Gov. Kevin Stitt’s recent comments on Medicaid expansion bring to mind the old story of King Louis’ talking horse.
On Oklahoma City radio station KOKC recently, Stitt said that the solution to the state’s health care problems is a Medicaid block grant waiver.
(Imagine here, a tall white stallion in a medieval French stable.)
Stitt recognizes that the state desperately needs about $1 billion available from the federal government to improve the health of its citizens. The money would allow the state to expand its Medicaid program to cover working age adults who earn less than 133% of the federal poverty level.
(The horse shakes his harness gently and digs in the stable’s dirt with one hoof.)
But, the governor says Medicaid expansion as designed by Congress would “handcuff” the state’s ability to deliver services.
“Do we want more federal dollars in our system?” Stitt said, according to reporting by The Oklahoman. “Absolutely, and I’m going to show Oklahomans a plan to get there.”
(In those days, two men were sentenced to death for capital crimes.)
Only one state — Texas — has a higher uninsured rate than Oklahoma. As a result, our workforce is sick and poor and our rural hospitals teeter on insolvency. Our economy plods along, unaided by a $1 billion stimulus that could be had for a 10% state match, quite literally pennies on the dollar.
(The two condemned men were brought before King Louis in his stables.)
For years Oklahoma’s elected representatives have balked at accepting the Medicaid money, claiming, among other illusory problems, that the federal government can’t be relied on to live up to its funding promises.
(The first man pleaded with the king for mercy, but the king was unmoved.)
For years, Gov. Mary Fallin refused the money, but she eventually came around on the issue.
(The second man asked only for a one-year stay of execution. He promised that if he were allowed to work with King Louis’ horse for that 12 months, he would teach the animal to speak.)
Still, the Oklahoma Legislature refused the money against all reason.
(A horse is a horse, of course, of course.)
Remember, Oklahomans pay the same “Obamacare” taxes as people in every other state.
(The king was amused and granted the second man his reprieve.)
We’re paying for Medicaid expansion in places like Arkansas and New Mexico. The people in Arkansas and New Mexico are paying for Medicaid expansion here too, but we won’t accept it.
(Afterward, the first man asked the second how he planned to teach King Louis’ horse to speak.)
Stitt’s latest nuance is to accept the money as a block grant, which would cap the amount the state receives, although the state might get the federal government to agree to an annual adjustment for inflation.
(“In the course of a year,” the man said, “King Louis may die ...)
Tennessee is working on a Medicaid block grant plan of its own. The legality of such schemes is questionable. Federal courts have blocked other plans to wire around Medicaid law.
(“... or I may die ...”)
If the feds agreed to a block grant waiver, it could leave the quality and scope of the care provided up to the whim of state government, which would have a financial incentive to divert the money to some other purpose.
(“... or the horse may die ...”)
The federal government has never reneged on statutory Medicaid funding matches. It’s record on block grant programs is less consistent. A block grant plan would make the state’s Medicaid funding stream less reliable, not more reliable.
(“or,” the horse’s new tutor said, “the horse may talk.”)
An unprecedented number of Oklahoma voters signed a petition to put a straightforward version of Medicaid expansion on the next general election ballot. It would be in the state constitution, which means it would be beyond the meddling of those who have been messing around with this issue for the past seven years.
I’m tired of waiting for this horse to speak up. I’m ready to let the people of Oklahoma to do the talking.