Medi-can’t (Oklahoma Gazette)

by Clifton Adcock, Oklahoma Gazette

Perlinda George, a student at Oklahoma City Community College, had hoped to sign up for coverage in an expanded Medicaid program under the auspices of the Affordable Care Act (ACA).  However, with Gov. Mary Fallin’s announcement last month that the state would not expand Medicaid, George will have to stick with her current plan for a while longer.

That plan: Don’t get sick. “I tried with DHS (Oklahoma Department of Human Services) to get some kind of medical (insurance), but they turned me down because I’m going to school. They basically told me to come back when I drop out,” said George, 36. “My goal is to get through school, and that way I can get medical.”

She’s not alone. About 17 percent of Oklahomans have no health insurance coverage. And in spite of Fallin’s decision, some groups vow that the fight for expanded Medicaid isn’t over.  

Fallin declined both options given to states under ACA, often referred to as Obamacare: a state-operated insurance exchange and an expansion of the state’s Medicaid program, SoonerCare.  Under the ACA, if a state fails to set up its own exchange, which allows consumers to choose coverage plans and options, the federal government will set it up for the state.

The Medicaid expansion was originally mandated by the ACA but became voluntary for states when the requirement was struck down by the U.S. Supreme Court. The provision enables a state’s Medicaid program, which receives the bulk of its funding from the federal government, to cover families living at up to 133 percent of the federal poverty level (such as a family of four earning $30,656 a year). 

No state exchange

Prior to Fallin’s decision, Dan Ramsey, president and CEO of Independent Insurance Agents of Oklahoma, the state’s largest insurance trade association, said a state-run exchange would be preferable to one run by the feds.  “We would be in better control of knowing what the people of Oklahoma need,” he said. “And we can decide what our needs are and what people want here, rather than having it dictated to us.”

But Fallin said an Oklahoma based exchange would have been state-operated in name only.

“It does not benefit Oklahoma taxpayers to actively support and fund a new government program that will ultimately be under the control of the federal government,” she said in a written statement, “that is opposed by a clear majority of Oklahomans, and that will further the implementation of a law that threatens to erode both the quality of American health care and the fiscal stability of the nation.”

Fallin said she opposed the Medicaid expansion because it would cost state taxpayers around $475 million over the next eight years and increase Oklahoma’s dependence on federal money.

“On a state level, massive new costs associated with Medicaid expansion would require cuts to important government priorities such as education and public safety,” she added.  “Furthermore, the proposed Medicaid expansion offers no meaningful reform to a massive entitlement program already contributing to the out-of-control spending of the federal government.”

No Medicaid expansion

Fallin’s decision earned praise from conservative activists and lawmakers, including House Speaker-elect T.W. Shannon and U.S. Sen Tom Coburn, but there were some critics.

Among them was David Blatt, director of the left-leaning Oklahoma Policy Institute.  “We had a chance, at minimal expense to the state, to expand health care insurance coverage, to improve coverage for Oklahomans, to reduce the burden of uncompensated care the hospitals and other providers are stuck with,” he said.  He noted that most people currently covered by SoonerCare are children, and that poor, working adults are rarely able to get coverage.

Patti Davis, executive vice president of the Oklahoma Hospital Association, expressed similar disappointment. She pointed out that a Medicaid expansion would have helped hospitals that serve high numbers of uninsured patients.  “If we don’t do a Medicaid extension program, we don’t know is what’s going to happen to the lowest-income people,” Davis said. “If we’re not going to address how we provide coverage in the most cost-effective manner, if we leave these folks without coverage, the dynamic in Oklahoma doesn’t change.”

Davis and Blatt both contend that the cost-estimate figures Fallin used to justify rejecting the expansion are faulty.  They said an earlier report by the Oklahoma Health Care Authority showed far less of a cost to the state if the program were expanded.  

“This is not over,” Blatt said.  “This issue is too important to give up on. It is too critical to Oklahomans’ health, to our economy. We’re going to continue to make the case to the public about the importance of this issue. We’re going to work as hard as we can along with others to get our political leaders to reconsider and hopefully change course.”


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