Gov. Mary Fallin recently decided not to participate in the Patient Protection and Affordable Care Act expansion of medicaid, nor to create a health insurance exchange, but the discussion is far from over.
“Despite my ongoing opposition to the federal health care law, the state of Oklahoma is legally obligated to either build an exchange that is PPACA compliant and approved by the Obama administration, or to default to an exchange run by the federal government,” said Fallin. “This choice has been forced on the people of Oklahoma by the Obama administration in spite of the fact that voters have overwhelmingly expressed their oposition to the federal health care law through their support of State Question 756.
“After careful consideration, I have today informed U.S Secretry of Health Kathleen Sebelius that Oklahoma will not pursue the creation of its own health insurance exchange. Any exchange that is PPACA compliant will necessarily be ‘state-run’ in name only and would require Oklahoma resources, staff and tax dollars to implement,” said Fallin. “I have also decided that Oklahoma will not be participating in the Obama Administration’s proposed expansion of Medicaid. Such an expansion would be unaffordable, costing the state of Oklahoma up to $475 million between now and 2020.”
Rep. Doug Cox has other ideas.
He began by explaining the Medicaid system in place now.
“Because we have a limited amount of money, the amount of money is limited to the low income children and pregnant women, low income elderly, and disabled,” said Cox. “The largest population covered by Medicaid is the low income pregnant women and children, but the most expensive are the aged because their health care needs are more expnsive. We also cover a large amount of Oklahomans in nursing homes.”
Cox said there is a large part of the population that falls through the cracks in the current program. Medical expenses, according to Cox, are the second leading cause of bankruptcy in Oklahoma.
“Working low income people fall through the gaps. They work but can’t afford healthcare so they are left without coverage of any kind,” said Cox. “ For example, take a family of four that makes $32,000 a year or less, insurance is going to cost them $5,000 a month. There is no way they could pay that, but if we did the expansion they would be covered.
“I see people who come in the emergency room and need care they can’t afford. They have conditions that could be under control but they cant afford the medicine to do so,” said Cox.
Cox said the expansion is a complicated thing to understand, but he has a good grasp on it because he is a practicing physician as well as a legislator.
“I am in a unique position because as a physician I want to help everyone without insurance. As a legislator, I understand the need to balance that with the budget.”
The expansion, Cox said, would allow the state to cover all Oklahomans within 133 percent of the poverty level. It would cover working adults.
“The federal government would pay 100 percent of the cost, no expense to the state,” Cox said. “Gradually, 10 percent of the cost would shift to the state by 2020.”
He said the total cost is about $5 million, but the Oklahoma economy could improve enough by 2020 to cover the cost, or money could be budgeted from other areas by then. According to the Supreme Court, the expansion is not required.
“My thinking is that we have nothing to lose by doing the expansion, the federal governemt is paying. Come 2020, if we see it is not a viable financial option for Oklahoma, we can always back out.”
Cox said he understands this is where the controversy arises, and there are two obvious questions to be asked. Where is the federal government getting the money to support this and what happens if the expansion must be “undone” in 2020?
“In 2020, it would take a lot of political pull to take coverage away if the state can’t afford it, but we can only do what we can afford. I will not cut education fuding to pay for this,” said Cox.
Cox said people often jump to cutting education funding first, but that a higher educated population is proven to mean fewer people needing the Medicaid system and higher level educations means fewer unhealthy habits, like smoking.
He explains that the federal government will create penalties for those without insurance, as well as require employers to pay. He said there is something that people just aren’t understanding.
“If we don’t do the expansion, the government will be using our tax dollars to fund the expansion in other states. It will also create more hardship for hospitals.”
He explains that every Medicare hopsital gets a reimbursement check, called a DISH payment, to compenstate for treating people with no health insurance. The federal governemt says that without the expansion, there will be fewer people without coverage, which means lower DISH payments.
“If we don’t do the expansion, we will still have the uninsured population, but without the compensation checks, this would put a huge hardship on hospitals, especially rural ones,” said Cox.
Cox admits there are problems with the Medicaid program.
“Because the patients have no responsiblity, co-pay or prescription costs, they tend to overuse the system which drives up the cost. They also overuse the very expensive emergency room care,” said Cox. “A large percentage of the adults covered in the Medicaid program, though there aren’t many, tend to overuse narcotics, so tax dollars are being spent on narcotics.”
On the other hand, he explains, Oklahoma is one of the leading states in the country for holding down costs. Oklahoma has an aggressive program to prevent fraud and abuse of the system, as well as leading the nation in online enrollment.
Cox said while the system has problems, that isn’t what is causing controversy on the issue.
“I think the expansion has become politically charged because people keep referring to it as Obamacare, rather than its official name, the Affordable Care Act,” said Cox. “Many of the ideas in the reform pre-date him.”
“For example, in 2006 I went to D.C and had a meeting with the Heritage Foundation, a conservative think tank, and they proposed an insurance exchange,” said Cox. “This is the exact same thing that was worked into the Affordable Care Act. Because its under that title, Obamacare, Oklahoma legislators want no part of it.”
Fallin talked about what the state will be doing, after rejecting the expansion.
“Moving forward, the state of Oklahoma will pursue two actions simultaneously. The first will be to continue our support for Oklahoma Attorney General Scott Pruitt’s ongoing legal challenge of PPACA,” said Fallin. “Our second and equally important task will be to pursue state-based solutions that improve health outcomes and can contain costs for Oklahoma families. Serious reform, for instance, should be pursued in the area of Medicaid and public health. I look forward to working with legislative leaders and lawmakers in both parties to pursue Oklahoma health care solutions for Oklahoma families.”