Expanding Medicaid in Oklahoma
Introduction
Medicaid is a United States public health insurance program for people with low income. The program covers one in every five Americans and includes many individuals with needs for medical care that are complex and costly. The program has helped many Americans as it provides health insurance for people who lack other affordable forms of health insurance. It is the principal source of long-term care for most Americans. The Medicaid program provides finances to nearly a fifth of all personal health care spending in the United States. In the past, adults of non-retirement age and were able-bodied did not qualify for the medical enrollees for the cover. However, as of 2017, the Affordable Care Act extended its coverage to non-retirement age individuals with income up to 138% of the federal poverty line. The intention of this expansion was to extend coverage to the working poor, both children and childless adults, and other categories for groups who lacked access to the previous affordable insurance coverage. In light of this expansion to the Medicaid expansion program, 32 states had implemented the Afford Care Act medical expansion program. The state of Oklahoma, however, decided not to take part in Medicaid expansion under the Affordable Care Act. This decision has led to poor health outcomes in the state due to lack of insurance coverage for low-income patients, with some of the hospitals on the blink of closedown.
Background
In 2012, Mary Fallin, the then Oklahoma governor, declined to accept the Affordable Care Act’s Medicaid expansion healthcare program that was going to benefit over 150,000 uninsured people in Oklahoma. She also declined to establish an online marketplace where individuals could shop for health insurance. This decision was met by a lot of critics who argued that the governor was turning down approximately $500 million in federal money annually to provide insurance to the low-income citizens who were in need of healthcare coverage. The governor, on the other hand, argued that the Medicaid was not acceptable to the citizens of Oklahoma State and that the expansion was not fiscally sound at the time. Additionally, the governor sighted that it would bring little benefit for the taxpayers of Oklahoma State to support and fund a new government program that would be under the control of the federal government. However, not every state representative was in agreement with this decision by the governor. State Senate Minority Leader Sean Burge stated that the governor’s decision was more political than it was for the benefit of the citizens of Oklahoma. He also added that the expansion program was important as it would improve the health care of individuals and would be the backbone for hospitals in the state, especially those in rural areas.
The decision to reject the expansion program seems to be doing more bad than good as the state now struggles to mind money for Medicaid. The healthcare department, particularly, is at risk of losing 25% in Medicaid funding. The rural hospitals are, especially, at risk of closing their doors while a third of long-term care facilities are at risk of shutting their doors too. This puts thousands of elderly individuals residing in the long term care facilities at the risk of losing their homes. After the negative consequences of rejecting the expansion plan, the governor later surprised everyone by taking a turnaround on the issue and wanting extra Medicaid help from the federal government. Her plan on funding the expansion program calls for a $1.50 per-packet tax on cigarettes (Ellis, 2017). However, conservatives do not want to expand the Medicaid program for Oklahoma, arguing that the policy will go over budget leaving taxpayers to pay the bill. They continued to mobilize against the tax increase on cigarettes (Ellis, 2017). This has left the uninsured individuals falling into an “insurance coverage gap” and unable to afford affordable insurance.
Landscape (Stakeholders and their Concerns)
Policymakers
Policymakers are among the key stakeholders in the issue of expanding Medicaid in Oklahoma. The policymakers have already come up with various proposals on how to address the issue, which are in various stages of development. Many lawmakers say that it is not an issue of if but more like a question of how Oklahoma will unlock federal funds to help about 5% of the population pay for their healthcare insurance. The lawmakers are concerned with answering two major questions. The first being how much expanding Medicaid will cost the state. The second question that lawmakers look to answer is how the traditionally tax-averse state will find the funds needed to unlock the nine-to-one federal matching plan that will be used in paying for the expansion. The lawmakers have been asked to be open to all ideas, including the increments of taxes. However, the policymakers have a tough decision to make as they are trying to avoid regressive forms of taxation, as this will hit the low-income earners even harder.
Health care and social services organizations
Healthcare and social service providers are also major stakeholders in the issue of expanding Medicaid. Their major concerns are on the benefits of the program to the state in matters related to the quality of healthcare. For the health care providers, expanding Medicaid transforms into better coverage, which means better health for the state’s citizens. They are also concerned with the financial implications of Medicaid expansion on the hospitals and other health care centers, which employ a lot of physicians. The concerns include the reduction in uncompensated care in the hospitals, improved operational margins, and the reduced possibility of closure, especially for rural hospitals. The health care and social services organizations have positive expectations of the Medicaid expansion based on evidence from other states that have already accepted the expansion program. Hospitals in Medicaid expansion states have seen a fall by big percentages in uncompensated care costs. Hospitals that serve low-income and insured people expect to benefit most from the Medicaid expansion.
The patient and advocacy community
The patient and advocacy community are also important stakeholders in the Medicaid expansion. Their concerns and input are highly critical to the successful implementation of the Medicaid program by building support for it and providing suggestions for its implementation. The patient community is mainly concerned with coverage and access. Medicaid expansion is linked with increased insurance coverage across all racial, ethnic, age, and income groups. The patient and advocacy community is mainly concerned with increased insurance coverage so that more low-income earners and other disadvantaged groups can get better quality care. Medical expansion is also linked with a higher proportion of the low-income population getting better access to quality health. With the coverage, the people will get better medical prescriptions and treatment methods. Patients and advocacy groups are also concerned with the improved outcomes of treatment associated with the program, especially in the treatment of chronic diseases like cancer.
Senior Medicaid and agency leadership
These are very crucial in the Medicaid expansion as they are in charge of redesigning the Medicaid program in several states. Their main concern is overseeing the leadership and organization structure that is put in place by the governor and the legislatures. Agency leadership’s core mandate is to oversee and examine the Medicaid expansion program leadership to ensure that taxpayers’ contributions are not misused, hindering the needed healthcare reforms. Effectiveness of Medicaid leadership is crucial and is of vital importance to the success fo the Medicaid expansion. The governor’s office, just like the legislature, is mainly concerned with the sourcing of funds for the Medicaid expansion and is concerned with answering the question of how Oklahoma will unlock federal funds to help about 5% of the population pay for their healthcare insurance.
Options
SoonerCare
The SoonerCare is a plan by the state government to expand Medicaid in Oklahoma. This program is jointly funded by the federal and state governments. The program helps pay all or some of the medical bills for a lot of individuals who are unable to afford them. This program is under the Oklahoma Healthcare Authority (OHCA), which is in charge of determining the financial eligibility of the program. The covered health care services under this option may include doctor visits, hospitalization, and prescriptions. While it may sound similar to the Medicaid expansion in that there are additional requirements tied to maintaining eligibility. Also, it is not fully funded by the federal government and, therefore, the state will have to source some of the funding for the program
SQ 802
This is an initiative petition launched by Oklahomans and Medicaid advocates to collect enough signatures from registered voters to put the State Question 802 (SQ 802), which is about implementing the Medicaid expansion on the ballot in 2020. This would result in the expansion of Medicaid by the federal government without condition to over 200,000 low-income Oklahomans through the amendment of the constitution (Brown, 2020). If the SQ 802 were to pass by a vote of the people, it would surpass and other expansion plans that have been put in place by the governor and the legislatures.
Another option is the supplemental hospital payment program, which suggests taxing or increasing fees on hospitals and other medical providers so as to help the Sate cover its share of the cost. These funds will be used to fund the Medicaid expansion, which would then benefit the low-income earners by reducing the costs of uncompensated care for the hospitals. Another option is the Premium assistance model that will utilize the state’s and federal government’s dollars in buying private insurance coverage plans on the federal market. Some states like Indiana have already tried this option, and it has helped keep costs in check and reduced the tendencies of individuals to shift between private insurance and Medicaid as their financial situation fluctuates (Brown, 2020). The state could also seek the approval two-tiered expansion plan by the federal government. This plan would make the dental, vision, and over the counter medication coverage contingent on wellness, personal responsibility, and work requirements. This plan would provide less than full coverage to a third of the expansion population.
Recommendations
The SQ 802 initiative to take the Medicaid expansion to the ballot in 2020 would be the best action for the State of Oklahoma to pursue as it provides much better benefits than the other options. Expanding Medicaid through this method will provide insurance cover for over 200,000 citizens of Oklahoma. This option is particularly the best as it won’t have the policymakers looking for ways to fund the medical insurance cover for the low-income earners as the federal government supports most of the funding. Additionally, expanding Medicaid will bring over a billion dollars of Oklahoman’s taxpayer’s money to boost its economy and keep its hospitals closed. This is the amount that other states that have expanded Medicaid get, but which Oklahoma has lost for many years. Medicaid expansion will be beneficial to individuals who work at hard jobs that do not give insurance for employees, individuals nearing the age of retirement but have lost their healthcare, and those who are trapped in the coverage gap. This option is better than SoonerCare because there are no costs incurred by the state, unlike the Soonercare plan, which will result in the state incurring a lot of costs to fund the program.
Conclusions
Being able to access medical care is very crucial for every individual as well as for the economy of every state. In order to help improve the health care system, the United States government introduced the Medicaid expansion plan so as to help low-income earners, that is, non-retirement age individuals with income up to 138% of the federal poverty line. While the program has been adopted by many states in the U.S, the state of Oklahoma decided not to take part in Medicaid expansion under the Affordable Care Act. This has been a problem as it has resulted in many issues of poor medical outcomes and deterioration of the health care system. This is because a large number of the population has no medical coverage to help them access and afford some forms of medical treatment. However, the people of Oklahoma could vote amendment of the constitution to bring the Medicaid expansion program, benefiting thousands of low-income earners in the state.
References
NewsOK (2017). Care providers: Medicaid cuts will shift costs. Retrieved from
Newsok.com/article/feed/1166041
Ellis, R. (2017). The proposed cigarette tax increase for Oklahoma passes first major test.
Rajbhandari‐Thapa, J., Zhang, D., MacLeod, K. E., & Thapa, K. (2020). Impact of Medicaid Expansion on Insurance Coverage Rates Among Adult Populations with Low Income and by Obesity Status. Obesity.
Brown, T. (2020). As Medicaid Expansion Push Heats Up, Funding battle Lurks in Background. Retrieved from https://oklahomawatch.org/2020/01/29/how-would-state-pay-for-medicaid-expansion-no-one-knows-yet/
Drabek, D. (2020). Explaining Medicaid Expansion in Oklahoma. Retrieved from https://www.tulsakids.com/explaining-medicaid-expansion-in-oklahoma/