Obamacare meets extra resistance in Oklahoma (Los Angeles Times)

October 3rd, 2013
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By Maeve Reston
 
The nation’s healthcare law was written with the residents of rural counties like Choctaw in mind. A quarter of the Oklahomans who live in the ranch country near the southeastern corner of the state are uninsured, one of many reasons their health ranks near the bottom of Oklahoma’s 77 counties. But that does not mean people here want Obamacare.

The state attorney general is leading one of the last state challenges against the law in federal court. The state insurance commissioner issued a sharply worded warning to federally funded “navigators” who are helping people sign up for insurance. And frightening rumors about the law — uncountered by any positive spin — are dissuading some residents from considering it.

At the Hugo livestock auction, the busiest spot in town last Friday, owner David Minyard waved his hand in disgust when asked about the law. If what he’s heard about it is true, he said, “I’m going to have to lock up and shut my door.”

“There isn’t nobody who’s read it or understood it,” Minyard said as ranchers pulled up their cattle trailers to unload in the yard outside. “No two people comprehend it the same way. You’re hearing one thing. I’m hearing another. He’s hearing another.

“Forty-thousand pages?” he said, vastly exaggerating its size. “Hell yes, it’ll be confusion.”

Minyard, a respected business owner in Hugo, says that no one — from his neighbors to his ranch hands — is turned away when they go to the local emergency rooms. “If they need medical care, they’re going to have it,” he said. “Why force somebody to do something they don’t want?”

Standing silently nearby was 26-year-old Chad Austin, who is coordinating the navigators working in 63 Oklahoma counties. Austin is trying to stay clear of the politics. But he knows what he’s up against.

“Bad news travels, and to a lot of Oklahomans right now, this is bad news,” said the former high school baseball coach, who worked until recently at a local funeral home. “We’re not offering any opinion on that; our goal is to help our community members.”

As the Obama administration and its emissaries began coaxing Americans to sign up for health insurance this week, they were facing not just countless misconceptions about the law in red states like Oklahoma, but also a stigma — its attachment to a president unpopular here — that may drive potential consumers away.

States like California are spending millions to promote the law, but here it is difficult to find a trace of information about it beyond cable news. Officials at two organizations that received grants for outreach say they are still training navigators on what they can and cannot do.

There are no billboards along the highways, no public service announcements on the radio. At a number of health clinics, there were no fliers last week about the law’s insurance marketplaces.

That’s just fine with many leaders in a state where Obama lost every county. During an interview at his office facing the state Capitol, Atty. Gen. Scott Pruitt, a Republican, said he was more concerned about “public protection” and privacy concerns related to the law than whether people know where to sign up for insurance.

“Folks want something to be done because they are fearful,” said Pruitt, who said the lawsuit might offer the “last best hope” to topple the Affordable Care Act.

Oklahoma’s lawsuit in federal court challenges the underpinnings of the president’s healthcare law: It argues that an Internal Revenue Service rule punishes large employers and claims the wording of the law prevents consumers from getting government subsidies to help them buy health insurance if they live in states like Oklahoma that are not running their own insurance marketplaces. Oklahoma is one of 36 states that have asked the federal government to run the marketplaces next year. The Obama administration and many experts fiercely dispute the state’s interpretation of the law.

Beyond the legal battles, the law’s advocates have also been thwarted by Republican Gov. Mary Fallin‘s decision to reject federal money to expand the state’s Medicaid program, which provides care for some of the poor and disabled.

Oklahoma’s program is already more limited than those in other states like California. Some of the state’s poorest adults, including the homeless, are not eligible for Medicaid if they are between the ages of 19 and 64 and do not have children. About 150,000 of the 630,000 people who are uninsured in Oklahoma would have been covered under the proposed Medicaid expansion, but Fallin argued that it was not in her state’s “best interest” to accept the money because of the rising costs of Medicaid.

“Adults below the poverty level are going to be left in a coverage crater where they will make too little to qualify for the subsidies on the exchanges, and most don’t qualify for traditional Medicaid,” said David Blatt, director of the Oklahoma Policy Institute. (Insure Oklahoma, a program created a decade ago, could fill part of that gap by helping low-income people buy insurance, but only a few thousand slots are available).

The practical and political hurdles — paired with the scarcity of information about the law — have left many Oklahomans confused.

In dozens of interviews here, many said they feared they would be forced to buy insurance they couldn’t afford. Some said they were told (erroneously) that insurance penalties would come out of their Social Security checks; others said they’d heard the law meant they’d soon have to travel several hundred miles to see a doctor.

“They say it’s affordable, but when you ain’t got no money, nothing’s affordable,” said 55-year-old Paul Bush of Midwest City, who accompanied his sister to a clinic for care last week. While he supports efforts in Congress to kill the program — “Heck yeah,” he said — he wasn’t happy about Fallin’s decision to reject the Medicaid expansion: “The state could really have used the money.”

Bush’s sister, Teresa Springer, might have qualified for care under a Medicaid expansion, but she supported Fallin’s decision.

Springer, who has applied for disability assistance, said she worried that fines related to the healthcare law would cut into her disability checks at the same time that some Republicans in Congress were talking about cutting food stamps.

“That’s all I have,” she said after a visit to the Mary Mahoney Memorial Health Center in Spencer, Okla. “I’m going to either pay my bills or not eat.” The law, she added, “is hurting everybody.”

In a back office at the clinic, Debbie Haller shakes her head when she hears those kinds of misconceptions about the law. It will fall to counselors like Haller, the clinic’s development coordinator, to clear up the facts about fines and eligibility.

In Springer’s case, she may qualify for federal tax credit subsidies, which are available to individuals earning less than $46,000 annually and families earning less than $94,000. If she cannot afford coverage because the premium is more than 8% of income, she would be exempt from any fine.

But those are complicated concepts to explain to the population served by the Mary Mahoney clinic, which is part of a network of seven clinics statewide that is known as Community Health Centers Inc. Haller noted that a sizable portion of patients they serve could not read or write.

“A lot of them don’t see the benefit,” she said in an interview. “People here are among the unhealthiest in the nation. The need is there … but the only thing that has been in the paper is negative.”

Leaders in the two consortiums that received federal money for a public education campaign in Oklahoma were still in the early phase of training as residents became eligible to sign up for insurance this week.

Austin, who works at the Little Dixie Community Action Agency in Hugo, emphasized that for now the priority was to not “mislead anybody.”

“Around the first of the year,” he added, “maybe we’ll do some more speaking engagements, or hanging some signs, or maybe some advertisements on the radio.”

Austin had just received a shipment of bookmarks with information about signing up for insurance at healthcare.gov. He joked that he would probably start handing them out at the library, rather than the livestock auction, in hope of an easier sell.

http://www.latimes.com/nation/la-na-obamacare-oklahoma-20131004,0,7851840,full.story