OKPOLICY.ORG
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.
After two shortened work weeks, the legislature began its first full week of considering bills in committee that were introduced first in the opposite house. There are quite a few bills left to be heard, and bills that haven’t been passed from committee by the end of this week will be dead for this year.
With eight weeks left in the session, not a lot of information is seeping out from behind closed legislative doors on the major budget issues like corrections, education, health care and DHS. It’s not that these are necessarily more important than others, but they tend to be the major recipients of state funding. The three parties in the state government process (House, Senate, Governor) still seem to be looking at options, but no one is yet ready to stick his or her neck out and make a serious proposal. Meanwhile state agencies are moving forward with plans to deal with draconian cuts.
The Health Care Authority announced this week it is looking at a 25 percent rate cut for Medicaid medical providers. This prompted the Oklahoma State Medical Association (OSMA) executive committee to unanimously vote to urge Oklahoma doctors to stop treating Medicaid patients. OSMA says doctors would be losing money every time they see a Medicaid patient. Nursing home operators said 93 percent of nursing homes in Oklahoma would also be operating at a loss with a 25 percent rate cut. At the same time, home and community based healthcare providers who contract through DHS to care for the elderly vulnerable at home, who would otherwise be in a nursing home, have coalesced to fight rate cuts in their contracts.
Also last week, the Health Care Authority proposed an expansion of Insure Oklahoma to bring 175,000 uninsured Oklahomans into the Insure Oklahoma program. Although those connected with the proposal deny it is related to the Affordable Care Act, the proposal is similar to the way Arkansas expanded Medicaid under the ACA when it was first enacted several years ago. The Leavitt report requested by Governor Fallin years ago also recommended expanding Insure Oklahoma as an “Oklahoma plan” to deal with Medicaid expansion. The federal government granted a waiver to Arkansas to make the expansion through private insurance companies, which presumably it would be willing to do for Oklahoma.
One stumbling block is that the 3 years of 100 percent ACA funding from the federal government is now gone, and it would take about $100 million for the state match. This adds $100 million to the $1.3 billion deficit the legislature already faces. There are ways to raise the $100 million, but they all involve political risk. The question for some legislators is whether doing nothing provides more or less risk. And just to make things dicier, the legislative filing period begins April 13th for all House members and half the Senate.
The insure oklahoma thing is not a good idea. Primarily because it targets people with very very low incomes that have little to no disposable income. These people struggle to keep insurance on their vehicles, there will be months where they won’t be able to afford health insurance no matter how small the premium. Second these subsidized insurance plans have high deductibles, copays, and the coverage is mediocre at best. This will leave this population with “insurance” that they can’t afford to use. Third, while the cost savings will be immediate (kicking thousands off SOONERCARE) the cost in the long run will be significant and significantly hard to quantify or plan for. Some of those that are going to be dropped from SOONERCARE have chronic conditions that will almost inevitably lead to more hospitalizations, disability, lost productivity, family hardships, and sometimes things like ESRD and other serious chronic conditions that will cost hundreds of thousands of dollars a year just to keep them alive. We must remember that these short sited solutions end up costing so much more in the future.
We could, however, legalize marijuana and have a sustainable, fair, and kill a bunch of other birds with that stone right there. It might be just brazen and bold enough to work.