Under health care bill, many could lose coverage to pay for tax cuts for a few (Capitol Update)

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.

Most of the action last week seemed to come from the federal level, and it was focused primarily on the health care debate. Well, as much as it was focused at all. There seems to be a consensus that changes in the Affordable Care Act are necessary to keep health care insurance companies in business and profitable at a premium rate that Americans can afford to pay. While some think the answer is a single-payer system, it’s fair to say we are at least one election away, probably more, from serious consideration of that idea. In the meantime, we will likely go through several variations of private/public insurance.

How does this national debate affect us in Oklahoma? It might be good to keep in mind where Oklahoma stands in the performance of our health care system in comparison with other states. According to figures from the U.S. Healthcare System Data Center published by the Commonwealth Fund, our performance is tied with Louisiana for 49th out of 51, including the District of Columbia. Mississippi is 51st. For overall access to health care, we are 50th. Texas is 51st. For prevention and treatment programs we rank 38th, and for avoidable hospital and treatment costs we are 45th. We also rank 45th for “healthy lives,” but, sadly we rank 50th for equity of health care based on income.

We are among the 19 states that have not expanded Medicaid to provide insurance coverage for those usually called the “working poor.” With the current U.S. House and Senate proposals, the states that took advantage of the federal dollars available to expand Medicaid coverage stand to lose coverage in several ways. First, many of the adults who gained coverage in Medicaid-expansion states will lose their coverage. Second, coverage for mental health and addiction treatment currently available in Medicaid-expansion states will be lost. Third, there are broader categories of people (men below age 65, for example) who are covered in Medicaid-expansion states but not Oklahoma. Our Medicaid services in Oklahoma will, however, be affected by proposed reductions in the overall Medicaid program for children, the elderly, and disabled. Also, the insurance policies people buy will be affected by the proposed reduction in required coverage. And the possibility of our expanding Medicaid would be forever foreclosed.

A positive side of the proposed federal changes might be that the taxes some Oklahomans are paying that fund the Medicaid expansion in the states that chose to accept it will be repealed. Less taxes for some, less health care coverage for some. Whether you consider that a positive is a matter of priorities. Also, what some call “reduction in required coverage,” others call “choice of coverage”, thereby framing the changes as positive.

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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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