Budget troubles rolling back Oklahoma’s gains on health care (Capitol Updates)

Photo by J Franklin / CC BY-NC-ND 2.0
Photo by J Franklin / CC BY-NC-ND 2.0

Steve Lewis served as Speaker of the Oklahoma House of Representatives from 1989-1991. He currently practices law in Tulsa and represents clients at the Capitol. You can sign up on his website to receive the Capitol Updates newsletter by email.

The Oklahoma Healthcare Authority (OHCA) announced last week that it will implement a 3 percent cut in medical provider rates beginning January 1, 2016. This is due to state funding shortages that are making it difficult for OHCA to meet the state match for federal Medicaid funds. The rate cuts will not affect behavioral health rates because the state funding for behavioral health providers comes from money appropriated to the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) rather than OHCA. So far, ODMHSAS has found other ways to meet its budget shortfalls without provider rate cuts. Behavioral health providers have good reason to feel fortunate, but there could come a time when the shoe is on the other foot and they suffer a rate cut when medical providers do not.

I don’t know if a 3 percent pay cut is enough to cause some doctors and other medical providers to stop taking Medicaid patients, but certainly a continuation of the trend will at some point have that result. Oklahoma has spent decades, when the opportunity presented itself, raising provider rates to attract good medical personnel to serve Medicaid patients. Because of that we have compared favorably to rates in some other states. But this is another example of our state “eating the seed corn” to survive because of lack of sufficient tax revenues. A Medicaid system that took years of intentional building to provide good medical services to lower income people, many of whom are children, can be lost in a short time. When the economy recovers will we restore what’s been lost?

The current crisis should be a good time to take another look at expanding Medicaid under the Affordable Care Act. The ACA has been upheld in court, and it’s a pretty safe bet that it’s not going to be totally repealed or replaced, at least by anything to the liking of those who don’t like the ACA. If things change at the federal level, so be it. But we are just punishing our economy, Oklahoma patients who could get timely medical care under the ACA, and our medical providers by stubbornly refusing to take the federal funding. The continued failure to accept Medicaid expansion is especially difficult to understand while doctors are taking a pay cut. Expanding Medicaid would bring millions of federal dollars per year into the state for medical services and save state money on services now being paid for by 100 percent state dollars. More money into healthcare might in some way help make up in volume what is being lost in rates, at least until rates could be restored.

It’s an understatement to say our policymakers have their work cut out for them in the next session. Hopefully, they’ll approach it with an open mind.

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Steve Lewis served as Speaker of the Oklahoma House of Representatives from 1989-1990. He currently practices law in Tulsa and represents clients at the Capitol.

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