Small: Work requirements a win for taxpayers

Work requirements a win for taxpayers

By Jonathan Small

“Work” may be a four-letter word, but it’s not an obscenity. You wouldn’t know that based on the reaction of many liberals to the new work requirements for Medicaid.

To stay on Medicaid, the new law requires able-bodied adults with no children to spend only 80 hours per month either working, going to school, participating in a work program, or doing community service.

If you’re thinking, “That’s doesn’t seem too hard,” you’re right. To suggest these extremely lenient work requirements are draconian is nonsense.

Small: Taxpayers shouldn’t subsidize idleness

Taxpayers shouldn’t subsidize idleness

By Jonathan Small

Oklahomans don’t mind providing a helping hand to those in true need. What they hate is paying for others’ idleness. In the view of Oklahomans, those who can work, should work.

That’s one of the major problems with the 2020 decision to expand Oklahoma’s Medicaid program to include able-bodied adults with no children, rather than confine the program to children, low-income pregnant women and the disabled.

That expansion has diverted hundreds of millions of state tax dollars away from other uses in the years since, and the price tag could explode by as much as $700 million per year if federal officials alter the state match for those able-bodied adults to roughly the same level as the state match for disabled people on Medicaid.

Small: Medicaid expansion’s harms continue

Medicaid expansion’s harms continue

By Jonathan Small

A key plank of Obamacare (the federal “Affordable Care Act”) allowed states to expand Medicaid programs to include able-bodied adults and not just the medically needy.

 

When expansion was narrowly approved by a public vote in Oklahoma in 2020, everyone knew it would require the diversion of up to $300 million annually in state tax dollars. But advocates called that a bargain since federal tax dollars would cover 90 percent of costs.

Obviously, it meant little to the average citizen if they pay for expansion with taxes paid to the state or taxes paid to the federal government, but that’s the kind of argument that too often passes for logic in politics.

But now the folly of buying that argument is becoming even more apparent.

Critics have long warned the 90-10 split was likely to change. Now that federal officials are trying to bring spending under control, there’s a good chance the 90-10 split could be replaced by something closer to a 60-40 split. If that happens, the state cost of Medicaid expansion could surge by $500 million to $700 million per year.

Facing that scenario, state officials should place repeal of Medicaid expansion before voters. And in the meantime, they should enact any associated budget cuts solely within Medicaid. If Medicaid expansion caused the state shortfall, Medicaid should take the hit.

Medicaid expansion was supposed to save rural hospitals. It hasn’t.

A 2024 study from the Foundation for Government Accountability found hospitals losses from Medicaid increased 115 percent from 2013 to 2021 in states that expanded Medicaid, but just 6 percent in states that did not.

In 2024 the Chartis Center for Rural Health found 22 rural Oklahoma hospitals were vulnerable to closure. A larger percentage of Oklahoma rural hospitals were vulnerable to closure than their counterparts in several states that did not expand Medicaid (such as Texas, Wyoming, Wisconsin, Mississippi and Georgia).

Similarly, a 2023 report by the Center for Healthcare Quality and Payment Reform found that about half of Oklahoma’s rural hospitals were at risk of closing with nearly one-in-three at risk of “immediate” closure.

Those numbers are significantly worse than prior to Medicaid expansion.

Similarly, Medicaid expansion has produced no notable improvement in health outcomes.

In 2019, the America’s Health Ranking report ranked Oklahoma 47th out of the 50 states in health outcomes. Today, Oklahoma is … still ranked 47th. Outcomes in several non-expansion states are significantly better.

Put simply, Medicaid expansion could quickly break the state budget, has done nothing to benefit hospitals and has failed to improve health outcomes.

As Oklahomans face a potential budget shortfall caused by Medicaid expansion, they should assess if expansion has provided meaningful benefits. Any serious analysis will end with a simple one-word response: No.

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

OCPA column: Medicaid expansion passed -- now we must pay for it

Medicaid expansion passed; now we must pay for it

By Jonathan Small

The June passage of Medicaid expansion means up to 628,000 able-bodied Oklahomans could be added to the medical-welfare program. And that creates a new challenge for state policymakers: How can they pay for expansion, particularly at a time of economic challenge?

One of the best solutions is for voters to approve a pending state question that could cover roughly $50 million in expansion costs by redirecting a portion of the state’s tobacco-settlement funding to Medicaid. But that will cover only a portion of expansion costs.

That’s because the true state cost of expansion is likely much higher than the laughable $164 million annual estimate supporters touted. At typical Medicaid costs, the true expense could run up to $374 million per year if all eligible citizens enroll.

Proof that Medicaid-expansion proponents lowballed their cost estimates came within weeks of the ballot measure’s passage. By August, a top legislative budget leader announced cost estimates had already surged from $164 million to $246 million—so $50 million is only a down payment.

1889 Institute: A Judicial Attack on Election Integrity

A Judicial Attack on Election Integrity

By Benjamin Lepak

The Oklahoma Supreme Court recently attempted to rewrite Oklahoma’s election laws, behind closed doors, on a compressed timetable, and without public input. All with an election looming in which the new rules would apply.

In May, the Court eliminated the requirement that absentee voters confirm their identity with a notary. Under the ruling, absentee voters would be permitted to vote with little more than a promise they are who they say they are, while in-person voters would still be required to show ID.

The lawsuit was filed by a coalition of progressive organizations called “Let the People Vote,” claiming voters could contract COVID-19 from notaries.

Count me skeptical. The coalition looked an awful lot like the one supporting State Question 802’s Medicaid expansion. They even hired the same law firm. The lead plaintiff in the case, the League of Women Voters, features only two advocacy items on its webpage, “Let the People Vote” and “Yes on State Question 802.”

Small: Speak up to prevent tax increases in aftermath of Medicaid expansion vote

Speak up to prevent tax increases

By Jonathan Small

Here come the tax increases. State Question 802 passed by the narrowest of margins this week, which means Oklahomans will now be constitutionally required to expand the Medicaid welfare program to include able-bodied, working-age, childless adults.

The state tab for that expansion could run up to $374 million extra each year, and that added cost comes even as lawmakers are expected to face a $1 billion shortfall in 2021.

This financial challenge was created in part by California labor unions that supported SQ 802 and urged Oklahomans to put the last optional piece of Nancy Pelosi’s Obamacare scheme into our state’s Constitution. (Notably, the pro-SQ 802 campaign broke state laws/regulations by refusing to file mandatory spending reports.)

To the degree there is a fiscally responsible approach to this challenge, it involves reducing spending elsewhere to offset increased Medicaid costs. But politicians, even in Oklahoma, are far more likely to promote tax increases than do the hard work of serious budget planning. You’ll recall just two years ago, facing a similar shortfall, the Legislature passed the largest package of tax increases in state history.

Well, here we go again.

Fortunately, this week’s vote on SQ 802 also shows why lawmakers should not enact tax increases if they have any sense of self-preservation. A majority of voters in 70 of Oklahoma’s 77 counties voted “no” on SQ 802.  Nearly 55 percent of those voting in person on election day voted against SQ 802. The yes campaign prevailed because of absentee ballots (of which 80 percent were “yes” votes, an astounding divergence with general voting trends).

This means most voters in most legislative districts held by Republicans opposed Medicaid expansion—period. If lawmakers want to stay in office, they would be wise to note that fact.

They should note that SQ 802 supporters didn’t include a funding source in their proposal, which was a tacit indication it should be funded without tax increases.

It’s also worth noting that Republicans who voted for tax increases in 2018 continue to pay a political price. In the 2018 election cycle, four Republican incumbents who supported tax increases were tossed out of office, and another nine Republican lawmakers didn’t even try to run for re-election after voting for tax increases. This week, another Republican senator who supported the 2018 tax hikes was ousted while three other Republicans senators who supported the tax increases were forced into runoffs. In a House race, an incumbent Republican who criticized the Oklahoma’s Constitution’s supermajority requirement for tax increases was defeated by a primary opponent who endorsed spending restraint over tax increases in times of shortfall.

If Oklahoma taxpayers don’t want to endure another shakedown in 2021, we need to start communicating to our legislators immediately that tax increases are unacceptable—and that those who vote the wrong way will pay a political price.

Sign up at www.highertaxesnotok.com to join the fight.

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

Arkansas State Rep: learn from our mistake, reject Medicaid expansion (SQ 802)

More from OCPA on State Question 802:

On May 13, 2020, Arkansas State Representative Josh Miller wrote a letter to Oklahoma leaders urging them to reject Medicaid expansion.

The letter read:

"Dear Leader David, Speaker McCall, Leader Echols, and other Republican Members of the Oklahoma Legislature,

In light of Oklahoma's consideration of Medicaid expansion, I write to briefly share Arkansas' experience. I will be candid—and hope to convey my sense of urgency. I cannot stress enough my primary takeaway from Arkansas' Medicaid program in recent years: expanding Medicaid to able-bodied adults is a raw deal. Let me explain.

Those who supported Medicaid expansion made lots of promises: increased federal funding to support our state budget, greater access to care for the needy, and relief for rural hospitals. But Arkansas is in a worse position today than before because these grand promises were built on the broken foundation of ObamaCare.

Instead, enrollment and costs shattered projections. Waste and fraud is more difficult to detect. Some of our rural hospitals are still struggling and a few have even closed. Greater costs are being shifted to the remaining Arkansans who pay higher private insurance premiums. More Arkansans are trapped in welfare dependency. And the truly needy—like those with physical and developmental disabilities who require home-based care—face long waiting lists and reduced services while able-bodied, working-age adults move to the front of the line.

In short, expansion was a big mistake for Arkansas.

In times of uncertainty like the COVID-19 pandemic, knowledge is power. And I know the experiences of neighbors, who have had to learn from their mistakes, can provide the most useful knowledge. Arkansas and Oklahoma share more than a border. Our cultures, economies, and enduring public policy challenges have much in common. If you want to avoid the mistakes of our state, I urge you to reject Medicaid expansion.

Sincerely,

Josh Miller
AR State Representative Dist. 66"

Now, I urge all Oklahomans to heed Rep. Miller's advice—reject Medicaid so that Oklahoma can avoid the woes that our neighbor has endured.

Sincerely,

Jonathan Small
President, Oklahoma Council of Public Affairs

Former Gov. Keating: "SQ 802 is bad for Oklahoma"

Former OK governor says ‘Vote No’ on SQ 802

By Former Gov. Frank Keating

Dramatic improvement in Oklahoma citizens’ health. Rural hospitals transformed from near collapse to thriving hubs of medical innovation. Literally a billion dollars raining from the sky.

Those are just a handful of the promises made or implied by supporters of State Question 802, which would expand Oklahoma’s Medicaid program to include many able-bodied adults as part of Obamacare.

You’re probably thinking, “That sounds too good to be true.”

You’re right.

Here’s the truth about State Question 802. It’s been tried in other states—and failed.

The reality of SQ 802 is far different than the pie-in-the-sky claims made by its supporters.

First, it won’t improve health outcomes. States with citizen demographics that are similar to Oklahoma—like Arkansas, Kentucky, and Louisiana—have all expanded Medicaid, yet still rank alongside Oklahoma (or worse) in health outcomes.

Small: “No” vote on SQ802 is a wise decision

“No” vote on SQ802 is a wise decision

By Jonathan Small

Soon, Oklahomans will consider State Question 802, which would increase welfare by expanding Oklahoma’s Medicaid program to cover able-bodied adults. Believing the arguments of SQ802’s supporters requires ignoring mountains of evidence.

Isn’t Medicaid expansion funded by “free” federal money? Nope. The federal government is broke and has a trillion-dollar deficit. Plus, State taxes are required as well. In Oklahoma, Medicaid expansion will cost state taxpayers up to $374 million annually.

1889 Institute: Think Carefully before Voting on SQ 802

Think Carefully before Voting on SQ 802

A vote “Yes” on State Question 802 would expand Medicaid to able-bodied adults above the poverty line. A vote “No” would keep taxpayers buying health care mainly for poor children and pregnant mothers.

State Question 802 is not that simple. Terms of Medicaid expansion would be set in our constitution, sidestepping our legislature, which is supposed to adjust to existing circumstances, taking that flexibility away. Consequently, funding for public education, roads, parks, prisons, courts, and other purposes, not constitutionally protected, will one day see deep cuts during an inevitable economic downturn, to fund Medicaid.

Commercials for SQ 802 lead us to believe that Medicaid expansion is a pure windfall. They never say it requires $100 million of our money, for which there is no source. If necessary, the money comes from the rest of the state’s budget, whose biggest funding item is public education.

Poor people don’t fund commercials. It’s big hospitals, with their million-dollar salaried CEOs. Low-income individuals are getting the basic health care services they need, and hospitals are making money. Otherwise, new hospitals and hospital expansion construction projects would not be constant. When health care industry spokespeople claim financial hardship due to poor people not paying bills, it’s a lie. Even using grossly inflated prices to exaggerate losses from charity and unpaid bills, these are minor expenses for the big hospitals.

Medicaid expansion is about making very wealthy people in healthcare richer. At some point, we’ll steal from our schools to pay big-city hospital administrators so they can buy a better model of Mercedes or another vacation home that’s not in Oklahoma.

But what about the rural hospitals? At a hearing in the state capitol some nurses testified about how their rural hospital was made financially sound. They stopped operating wastefully like big-city hospitals and stopped providing services better suited to big hospitals.

Most of healthcare’s almost 20 percent of GDP is a pure transfer from everybody else to wealthy health care providers through grossly over-priced services in an industry where competition mostly does not exist because patients don’t pay their own bills.

But, health care is a right. We all need it, for good health, for dignity, and for life itself. You can make the same argument about food and housing, and indeed, these are often provided by government. But the problem with saying any one person has a “right” to something another person must produce is that you are also saying you have a right to another person’s labor. Paying them with taxpayer money only means you have a right to taxpayers’ labor, without recompense.

There’s a word for when a person has a “right” to another person’s labor without recompense – it’s “slavery.” Keep that in mind while casting your vote on SQ 802 on June 30.

Byron Schlomach is 1889 Institute Director and can be contacted at bschlomach@1889institute.org.

Gov. Stitt: "I'm voting NO on SQ802"

Governor Kevin Stitt went on camera with AFP-OK's John Tidwell to discuss State Question 802 and why he is voting against it:

Voters to decide on using TSET funds for Medicaid expansion program

Senate approves bill to use TSET funds for Medicaid; SJR27 will send plan to voters to decide

OKLAHOMA CITY – A plan to help pay for Medicaid in Oklahoma passed off the Senate floor Friday. Senate Joint Resolution 27, by Senate Majority Floor Leader Kim David, R-Porter, refers to Oklahoma voters a constitutional amendment to allow a larger portion of the Tobacco Settlement Endowment Trust Fund (TSET) annual settlement payments to go towards paying for either the governor’s Medicaid expansion program or Medicaid expansion that may result from the approval of a pending state question.

OCPA comments on Medicaid expansion petition

OCPA statement on Medicaid petition

OKLAHOMA CITY (Oct. 24, 2019)— Jonathan Small, president of the Oklahoma Council of Public Affairs, today said the delivery of initiative-petition signatures for a Medicaid expansion proposal marks only the beginning, not the end, of the expansion debate.

“Medicaid expansion would add up to 628,000 able-bodied adults to Oklahoma’s welfare rolls and cost state taxpayers as much as $374 million annually,” Small said. “At the same time, numerous experts have told a legislative working group that Medicaid expansion will do almost nothing to improve citizens’ health outcomes. And, based on what has occurred in other states, Medicaid expansion will primarily benefit wealthy urban hospitals while doing little for rural communities, which will continue to see hospitals close.

“Medicaid expansion only promises to generate the same poor health outcomes at a much higher taxpayer cost that forces the diversion of funds from schools and roads, tax increases, or both,” Small continued. “As Oklahomans learn these facts, and of the existence of fiscally responsible alternatives, I am confident they will reject this fatally flawed proposal, just as they have similar ballot initiatives put forth by liberal activists in recent years.”

Based in Oklahoma City, the Oklahoma Council of Public Affairs works to advance  principles and policies that support free enterprise, limited government, and individual initiative. For more information, go to www.ocpathink.org.