Capitol Report, Wayne Greene: Changing Fallin's mind on Medicaid won't be easy
BY WAYNE GREENE World Senior Writer
Sunday, January 20, 2013
1/20/13 at 6:06 AM
What would it take for Gov. Mary Fallin to change her mind about using federal Affordable Care Act money to fund a Medicaid expansion in Oklahoma?
When Republican Gov. Jan Brewer of Arizona, who is no friend of the president or his Obamacare program, made a surprise announcement last week that she was ready to take Medicaid enhancement money, it got advocates wondering about what it would take for Fallin to do the same thing.
It seems to me that at least five things would be needed.
Mass support: Fallin is a politician. If she felt the majority of Oklahomans wanted the Medicaid funding, I suspect she'd move that direction pretty fast.
She's already demonstrated that a concerted outpouring of public sentiment can change her mind on Affordable Care Act issues, although Medicaid expansion advocates probably won't take any comfort in remembering that story.
When she first came into office, Fallin agreed to accept $54 million in federal money to pay for construction of a state health insurance exchange, a critical element of implementing the ACA.
When tea party Republicans howled and legislators revolted, Fallin told the feds to keep their money. Later, she decided not to build a state exchange at all. That won't prevent the U.S. Department of Health and Human Services from building one and imposing it on the state, which Fallin once said was a scenario that absolutely had to be avoided.
There's a rally of Medicaid expansion supporters planned for the day after Fallin delivers her State of the State address next month.
If a small fraction of the 155,000 Oklahomans who will be shut out of health coverage because of Fallin's decision were to attend, that would get some attention.
If it fizzles, it's another reason for Fallin to do nothing.
Unfortunately for the Medicaid advocates, this is a complicated issue that doesn't appear to have captured the interest of the people who will be affected.
Texas: Many people have speculated that one of the reasons Brewer made her choice was that surrounding states - California, Nevada and New Mexico - had done so.
Brewer may not have wanted to explain to Arizonans why they could look across the border and see their healthier neighbors and hospital emergency rooms that weren't clogged with uninsured sick people.
She also might not have wanted to explain why she turned down a program that would fund 100 percent of the costs of new benefits for thousands of her state's residents though 2016, when the surrounding states were moving ahead with the plan.
Fallin really doesn't have that peer pressure.
Arkansas has accepted the Medicaid money. So have Missouri, Colorado and New Mexico.
But Kansas hasn't. Neither has Texas, the biggest kid on our block.
Texas Gov. Rick Perry has been steadfast in his refusal to buy in, but he's under the same internal political pressure that Fallin is. Hospitals, business leaders and Democrats are pushing him to deal with the fact that a higher portion of Texans lack health care coverage than any other state and that Medicaid expansion would generate $100 billion in federal money for the state in 10 years and cover about 2 million people, according to Kaiser Health News.
If Texas were to reverse course, Fallin would have to look at doing the same thing.
More evidence: The Oklahoma Health Care Authority has authorized a $500,000 contract with the consulting firm founded by former Utah Gov. Mike Leavitt to figure out how to cover 200,000 uninsured Oklahomans who would have qualified for Medicaid if Fallin had accepted the expansion.
If that study comes up with a viable plan that's cheaper than Medicaid expansion, Fallin's safe. On the other hand, if the plan is too expensive or falls short of the mark in a significant way, it would seem the pressure intensifies on her to go back to Plan A.
But if other states - most notably Arkansas - can demonstrate that their people are getting healthier, that their economies are prospering and their state budgets are not foundering, it will become increasingly difficult to turn the federal money away.
Political cover: It would be easier for Fallin to say the situation has changed than to say she changed her mind.
If Oklahoma's hospitals and chambers of commerce want the Medicaid money to start flowing into the state, they need to keep an eye open for a situation-changing opportunity.
It could come in a bad report on the state's overall health or the number of uninsured people.
It could come in rural hospitals closing or threatening to close.
It could come with federal officials announcing some marginal change in policy designed to make the Medicaid medicine easier to swallow.
In a sense, however, that's a self-fulfilling situation. If the governor wants to change course, she'll find the cover to justify it.
Political confidence or doubt: Right now Fallin can feel there's no reason to be concerned about her chances in the 2016 general election.
On the other hand, if she wants to have a run for her life in the 2016 Republican primary, all she has to do is to cuddle up next to President Obama's health-care plan.
In a sense, this goes back to demonstrating mass support for the issue, but it could also come in subtler ways, perhaps a demonstration that Fallin's most potentially dangerous GOP opponents really aren't in the field or aren't all that potent.
Perhaps as dangerous as a big name challenge would be a prairie-fire opponent - Candidate X - who can capture the energy of the state's tea party movement.
To change Fallin's policy thinking on Medicaid, advocates are going to have to change her political thinking about it first.
Giving her the confidence that she isn't writing her own political obituary if she accepts the Medicaid money could be the most important and most difficult step.
What would it take for Gov. Fallin to change her mind on Medicaid expansion?
I'm reminded of the joke on the side of a coffee cup someone gave a friend a long time ago.
What does it take to admit you're 30?
It takes courage. It takes self-confidence. It takes two or three years.
Original Print Headline: Fallin's Medicaid stance tough to change