninsured people who would get federal subsidies through health-insurance exchanges that Fallin and Attorney General Scott Pruitt are trying to block; the insured Oklahomans who will have to continue to pay ever-increasing insurance premiums and other costs arising from uncompensated care; the many hospitals in the state that will collectively lose tens of millions of dollars a year in uncompensated care subsidies.
Even if the Medicaid expansion did cost the state a dab of extra money each year, the benefits of insuring tens of thousands of residents undoubtedly would far outweigh that cost.
It's doubtful Fallin will reconsider her decision. Our only hope is that some new wrinkle we haven't yet foreseen - maybe that tweaking Cox referred to - will open the door for the recalcitrant governors to get on board. If so, let the tweaking begin.
Original Print Headline: The debate goes on
Janet Pearson 918-581-8328
Gov. Mary Fallin addresses the Tulsa Chamber at the Tulsa Convention Center in July. Fallin's decision against Medicaid expansion still is generating debate. MATT BARNARD/Tulsa World file