Tahlequah Daily Press

January 28, 2013

Medicaid expansion gaining support

Staff Writer

TAHLEQUAH — When the Patient Protection and Affordable Care Act became the law of the land last year, over 200,000 uninsured Oklahomans thought they would be eligible to receive health care.

But Gov. Mary Fallin is among 10 governors who have declined setting up the PPACA-required health care exchanges, and 25 state leaders who refuse to expand Medicaid to cover citizens who make too much under the current standards to qualify for the service, yet cannot afford private insurance premiums.

According to a report by the Associated Press, Fallin recently cited a study saying the cost of Medicaid expansion to the state would be $689 million between 2013 and 2022, and could force the state to dramatically cut other services. She instead proposed a $40 million budget increase for the Oklahoma Health Care Authority to expand coverage to residents who aren’t enrolled in Medicaid, despite being eligible.

Local lawmakers – including  Rep. Mike Brown, D-Tahlequah, and Sen. Earl Garrison, D-Muskogee – believe Medicaid expansion is crucial.

“The figure Fallin is giving for the cost - about $700 million – is just false,” said Brown. “If we don’t expand, it will hurt Tahlequah City Hospital and NeoHealth. It will also funnel federal dollars to other states that we could use here.”

In an earlier Daily Press report, Tahlequah City Hospital CEO Brian Woodliff indicated the emergency room has about 25,000 visits annually, of which nearly 40 percent Medicaid or uninsured. He said 80 percent of those visits are for non-emergency conditions. Medicaid expansion would address this issue, providing better access to primary and specialty care for those who are using the emergency room as a stop-gap.

Former Sen. Jim Wilson is now a board member for NeoHealth, and said NeoHealth and Cherokee Nation Health Services furnish health care to patients, regardless of their ability to pay. The ability for both to provide services is limited to resources available through budgetary constraints.

The U.S. Census Bureau reports the 2011 median household in Cherokee County was $33,990, with 25.8 percent of citizens below the poverty level.  A family of four would qualify for coverage under Medicaid expansion with an income of $31,809.

“Family health insurance premiums average a little over $15,000 per year, with an additional $5,000 out-of-pocket cost,” said Wilson. “It is unlikely a family earning $31,809 can spend $20,000 a year on health care.”

Wilson said Medicaid expansion means Cherokee County residents would have more access to health care, and providers would now be paid for what is now  uncompensated care.

“Cherokee Nation and NEO Health, the two major providers charged with providing services regardless of ability to pay, would be able to improve and expand services because of additional cash flow from PPACA’s Medicaid expansion,” said Wilson. “Some $,1200 per year, per person paid in health insurance premiums is used to pay for uncompensated care. Eventually, because of Medicaid expansion, the excuse for overcharging for insurance premiums would disappear.”

Garrison said it just makes sense to accept PPACA as the law.

“Here’s the situation, as you well know we have a lot of people who have no health care [insurance],” Said Garrison. “If we don’t take [the federal money for Medicaid expansion], some other state will. I’m just a common-sense person, and if you have 200,000 people without insurance, why wouldn’t you do what you could to help them?”

Garrison believes having taxpayers pick up bill for the uninsured via a higher cost in premiums is silly.

“I don’t think it’s very smart,” said Garrison. “I understand the philosophical differences [between the federal government and Fallin], but it’s the law of the land now, and we’re a nation of laws, and we need to abide by them.”

Garrison said Fallin is proposing bond issues to repair the capitol, which he believes is nonsensical.

“At the same time [we’re rejecting Medicaid expansion citing the cost], we’re talking about bond issues to put the state in debt,” said Garrison.

“We’ve got [Fallin’s proposal] to cut taxes, and if that happens, that’s $2.3 billion we lose. Until we get all of our core services back to 2008 levels, we shouldn’t be doing that.”

Rep. Doug Cox, R-Grove, is an emergency room physician, and said he chooses  compassion over politics when it comes to expanding Medicaid. He has provided comment for a number of Daily Press reports on PPACA, and said Fallin should reconsider her stance.

“I respect Gov. Fallin’s decision not to participate in expansion of  Medicaid in Oklahoma, but I believe this state should proceed toward a path of conservative, common-sense reform of the Medicaid system to make health care available for our poorest neighbors,” said Cox. “Oklahoma can still accept the [federal] dollars in a responsible way.”

Cox cited three reasons why Oklahoma should participate, including the fact PPACA is the law. He also said states that don’t accept the funding are allowing other states to claim the money, creating jobs that Oklahomans need. He used Arizona Gov. Jan Brewer’s reasons for changing her mind about Medicaid as an example. Until recently, Brewer, like Fallin, had rejected any expansion.

“Brewer estimates that Medicaid expansion would inject $2 billion into the Arizona economy and bring the state an additional $7.9 billion in federal funds over four years to restore and expand the state’s health care insurance program,” said Cox. “Brewer will scale back enrollment if the terms of the deal change by the feds. I agree with Fallin that we can’t commit ourselves to unknown future costs.”

The final reason Cox cited is pure economics.

“By agreeing to expand, Arizona would protect rural and safety-net hospitals from being pushed to the brink as they care for the poor an uninsured,” said Cox. “With this move, Arizona will secure a federal revenue system to cover the costs of the uninsured who already access the health care system. The Oklahoma Hospital Association has been a leader in making some of these same arguments.”

Cox is one of several scheduled speakers at a rally for the Coalition for Medicaid Expansion slated at noon, Tuesday, Feb. 5, on the north steps of the state capitol.

Wilson said there is no good health or financial reason for Oklahoma to reject Medicaid expansion.

“Without measuring the obvious financial benefits of a healthier population, the diversion of existing state health care expenditures to federally funded Medicaid, plus the economic impact and tax revenue from additional middle- and upper-class health care workers, more than compensate for any out-of-pocket expense by the state,” said Wilson. “It is important to recognize that not accepting Medicaid expansion will merely move the money to other states without reducing federal taxes for Oklahomans.”

Wilson believes Fallin’s rejection of the measure is fueled by special interests.


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