5. Medicaid expansion

Medicaid expansion saves lives.

Since 2014, the federal government has funded Medicaid coverage for working-age people who earn up to 138% of the federal poverty level. Thirty-six states and Washington, D.C., have bought into the program, currently and permanently funded with 90% federal money.

Oklahoma is one of the 14 states that pays for Medicaid expansion, but refuses to accept it. An initiative petition will soon be circulated to bring Medicaid funding to the state, and Gov. Kevin Stitt is working on his own program that might accept the funding in some sort of hybrid program, possibly involving private insurance or other variations.

There’s no reason to accept the money if it won’t make Oklahomans healthier. Obviously, Medicaid expansion would increase the number of people who have health care coverage, which is good for hospitals, doctors and, potentially, insurance companies. But if expansion doesn’t actually lead to better, longer lives for the people it covers, it’s just spending more money to get the same results.

The good news is mounting evidence shows Medicaid expansion does lead to healthier outcomes.

• A June 2019 study published in JAMA Cardiology shows that fewer people died of heart disease in Medicaid expansion states. After accounting for demographic, clinical and economic differences, counties in expansion states had 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in nonexpansion states. If you round off Oklahoma’s population to 4 million, that’s 172 fewer people dying of heart disease per year.

• Infant and maternal mortality rates go down when states accept Medicaid expansion. Georgetown University research released earlier this year compares infant mortality in expansion and nonexpansion states and finds a 50% greater reduction in infant mortality with expansion. Maternal mortality also improved: 1.6 fewer deaths per 100,000 women.

• A 2019 study examining Medicaid expansion and cancer screening finds that the five states and District of Columbia that first adopted Medicaid expansion saw larger increases in colorectal cancer screening than those states that did not expand Medicaid. The study estimates that if nonexpansion states had experienced the same increase, an additional 355,184 people would have been screened. We can’t say (yet) that fewer people die of cancer in expansion states, but more screenings are likely to lead to earlier treatment and greater chances of success.

• A federal study of people in Kentucky, Arkansas and Texas found that Medicaid expansion improved access to care and medication among persons with depression, even in areas with relative shortages of mental health professionals.

• Medicaid expansion states are healthier as a whole than those that don’t expand. United Health Foundation puts an annual health ranking of the states. The 22 healthiest states in the 2018 rankings have all agreed to accept the Medicaid funding. Maine, an expansion state, rose seven spots in the rankings to No. 16, the greatest gain by any state. Arkansas, also an expansion state, rose two places to No. 46. That’s not great, but it’s one place better than Oklahoma, which fell four places — the worst decline of any state. Of the three states below Oklahoma, only Louisiana (No. 50) is an expansion state.

• • •

Quietly, Gov. Kevin Stitt has moved Carter Kimble, a Medicaid guru and former director of health policy at Oklahoma State University, into his office as deputy secretary of health and mental health. Kimble was once the in-house liaison to the Legislature for the state’s Medicaid agency. He’s a smart guy who combines experience with the state and federal bureaucracy and the politics of the state Capitol.

A news release from the governor’s office says Kimble has been assigned to come up with a plan “to improve health outcomes by increasing access for all Oklahomans to affordable coverage and modernizing health services delivered by state agencies.”

Looking for evidence Stitt is ready to look seriously at Medicaid expansion in one form or another? There it is.

We know how to improve health outcomes by increasing access. It’s staring us in the face. Accept $1 billion a year in federal funding to give working poor Oklahomans health care coverage through Medicaid expansion.


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