No political will for Medicaid expansion in Oklahoma

Oklahoma City (AP) — While some Republican-led states are exploring whether to expand Medicaid to include more low-income residents, Oklahoma's GOP leaders remain steadfastly opposed to the idea.

The head of the Oklahoma Health Care Authority — the agency that runs the state's Medicaid program called SoonerCare — says there is no effort underway to seek a Medicaid expansion or even develop an Oklahoma-specific plan for seeking available funding.

Indiana recently received approval to expand Medicaid through a state-run program, making it the 28th state to do so and the 10th with a Republican in the governor's mansion. An expansion proposal endorsed by Tennessee's Republican governor was shot down by the GOP Legislature last week, but Arkansas' Republican-controlled Legislature last week agreed to continue that state's program pending a task force review.

But in Oklahoma, even Republicans who support expansion, arguing it would infuse billions of federal dollars into the state's health economy and help provide health care to some of the state's poorest residents, say the political will simply doesn't exist in the GOP-controlled Legislature.

"As a physician, I shake my head over it every day," said Rep. Doug Cox, an emergency room physician at a hospital in Grove. He said he sees firsthand the benefit Medicaid expansion would bring to the state's health infrastructure, especially rural hospitals like the one where he works in northeast Oklahoma.

In previous years, Cox has worked with other Republican legislators on alternative plans for a Medicaid expansion that would require most recipients to work and pay modest copayments, but the idea has never gotten off the ground. This year, Cox said he's not even trying.

"As a legislator who deals with political realities, I realize that it's an uphill struggle," Cox said, "and I'm not going to expend too much political capital on it, because the will is just not there."

Republican Attorney General Scott Pruitt continues to challenge the Affordable Care Act in federal court, seeking to dismantle the program by attacking the tax subsidies that allow low-income people to buy health insurance through the federal marketplace. And Gov. Mary Fallin says she's not interested in pursuing an expansion under Medicaid, a position that has drawn bitter criticism from public health advocates and Democrats who accuse her of putting politics ahead of good public policy.

"If the governor would step up and ... make the case for bringing our own federal dollars home to ensure our hospitals are solvent and that our citizens have health insurance, I think she could help create the political will," said House Democratic Leader Rep. Scott Inman, D-Oklahoma City. "She's playing politics with people's lives."

Fallin and other Republican leaders decry the cost to the state of expanding Medicaid. Although the federal government pays the entire cost of the program for the first three years, federal support declines over the next several years until 2020, when the state share shifts to 10 percent of the cost.

A report by the health consulting group Leavitt Partners commissioned by the state two years ago showed that while the direct cost to the state of Medicaid expansion would be $850 million over the next decade, the infusion of revenue through billions of dollars in federal money and the improved health of its citizens would result in a net gain to the state of nearly $500 million over 10 years.

The same report projected that between 187,000 and 275,000 uninsured Oklahomans would receive health coverage under the expansion.

By Sean Murphy, Associated Press. Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

The Gayly – February 8, 2015 @ 12:30pm.