After more than 10 years, Oklahoma’s Medicaid expansion prize fight is about to go into the final round.
We’ve slugged it out with competitive think tank reports and bloody press conferences. After one decade, two governors, an initiative petition drive and too much sickness among the state’s working poor, the question will be resolved by the voters on Tuesday.
If approved, State Question 802 will rewrite the Oklahoma Constitution to mandate accepting federal Medicaid expansion funding under the Affordable Care Act within one year.
I’ve been thinking about this issue for a long time. The Tulsa World’s archives shows my first story with the phrase “Medicaid expansion” in it was in 2012. There were 125 others after that. As of today, 126.
The more I’ve followed the issue the more I’ve become convinced that expansion will make the state financially and physically healthier and that we can’t afford to continue refusing $1 billion a year just because it comes from legislation signed by President Barack Obama.
Here are my top 10 reasons for thinking that way:
1. It will bring $1 billion a year into the state economy. That’s $100 million more than the value of the state’s 2019 wheat crop … and the 2018 crop… combined.
2. We can afford it easily. The state’s portion of the costs are ridiculously low. The federal government will pay 90% of the cost of newly eligible Medicaid clients. That’s an enormous bargain. For children, pregnant and elderly people currently on Medicaid, the federal match is usually around 66%, depending on fluctuations in the state’s economy. The federal government has never reneged on its Medicaid obligations.
3. Oklahomans are already paying the taxes to support Medicaid expansion, we’re just not getting any of its benefits. That doesn’t even address the issue of uncompensated care. When they get sick, poor people still get treatment. They just get it too late, when chronic conditions become emergency conditions, when it costs more and is harder to cure and when it can cost months or years of lost work. Those costs — often accumulated in hospital emergency room — get passed along to insured patients, a hidden tax.
4. Thirty-six other states and Washington, D.C., are taking advantage of Medicaid expansion. Arkansas has it. So do Colorado and New Mexico.
5. Expansion will save the state’s rural hospital system. In the past 10 years, 120 rural U.S. hospitals have closed. Eight of them are in Oklahoma. More are teetering. A 2019 court filing by the Oklahoma Hospital Association and other SQ 802 proponents says that 17 rural Oklahoma hospitals are at risk of closing and 54% of the state’s rural hospitals have a negative operating profit margin.
6. It will reduce the state’s unacceptably high number of people who don’t have health care coverage. Only one state — Texas — has a higher portion of its population without insurance. Before the COVID-19 shutdown, estimates were that Medicaid expansion would bring coverage to some 200,000 Oklahomans.
7. It will make us healthier. If people have health care, they will get treatment for chronic conditions. They will have physician assistance in dealing with long-term issues like obesity, tobacco use and sedentary lifestyles.
8. It will make us more productive. Healthier people can work harder. They can hold jobs. They’re better parents. They participate in their community.
9. The rising tide lifts all boats. The potential economics of Medicaid expansion are remarkable. The federal government will pick up 90% of the costs of some medical expenses currently paid 100% by the state. More medical care means more doctors and nurses paying more income taxes, buying more things and paying more sales taxes. If the true economic impact could be figured, it could easily work out that Oklahoma ends up making a fiscal profit from Medicaid expansion.
10. It’s the right thing to do. Am I my brother’s keeper, Cain asked God.
The answer was and is: Yes.