Friday, February 21, 2020

Small: Stitt's rapid about-face on Medicaid expansion


A rapid about-face
By Jonathan Small

In the past decade, Republican governors in several states, eager for Obamacare federal dollars but aware their constituents opposed Obamacare, adopted “modified” versions of Medicaid expansion that included very minimal work requirements or premiums.

Almost all subsequently trashed those “conservative” reforms, usually after left-wing groups threatened to sue.

The same pattern can now be seen in Oklahoma, but at a much faster pace. Reportedly at the urging of Vice President Mike Pence and Centers for Medicare and Medicaid Services Administrator Seema Verma, Gov. Kevin Stitt told lawmakers Feb. 3 that he wanted Oklahoma to expand Medicaid through a federal waiver that would allow “moderate premiums and work requirements” for the estimated 628,000 able-bodied adults added to the welfare program, similar to Pence’s expansion of Medicaid in Indiana.

But by Feb. 16, Oklahoma Watch reported that Stitt’s deputy secretary of health said the state would actually expand Medicaid on July 1 with no work requirements or cost-sharing provisions. “After that, he said, the state plans to apply for a federal waiver that would incorporate many of the ideas in Stitt’s SoonerCare 2.0 plan,” Oklahoma Watch reported.

Thus, proposed “conservative” Obamacare/Medicaid expansion was abandoned in near-record time in Oklahoma—about three weeks. Sadly, the rapid abandonment of promises made to Oklahoma voters is what too often passes for government efficiency in Oklahoma.

These events prove Oklahoma’s Medicaid-expansion effort has never been about improving health outcomes or fiscal prudence. Instead, state politicians and special-interest groups cared only about getting federal money.

In the weeks ahead, we will witness lawmakers tap dance around another major Obamacare issue: Embracing Medicaid expansion means Oklahoma must come up with as much as $374 million annually to pay for it at a time the state already faces a shortfall of $85 million. Among the funding idea is, no surprise, a de facto tax increase: a hospital “fee.” The Democratic leader of the Senate had the candor to note that fee (which is being touted by Republicans) will drive up the costs of premiums for Oklahomans. Her GOP counterparts change the topic when that fact comes up.

The results of an Oklahoma embrace of Obamacare are obvious. Taxes will go up and so will health care costs. But health outcomes will remain unchanged, as can be seen by the experience of other states that expanded Medicaid like Colorado, Indiana and Arkansas. Indiana had to spike a teacher pay raise last year due to rising Medicaid costs, and citizens in those states now face higher medical bills, as even left-wing organizations concede in Colorado.

Oklahoma Republicans say they must offer an “alternative” to a Medicaid expansion plan scheduled for a public vote this year, but so far their alternative is almost a carbon copy of the ballot measure. A true alternative would involve rejecting Obamacare and focusing on real solutions, not me-tooism.

Jonathan Small serves as president of the Oklahoma Council of Public Affairs.

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