Based on the court’s ruling, Oklahoma now could choose not to expand Medicaid to cover more people without insurance living below the poverty line. But such a choice would squander the chance for as many as 180,000 struggling Oklahomans to get health insurance coverage while leaving hospitals and other health care providers on the hook for uncompensated medical care.
The choice for Oklahoma — and other states — should be simple. Under the ACA, the federal government will pick up the bulk of the tab for expanding Medicaid. It will cover 91.7 percent of the cost of providing health insurance to between 137,000 and 180,000 Oklahomans between 2014 and 2020, according to state government estimates. While Oklahoma would assume a small portion of the cost for this population, the expense would be offset by state savings associated with serving a smaller indigent population.
Who are the people who would be shut out of Medicaid if Oklahoma opts against the expansion? The very Oklahomans who are struggling the most: primarily working-poor parents and other adults who work for low wages and either are not offered employer-based coverage or can’t afford it. Right now, if you have children but earn more than $7,000 a year for a family of three, you make too much money to qualify for Medicaid in Oklahoma. And if you don’t have kids, you can’t qualify for Medicaid at all, no matter how little money you make.
If Oklahoma chooses not to expand Medicaid, many of those who would have gained coverage under the expansion will have no options. Since the ACA assumes that adults with incomes below the poverty line will enroll in Medicaid, it does not make this population eligible for tax credits to purchase coverage in the new state health insurance marketplaces — called exchanges — that are slated to launch in 2014. In effect, Oklahoma would be creating a crater-sized “coverage hole” into which adults below the poverty line would fall.
Even if Oklahoma opts not to expand Medicaid to cover its own low-income uninsured, Oklahoma taxpayers will be funding the federal share of Medicaid costs in other states that do participate. Could we justify Oklahomans paying for health insurance coverage for low-income New Mexicans and Oregonians, but not for low-income Oklahomans?
And how would we explain that Oklahoma legislators are receiving publicly funded health insurance at taxpayers’ expense, yet denying coverage to their poorest constituents?
As much as some Oklahoma politicians may be tempted to adopt a stance of all-out opposition toward the Affordable Care Act, leaving the lowest-income adult population out in the cold by refusing to expand Medicaid would be contrary to the state’s interests and lacking in basic compassion and common sense.
Blatt is director of the Oklahoma Policy Institute, a think tank based in Tulsa.
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