When we elect someone to public office, should we expect them to use their best judgment in making decisions about the public interest? Or should they adhere to the dictates of outside groups that always take the most simplistic and extreme stance on their particular issue, regardless of the context for Oklahomans? And when politicians sign a pledge sponsored by a special interest, should that give the interest veto power over the legislators’ judgment?
A couple of recent events have put these questions into dramatic relief. The first concerns a hospital provider fee, which would be assessed on participating hospitals and matched with federal dollars to pay for treating Medicaid recipients. Hospitals support the fee, since the match would generate another $223 million beyond the $153 million they pay into it, and the combined funds would then return to the hospitals as reimbursements for patient care.
The Senate passed the fee by a large, bipartisan margin. Previously the House voted for it with similarly strong support. The bill was slightly amended in the Senate, so it now heads back to the House. However, a letter by Americans for Tax Reform (ATR), the anti-tax lobbying group headed by Grover Norquist, threatens to throw a wrinkle into the debate.
Norquist said he would score support for the fee as a violation of ATR’s “no new taxes” pledge. Yet even by Norquist’s own logic, his opinion should have no bearing on the issue. This was revealed in the second recent event, an exchange between Norquist and Senator Tom Coburn.
When Coburn expressed support for eliminating ethanol subsidies and using the revenue to pay down the deficit, Norquist said he was breaking the ATR pledge. In response, Coburn asked which is more important, “The pledge to uphold your oath to the Constitution of the United States? Or a pledge from a special interest group who claims to speak for all of American conservatives, when in fact they really don’t?”
Norquist replied that when Coburn signed the pledge, he was making a promise to his constituents, not Americans for Tax Reform. Yet if that’s the case, it shouldn’t be up to Norquist to determine what is and is not a tax.
By their votes, legislators have already made clear that they view the fee as a reasonable strategy for funding Medicaid. It was carefully designed to act as a fee rather than a tax, since increasing taxes is constitutionally restricted in Oklahoma. Rather than being passed on to consumers, it would reduce hospitals’ burden by eliminating cost-shifting to cover inadequate state reimbursements for Medicaid. It would rely on federal money, but even if you believe federal spending needs to decrease, there are plenty of ways to do that without depriving hundreds of thousands of Oklahomans of accessible health care.
And make no mistake, that’s what denying the hospital provider fee would mean. About one in five Oklahomans, or more than 700,000 people, rely on Medicaid for treatment. Without additional funds provided by the fee and match, hospitals would continue to lose money treating Medicaid patients and many could be forced to close their doors. That would put hundreds out of work and eliminate what could be the only nearby health care provider, especially in rural areas.
Only 7 of 48 Oklahoma Senators and 26 out of 101 House members have signed the AFR pledge, though Gov. Fallin and Lt. Gov. Lamp are also signatories. These leaders now have a choice: do they represent Grover Norquist, or do they represent Oklahoma?