No on SQ802: Arkansas warning

Before Oklahomans foolishly enshrine a new, unfunded and unlimited entitlement into our state constitution (SQ802), we ought to heed the experience of our neighbors to the east.

On May 13, 2020, when the Oklahoma legislature was debating a Medicaid expansion bill, Arkansas State Representative Josh Miller, a Republican, wrote a letter to Oklahoma leaders urging them to reject Medicaid expansion. Arkansas adopted a "private option" program in 2013, using new federal funds to purchase private medical coverage for the newly eligible (able-bodied and below income limits). Arkansas requires recipients in the expansion pool to work if able in order to receive these benefits, but Federal courts have stayed that requirement. Oklahoma SQ802, the Obamacare Medicaid expansion on the ballot next Tuesday, would prohibit the state from requiring that able-bodied recipients work or pursue education and training to receive benefits -- that ban would be written into the state constitution.

Miller writes that Arkansas is worse off because of its decision to expand Medicaid: "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."

Here's the complete letter:

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

Hat tip to OCPA President Jonathan Small for Rep. Miller's letter.

MORE: Former Governor Frank Keating urges Oklahomans to vote no on 802. Here's an excerpt:

What about all that "free" federal money? Here's the truth: State taxpayers must also come up with hundreds of millions in extra funding for Medicaid expansion--up to $374 million based on the estimated 628,000 able-bodied who will be made eligible. Not only that, but those able-bodied adults would take priority over the truly needy--such as the elderly and disabled--forcing them onto long waiting lists to get the care they need.

Last year Governing Magazine found 13 states had to raise taxes, fees, or cut provider rates to cover the state portion of expansion costs. More are expected to follow suit.

Here's another fact. Medicaid is already diverting resources from areas like education--without expansion. Since 1998, when I was governor, Oklahoma's population has increased 18 percent. But our Medicaid enrollment has increased 126 percent and the taxpayer cost of Oklahoma's Medicaid program has increased 254 percent.

Paying for Medicaid is already a financial challenge for Oklahoma. Expanding Medicaid doesn't solve that financial challenge; it puts it on steroids.