Oklahoma Medicaid debate: It's not over till it's over
BY JANET PEARSON Associate Editor
Sunday, March 10, 2013
3/10/13 at 7:38 AM
If the Medicaid expansion issue is settled in Oklahoma, then why are there just as many articles, columns, blog posts and reports as ever devoted to the subject?
Maybe it's not quite as settled as some would like to believe.
Several recent developments do suggest the health-insurance issue is still in a state of flux in Oklahoma, as in some other states. Maybe it really isn't over till it's over.
Add to the growing list of analyses on Oklahoma's situation "Medicaid Proves Its Worth in Oklahoma," by Oklahoma Policy Institute Director David Blatt.
The home-grown think tank, known as OK Policy, has been one of the staunchest advocates of the Medicaid expansion called for in the federal health-care reform act known as Obamacare. If Medicaid were expanded here as envisioned, an estimated 180,000 Oklahomans who now lack health insurance could receive coverage.
Gov. Mary Fallin announced last November she would not go along with expansion, and has reaffirmed her stance periodically since then. Instead of accepting expansion, Fallin wants a recently hired consultant - Utah-based Leavitt Partners - to come up with an "Oklahoma plan" for providing coverage for those Oklahomans.
Blatt's recent analysis attempts to refute the oft-repeated claims of opponents who argue Medicaid is a broken system that causes more problems than it fixes.
Blatt concluded that Medicaid costs have risen "at a more modest pace" than other health-care and premium costs, and "Oklahoma's Medicaid costs are well below the national average" - countering claims it's an inefficient, costly system. He also found that the 34,000 medical providers currently providing Medicaid services could serve more than twice as many recipients as they do now - countering the claim that the system can't handle a large expansion in enrollment.
Also, Oklahoma's Medicaid providers receive among the nation's highest reimbursement rates, at 96.5 percent of Medicare rates, which suggests rates aren't a big issue. The program also generates high levels of patient satisfaction - 91 percent calling the care above average, according to surveys - which counters the claim it's an inferior system.
Compare Blatt's findings and conclusions with some of those of critics, and you'd think they were talking about two entirely different programs. The anti-Medicaid crowd continues to claim that the program forces patients into dependency, provides inferior health care, leads to poor outcomes, and bestows unwarranted power on the federal government - despite evidence and argument that contradict every single argument.
So why was this war of words continuing as recently as last week if the matter is decided? One columnist just last week predicted Oklahoma could become a milk-and-honey kind of place "if Fallin sticks to her guns" and continues to reject expansion. Why would anyone think she wouldn't stick to her guns?
In part, perhaps, because several other GOP governors have put aside their guns. In recent weeks, Govs. Jan Brewer of Arizona, John Kasich of Ohio and Rick Scott of Florida all have decided to accept the Medicaid expansion. While these governors pointed to the economic benefits in making their decisions, several also brought up the moral argument. Scott, who had been a staunch expansion foe, said he now "cannot in good conscience deny Floridians that needed access to health care."
These recent changes of heart and mind so far have not swayed our GOP governor - at least not publicly - but there are other persuasive developments at work. Increasingly, the feds are signalling they are happy to work with states to develop alternatives that are more palatable to local constituencies. One of the most far-reaching of these developments was announced last week in Arkansas, where officials have struck a deal with the feds on an alternative to Medicaid expansion.
The Arkansas alternative will allow that state to provide private insurance to about 250,000 residents using expansion funds. Instead of enrolling them in Medicaid, Arkansas will be using that money to pay premiums on private insurance provided through the state's health insurance exchange.
"The feds have agreed to do what my legislators in various conversations have asked me to go ask them to do. Basically they've agreed to give us about everything we've asked for," said Gov. Mike Beebe.
Said the state House speaker: "It's a whole new ballgame."
Indeed, it appears to be. In announcing nearly $300 million in Medicaid innovation grants, U.S. Health and Human Services Secretary Kathleen Sebelius declared: "States have long been innovators and leaders in promoting these kinds of improvements through the Medicaid programs."
Yet another development that could affect Fallin's thinking in weeks to come is the anticipated recommendations from the Leavitt group, tasked with coming up with an Oklahoma solution to the health-insurance dilemma. That well-respected firm, hired in January for $500,000, was founded by former Utah governor Michael O. Leavitt, who also served in the Cabinet of President George W. Bush. Because of both the study's significant cost and its consultant's pedigree, it just about has to be taken seriously. Will a Medicaid element be among the consultant's recommendations? Some insiders think so.
"In my mind, the path to Medicaid expansion could be through Leavitt," suggested Blatt. He also believes the recent decisions by "bona fide conservatives like Kasich, Brewer and Scott" to accept the expansion "have to be forcing some reconsideration here in Oklahoma."
And, the "strong, strong signs from the federal government that they are looking at flexibility for states" also could affect the Oklahoma debate.
"They are being very open to working with states, so I do think this gives Gov. Fallin a chance to say we are willing to enter into discussions with the federal government," he said.
"I'd say I'm more optimistic now than I was immediately after the governor's decision for all of those reasons," he added. "We were never convinced that this was settled."
Is it, or isn't it? Stay tuned.
Original Print Headline: It's Not Over Till It's Over
Janet Pearson 918-581-8328
Members of the National Governors Association Executive Committee, from left, Arkansas Gov. Mike Beebe; Wisconsin Gov. Scott Walker; Minnesota Gov. Mark Dayton; Chairman, Delaware Gov. Jack Markell; Utah Gov. Gary Herbert; and Vice Chair Oklahoma Gov. Mary Fallin, leave together after speaking to members of the media outside the West Wing of the White House in Washington in December. Associated Press file