Heal thyself

Oklahoma’s insane refusal to expand Medicaid

There’s a moment in Jim Bouton’s “Ball Four,” when Bouton, an MLB pitcher, armed with his past season’s statistics of wins, losses, saves, and earned-run average, tries to persuade his general manager to give him a raise. The GM, duly unimpressed, tells Bouton, “Tell your statistics to shut up.”

Which brings us to the debate about Medicaid expansion in Oklahoma and those elected GOP officials who, though plied with facts and figures—all positive and certifiable outcomes from states that have expanded the program—keep telling the statistics to shut up.

Like these:

• 14.2 percent of Oklahomans are uninsured.
• 8.8 percent of Americans are uninsured.
• Oklahoma is one of 14 states that has not expanded Medicaid.
• An additional 233,000 Oklahomans could be insured if Medicaid coverage was expanded.
• The state will forego about $11 billion over the next decade in federal funds.

As of late, though, the newly-elected Gov. Kevin Stitt and GOP leaders say they are open to expanding Medicaid in this state—not ready to do it, mind you, but considering it—as long as they get to demagogue the issue until we’re all dead.

“I’m going to be very careful where I don’t put Oklahoma in a tough situation … where we’re stuck providing more government services and a billion-dollar price tag,” Stitt said about the idea of expanding Medicaid. “We’ve got to be very careful, but absolutely.” 

Be still my heart arrhythmia.

This is a profile in incrementalism.

The issue of Medicaid expansion has been a thorny one for Oklahoma Republicans, many of whom see the benefits the increasing federal funds would bring to the state’s health system but who also have demonized the Affordable Care Act on the campaign stump. The federal government would offer a 9-to-1 match for state funds to pay for the expansion, but Stitt and GOP leaders said they want the ability to opt out of the expansion if the state’s share became much larger.

A nine-to-one match on state funds to pay for a program that would insure almost an additional quarter million Oklahomans, and GOP leaders still can’t make the call?

It’s free money! More to the point, it’s our money.

For even though Oklahoma has refused to expand Medicaid, its residents still pay federal taxes, which means our money is going to those states that have expanded it, all the while refusing to take money from these very states to expand health services here.

That’s a special kind of stupid.

And counterproductive:

House Bill 2932 asked the Oklahoma Health Care Authority to request federal permission to require able-bodied adults who meet certain criteria to work for 20 hours a week, engage in work-training programs, or a combination of both to qualify for Medicaid benefits.

Gutting people’s insurance because they didn’t leave a forwarding address is mean, since one of the byproducts of being poor is that housing is always in flux, and work requirements are a con, since the jobs available—and we’re only talking about at most about 6,000 Oklahomans who will be affected —don’t pay a living wage, but pay too much to keep people eligible for Medicaid.6

Stupid and mean is no way to run a state.

Gov. Fallin, who signed the bill into law (it now goes to the Trump Administration for approval), said, “It is imperative to provide expectations for all of our citizens who are able to work.”

Please. As The Journal Record points out, “Oklahoma’s application states that the number and categories of affected residents are unclear.”

So the legislators passed a law without first doing due diligence, and having no idea its effects and on whom?

[A] study by the Georgetown University Health Policy Institute Center for Children and Families found that very poor mothers, especially in rural areas, would be the most affected. About 60 percent of parents using Oklahoma’s Medicaid program saw incomes significantly below the poverty line: 20 percent of that cutoff or less. That means they bring in no more than $4,156 annually or $346 a month.

That’s just brutal.

And unnecessary:

Among Medicaid adults (including parents and childless adults — the group targeted by the Medicaid expansion), nearly 8 in 10 live in working families, and a majority are working themselves. Nearly half of working Medicaid enrollees are employed by small firms, and many work in industries with low employer-sponsored insurance rates.

Another byproduct of the state’s decision to not expand Medicaid is that our rural hospitals are closing. There are many reasons, including reimbursement rates and state budget cuts, but also because when the uninsured get sick, they go to emergency rooms for treatment, and unlike private facilities, public hospitals cannot by law turn away patients for their inability to pay.

And when the sick can’t pay in a for-profit healthcare system, hospitals can’t function.

There’s something else at play: hypocrisy. At present, Oklahoma receives about 34 percent of its total revenues from the federal government. If you’re scoring at home, nine of the top 10 states most dependent on the federal government are Red States.

Presently, Oklahoma ranks 21st in the nation in federal dependency. We rank in negative balance of payments between what we send to Washington in taxes and what we get back. In short, we’re sponges. We’re the kind of state against which we rail. We take federal money for roads, for agriculture, for environmental quality, for more than 900 federal programs, but we draw the line at Medicaid expansion? Why?

One word: Obama.

When the former President of the United States proposed and was successful in passing the Affordable Care Act, he was called a socialist. The Supreme Court did allow states to opt out of Medicaid expansion, though, which some did, because of ACA requirements—and nobody was going to tell Oklahoma what it had to do, even though every other federal program for which we get funds also has strings attached.

As to those socialist claims, spare me. Approximately 13 percent of Oklahoma’s population is over 65, meaning in a state of 3.9 million people, there are about 500,000 of us in toupees and gabardine pants on “socialized medicine”—you may know it as Medicare. To this point, once in Las Vegas, I had dinner with my father and about a dozen of his friends, all upper-middle class, all mid 80’s, all on Medicare, and all bitching about government-run healthcare.

“You know, you’d all be dead without it,” I said. “You’re welcome.”

In 1965, when Medicare (and, for that matter, Medicaid) began, it provided basic healthcare for Americans 65 and older. It was thought a nation as rich as the United States owed its seniors something.

Before Medicare came into existence, only about half of Americans over age 65 had health insurance. One of the primary reasons for this was because coverage for individuals in this age category was unaffordable. Because of this, roughly one in four seniors went without medical care at all due to cost issues. By making care available to more people, Medicare has essentially advanced the effort to not just treat illness and disease, but to also deliver more preventive care and to address more issues before they become acute. Today, only 2 percent of Americans over 65 are uninsured – and, according to analysts, Medicare has even helped to increase the life expectancy for Americans over age 65 by five years.

Certainly wouldn’t want to unleash that kind of calamity today.

During his campaign, Stitt said Obamacare was “a disastrous law that Congress should repeal and replace with a solution that encourages a competitive business climate to drive down cost for all Oklahomans and increase health care health-care options.”

Private insurance companies always do such a bang-up job; by all means, let’s shovel more business their way. What could possibly go wrong?

For starters, this: “Combined, the nation’s top six health insurers reported $6 billion in adjusted profits for the second quarter.”

In one quarter.

But medical costs are out of control because some able-bodied male in north Tulsa refuses to get a job?

Stitt’s desire to opt out of expansion if the feds don’t honor their agreement of a nine-to-one match in funds is a disingenuous and dusty dodge. The federal government has always kept its word on the funding mechanism equation. Who hasn’t kept their word, though? The state GOP. Or maybe I forget how well those Republican-led tax cuts ushered in an era of prosperity for the state.

One final thing. Here’s what happens if Oklahoma expands Medicaid:

• Additional lives saved per year: 484
• Additional cancer diagnoses per year: 132
• Additional early-stage cancer diagnoses per year: 104
• Bankruptcies prevented per year: 48
• Reduction in families’ accrued medical debt: $214.4 million
• Reduction in families’ collection balances: $265.6 million
• Money kept in families’ pockets from less costly credit per year: $66.2 million
• Savings to local communities from enhanced public safety per year: $265.2 million

Curious thing about statistics. No matter how many times you tell them to shut up, they never do.