At long last, it appears that the Affordable Care Act will remain the law of the land. Efforts to repeal and replace the Affordable Care Act have fallen apart over deep and fundamental schisms around health care within the Republican party, particularly where Medicaid is concerned. With the ACA and the coverage it provides shifted out of the political spotlight, it’s time for Oklahoma leaders to deal with the law as it is and work within it to improve health care coverage and outcomes for Oklahomans. One way they can do this is by expanding Medicaid coverage. 

This opportunity couldn’t come at a better time. After years of shrinking revenues and subsequent budget cuts, we are very close to being unable to fund core functions of government. At the same time, our uninsured rate remains stubbornly high, threatening families’ financial security and putting pressure on overburdened safety net providers. However, lawmakers have an opportunity to address both problems at once by bringing accessible, affordable health coverage to more than 160,000 Oklahomans.

Oklahoma’s existing Medicaid program (also known as SoonerCare) is effective and efficient. More than 800,000 Oklahomans every month, and more than one million every year, access their health care through SoonerCare. Medicaid provides care more efficiently than either Medicare or private health insurance, and Oklahoma patients report being satisfied with the program, like their counterparts across the country.

With Medicaid’s success, there’s no reason why the state shouldn’t accept federal funds to expand the program to more uninsured Oklahomans. More than 30 states have accepted those funds so far, successfully insuring millions of people. States have flexibility on how they use the federal funds, too. Some states have simply expanded their existing Medicaid programs; others have used those funds to subsidize private coverage through programs like Insure Oklahoma. Expansion states have found that expanding coverage is a good deal for everyone: it saves state dollars, creates jobs, and — most importantly — improves working families’ financial security and access to basic care.

Medicaid expansion is good for state finances

The federal dollars would be a much-needed boost for a state whose finances are hurting. For every dollar Oklahoma would put towards expansion, the federal government would pay $9 or more.  As a result, expanding coverage would save cash-strapped state agencies millions of dollars, according to a Leavitt Partners report commissioned by Governor Fallin. Every state that accepts expansion funds should be able to realize state Medicaid savings, reduce state spending on the uninsured, and bring in additional revenues, according to a 2016 analysis by Manatt. States that already chose to expand health coverage are enjoying this prosperity. In Arkansas, expansion was originally projected to save the state $438 million, but expected savings are now nearly twice that.

Medicaid expansion is good for community health centers and rural hospitals

Furthermore, an infusion of federal funds would be a boost to overburdened health care providers, especially community health centers and rural hospitals. Expansion states have seen major reductions in uncompensated care at safety-net providers and big savings for hospitals and community health centers. In the first year of Arkansas’s expansion, the number of uninsured people admitted to Arkansas hospitals was cut in half and the number of uninsured patients in Arkansas ERs dropped 40 percent. Hospitals reported their uncompensated care losses dropped by 55 percent as a result.

In contrast, Oklahoma’s rural hospitals are shutting down or barely hanging on, and community health centers are struggling to stay afloat. Nationwide, the percentage of rural hospitals at risk of closure in non-expansion states is twice that of rural hospitals in expansion states. 

Medicaid expansion is good for Oklahoma families

Finally, expanding coverage is good for Oklahoma families. Oklahoma’s uninsured rate is nearly twice what it is in expansion states, and polling shows that more than half of these uninsured adults want access to coverage.

Getting health coverage through Medicaid expansion would mean more working-age adults with chronic illnesses like diabetes or heart disease could keep their illnesses in check. After Ohio expanded coverage, half of the workers  who gained coverage through expansion said that Medicaid made it easier to keep working, and three-quarters of those in the expansion population who were unemployed reported that Medicaid enrollment made looking for work easier. The 160,000 uninsured Oklahomans who would gain coverage through expansion largely work in service industries, preparing our food and taking care of our children and elders.

Aside from making it easier for people to keep working, expanding coverage would help Oklahomans work and raise their children without the threat of financial ruin from a health emergency hanging over their heads. Expansion strengthens family budgets — in Colorado, family household earnings are estimated to have grown more than $600 due to Medicaid expansion.

Expansion would also mean Oklahomans suffering from mental illness and drug addiction would more easily get the treatment that can save them from a downward spiral ending in prison. Uninsured individuals relying on the Department of Mental Health and Substance Abuse Services for help could have access to a full panoply of health services through Medicaid. Instead of staying one of the least-healthy and least-insured states in the US, Oklahoma could make huge progress in taking care of our own.

In short, expanding Medicaid would give us the freedom to take better care of our people, grow the economy, and save state funds. Lawmakers have difficult decisions ahead of them. But the question of whether or not to expand coverage for thousands of Oklahomans should be a simple one.