OKLAHOMA HEALTH CARE AUTHORITY’S LATEST PLAN IS SIMPLY OBAMACARE MEDICAID EXPANSION BY ANOTHER NAME PUBLISHED BY THE OKLAHOMA COUNCIL OF PUBLIC AFFAIRS & THE FOUNDATION FOR GOVERNMENT ACCOUNTABILITY
FULL STUDY CAN BE FOUND AT OCPATHINK.ORG/MEDICAID
What few details the Oklahoma Health Care Authority has offered about its “rebalance” plan make clear that Medicaid expansion would be a bad prescription for Oklahoma: • • • •
• • • • • • •
While thousands of Oklahomans with real needs continue to sit on waiting lists for services, OHCA’s plan would create a new entitlement for able-bodied adults. OHCA proposes kicking 175,000 pregnant women and children off of Medicaid to make room for more than 175,000 able-bodied adults. However, OHCA’s own consultants estimate that as many as 628,000 able-bodied adults would be newly eligible for Medicaid under this plan. Guts the Insure Oklahoma program by removing enrollment caps, work requirements, and accountable cost sharing. Similar expansions have been disastrous in other states. • Ohio’s expansion has run $3.1 billion over budget and this is expected to rise to $8 billion by the end of 2017. • In the first 18 months of operation, Kentucky’s costs exceeded projections by $1.8 billion. • In Illinois, expansion has run roughly $1 billion over budget each year. The U.S. Government Accountability Office estimated that a similar plan in Arkansas would cost taxpayers nearly $800 million more than traditional Medicaid expansion. Nebraska state actuaries estimated that using commercial plans to expand Medicaid would be nearly twice as expensive as traditional Medicaid expansion. Obamacare’s funding formula incentivizes state lawmakers to prioritize able-bodied adults over the truly needy. Expanding Obamacare has nothing to do with restoring provider rates, but would in fact make increasing reimbursement rates more difficult. Moving higher-income enrollees off Medicaid has nothing to do with expansion. Oklahoma’s Medicaid program has already expanded from $315 million in 1995 to $2.1 billion in 2015. The amount of Oklahomans dependent on healthcare entitlements would grow from 27 percent to 33 percent—all paid for by Oklahoma taxpayers.
Oklahoma policymakers should reject OHCA’s proposal and instead refocus their efforts on improving Medicaid for the most vulnerable: • • • • • •
Decouple and adjust the various provider rates based on need, so that critical services like nursing home care, rural primary care, rural hospital care, and other critical services with limited revenue streams can be prioritized for funding. Given it would take just $10 million to protect nursing homes from harmful cuts, thorough analysis reveals affordable state-based solutions can be effective. Implement the Medicaid reform pilot program which was passed by the legislature in 2015 and which special interests tried to repeal during the 2016 legislative session. Restructure OHCA into a cabinet-level agency with the CEO and Medicaid director appointed by the governor and reorganize the OHCA board into an advisory board. This will allow operational decisions to be made unclouded by the pressure special interests currently wield on OHCA and will improve the overall effectiveness of the agency, just as lawmakers improved the Oklahoma Department of Human Services. Utilize 21st-century tools to protect program integrity and ensure only those actually eligible are enrolled in the program. Illinois saved an estimated $350 million per year by implementing such a program. Oklahoma’s Medicaid program could save an estimated $20 million per year by implementing a similar program. Encourage local communities to increase local support and local financing for health providers that are struggling. Extend Medicaid reform efforts to other populations currently enrolled in Medicaid. Further coordination of care, greater use of health plans to better manage care, and increased use of capitation could save more than $80 million, based on other states’ experiences.