Obamacare Medicaid rebalancing bad for Oklahoma

In his Tuesday blogpost, Trent England of the Oklahoma Council of Public Affairs answers seven questions about "Medicaid Rebalancing", a proposal currently before the Oklahoma legislature. It is an attempt at passing the Obamacare Medicaid expansion, previously rejected by Oklahoma under a different guise, for a short-term benefit (extra federal money in the short term), while ignoring the long-term costs (increased state spending in the long term as the federal subsidy dries up and more people sign up than expected). Lawmakers pushing this plan say that provider rates will need to be cut unless we swallow the Obamacare Medicaid poison pill.

England points out that we're still waiting for a state budget. If the state follows OCPA's recommendations and adopts the numerous cost-cutting reforms and eliminates lower priority spending, that could be enough to allow the state to maintain provider rates. Even if provider rates need to be cut, the real impact might not be that bad, as Oklahoma's reimbursement rates are well above the national average, 10th overall. Medical companies might lose some revenue, but everyone needs to tighten their belts.

The legislative sleight-of-hand that turns this Medicaid expansion into a rebalancing is moving 175,000 pregnant women and children off of Medicaid and into the Obamacare-subsidized exchange, and this number is the same as the number of newly-eligible Oklahomans expected to sign up for Medicaid. But the change would make over 600,000 Oklahomans eligible, a number that includes able-bodied, childless adults and even some who are on employer-sponsored health insurance. Other states that voted for Medicaid expansion have seen far greater enrollments than expected, leading to budget problems. England's article includes links to reforms that would refocus Medicaid dollars to better meet needs and save money.

England asks and answers a pointed question of our not-for-profit hospitals, who have been lobbying for Medicaid expansion:

3. Hospitals complain about charity care, but isn't that their mission?

Many of Oklahoma's largest hospitals describe themselves as religious non-profit corporations. They collect money from the state, from private patients, and from donors, and enjoy preferential treatment by government. Many have wonderfully expensive buildings and large staffs of well-paid managers and middle managers. When these major corporations pay lobbyists to demand more money from the public, it is fair for legislators and taxpayers to ask whether they are really focused on their original mission of service.

Finally, England reminds legislators that many of them "won office campaigning against the overreaching and unconstitutional power of the Obama Administration--speaking out in particular against the hastily passed Obamacare scheme. Those legislators, considering the Medicaid Rebalancing Act, face a simple, personal question: How important is honesty, integrity, and their reputation?"

OCPA has a detailed and footnoted analysis of the Oklahoma Medicaid rebalancing proposal.