As the nation’s largest health care program and an important driver of improved health outcomes, Medicaid is always an important governmental investment. However, as the COVID-19 pandemic continues to ravage the state and the nation, hurting the economy and increasing racial and economic disparities, Medicaid is more important now than ever in providing critical coverage to people who wouldn’t otherwise be able to see a doctor or fill a prescription. As Oklahoma moves to implement Medicaid expansion in July 2021, some 200,000 newly eligible Oklahomans will gain access to affordable health care, and the state will see significant economic returns. Medicaid provides a pathway to coverage for nearly one in four Oklahomans, and the state and federal governments must protect this access to care.
Medicaid provides vital support
Medicaid was designed to provide support, particularly in a time such as this. Enrollment in Oklahoma’s Medicaid program, or SoonerCare, increased 19.5 percent between February and December 2020. This is in part because states are prohibited from terminating coverage while accepting extra pandemic-related federal funding (discussed in detail below). The economic downturn also has driven enrollment due to significant loss of jobs and employer-sponsored health insurance. As more Oklahomans rely on Medicaid to see a doctor, SoonerCare is fulfilling its purpose: providing people with affordable health coverage in times of need.
Even so, many Oklahomans remain uninsured. Before the pandemic, nearly 1 in 5 of all Oklahomans were uninsured, and the rate was significantly higher in many communities of color due to entrenched and systematic inequities. The state’s high uninsurance rate has undoubtedly played a role in Oklahoma’s high number of COVID-19 deaths, as recent research has found a strong correlation between the proportion of uninsured residents and high numbers of COVID-19 cases and deaths. In Oklahoma at the time of the study, some 48 percent, or almost half, of all COVID-19 deaths were linked to being uninsured. Medicaid expansion will be a good first step towards mitigating these large gaps, but the state must commit to prioritizing the health of all Oklahomans by providing accessible paths to affordable coverage.
Increased federal funding will ensure Oklahoma can provide coverage to all who need it
The federal government has committed to supporting states in their efforts to provide coverage for many who would be otherwise uninsured, by helping states fund their Medicaid programs through the Federal Medical Assistance Percentage (FMAP) program. Since 2011, Oklahoma’s FMAP rate has stayed relatively constant, with the federal government paying about 60 percent of the state’s Medicaid costs, or roughly two dollars for every dollar the state spends on Medicaid. However, the Coronavirus Aid, Relief and Economic Security (CARES) Act, passed by Congress in March 2020, provides a 6.2 percentage-point increase in federal Medicaid matching funds for the duration of the public health emergency. Because of this increased funding, Oklahoma is estimated to receive an additional $950 million for Medicaid expenses between January 2020 and December 2021.
On top of this, Oklahoma will get even more assistance in the near future. The American Rescue Plan (ARP), a new federal COVID-19 economic relief bill will provide an additional five-percentage point increase in the base federal match for non-expansion individuals for states that have not yet implemented Medicaid expansion. This change will not impact the 9:1 federal match paid by the federal government specifically for Medicaid expansion, providing a unique opportunity for Oklahoma to expand coverage without a significant impact on the state budget. Now that this bill has been signed into law, Oklahoma could receive an additional $860 million between July 2021 and July 2023.
Together, these federal initiatives are expected to return an additional $1.8 billion to the state of Oklahoma for Medicaid-related expenses between January 2020 and July 2023. This influx of dollars is more than enough to cover the estimated annual cost of Medicaid expansion, between $117 million and $164 million. And as federal funding returns to normal levels in the next few years, Medicaid expansion will still generate net savings and additional revenue, providing an opportunity to not only maintain health care spending, but to reinvest savings into improving health care for all Oklahomans in the future.
Lawmakers have a responsibility to protect and expand Medicaid
SoonerCare must be fully funded and accessible so that everyone has access to comprehensive, affordable health care. To ensure that all Oklahomans can continue seeing their physicians, Oklahoma leaders must do their part. Legislators and other state leaders should ensure that Medicaid expansion is free of barriers and accessible to all Oklahomans who qualify.