Could the tide be turning on Obamacare?

BY JANET PEARSON Associate Editor
Sunday, January 20, 2013
1/20/13 at 7:08 AM

Is the united front of conservative opposition to "Obamacare" crumbling?

With Arizona Gov. Jan Brewer's surprise announcement that she now supports an expansion of Medicaid in her state, some observers think maybe so. And Brewer's not the only conservative governor rethinking Medicaid expansion, a key element of Obamacare: Nevada's Brian Sandoval and New Mexico's Susana Martinez also recently broke "from the national party (to) embrace the expansion - and they probably won't be the last," Governing magazine concluded in a Jan. 16 article, "Why GOP Governors Are Coming Around on the Medicaid Expansion."

Our governor hasn't come around yet, and may not ever, but her push to develop an "Oklahoma solution" to the health-care issues of the day is another indication this saga is far from over.

The Arizona governor, perhaps best known for wagging her finger in Obama's face at an airport encounter a year ago, has been a staunch foe of both the president and the Affordable Care Act, but she finally became convinced that Medicaid expansion would be good for her state in several ways: It would help poor residents who can't afford health care, and hospitals and other providers hurt by the costs of the uncompensated care they must provide to the needy. These are the identical arguments advanced by advocates in Oklahoma, but to date they have not been persuasive to our governor.

Gov. Mary Fallin has cited concerns about costs to the state that would arise from Medicaid expansion. The act calls for the federal government to pay 100 percent of the expansion costs for the first three years, with states picking up no more than 10 percent in subsequent years.

Unlike Fallin, some Republican governors formerly opposed to expansion have changed their views about the cost issue.

According to the Governing article, Sandoval's office estimates that Medicaid expansion would provide coverage for 78,000 people and bring in more than $700 million federal dollars in the first three years. "That's a massive leverage of federal dollars," said Jeff Mohlenkamp, Sandoval's budget director. "Considering how many federal dollars we are leveraging, the cost (of expansion) is fairly small."

That massive infusion of federal funds prompted one expert to tell the magazine that expansion is "a deal that most states will not be able to refuse in the long run. That's why the administration is acting confident that all states will come in."

The case for expansion

Instead of accepting our share, which would provide coverage for more than 150,000 currently uninsured Oklahomans, Fallin has state health leaders hard at work on a home-grown plan that so far is pretty nebulous. They don't have much time to come up with an alternative - full implementation of Obamacare starts next year - and there's no assurance that any state proposal would win federal approval (known as a waiver). In fact, some knowledgeable observers believe a waiver likely won't be forthcoming. So it could be that our bureaucrats will just be wasting time coming up with a plan that doesn't have a chance of federal approval.

Fallin's refusal to expand Medicaid has been met with disapproval by not only the usual suspects - the lefties - but also some fellow Republicans and many business and health-industry leaders.

State Rep. Doug Cox, R-Grove, is an emergency room physician and has spoken up often about the need for more coverage in Oklahoma. He says he respects the governor's decision, but his emergency-room experience gives him a totally different take on expanding Medicaid.

"Even though I'm not a fan of the (Obamacare) system, it's here. I think we're banging our heads against the wall by thinking we can overturn that. So my attitude is let's work with what they sent us to do the best we can for the citizens of Oklahoma."

If the costs to the state end up being too high, "we can always opt out."

"The argument against that is there won't be the political will to take it away. But unlike the federal government, we have to balance our budget. So of necessity the political will has to be there," Cox said. "In the meantime let's participate and serve the health care needs of our state and take it a year at a time."

He added: "If we can get those people healthy, keep them healthy, keep them in school or at work, our state's going to win in the long run."

Another vocal and articulate supporter of Medicaid expansion is Jake Henry, Jr., Saint Francis Health System CEO. He was installed as the 2013 chair of the Tulsa Regional Chamber's board of directors on Wednesday and took advantage of his new bully pulpit to speak to the issue. Medicaid expansion is the chamber's top public policy priority for the 2013 legislative session.

"Former Vice President Hubert Humphrey said that the moral test of any government was how that government 'treated those in the dawn of life (its children); those in the twilight of life (the elderly) and those in the shadows of life (the sick, the needy and the handicapped).'

"Extending coverage to the most vulnerable among us is, in my view, a core responsibility of government," he said.

Like Cox, Henry noted that recent events - the president's re-election and the Supreme Court ruling upholding the law - ensure that the "Affordable Care Act is the law of the land."

"Had Oklahoma expanded its Medicaid program, it would have: protected rural and safety-net hospitals from being pushed to the brink by their growing costs in caring for the uninsured; it would have taken advantage of enormous economic benefits, injecting as much as $10 BILLION into our economy (and) saving and creating thousands of Oklahoma jobs; and provided health-care coverage to some 200,000 currently uninsured and low-income Oklahomans."

Medicaid expansion also "would have secured a federal revenue stream to cover the cost of the uninsured who already show up in our doctors' offices and emergency rooms. Currently these costs are passed along to Oklahoma businesses and families. Health-care premiums are raised year-after-year to account for expenses incurred by our hospitals as they provide care to the uninsured.

"Saying 'no' to this plan will not save these federal dollars from being spent nor will they be directed to deficit reduction. Instead, Oklahoma's tax dollars will simply be passed to other states, generating jobs and providing health care for citizens in California, Colorado, New Mexico, Nevada, and most recently Arizona ... "

Original Print Headline: The growing Drumbeat

Janet Pearson 918-581-8328
janet.pearson@tulsaworld.com

Associated Images:

Tulsa World photo illustration file