Under the Affordable Care Act, states will be given an opportunity to opt into an expanded provision of Medicaid, effective 2014. This provision in the ACA is of vital interest for Oklahoma. It means 200,000 more Oklahomans will be eligible, if they enroll, to receive health insurance (about 29 percent of Oklahomans are currently uninsured).
These are mainly parents and child less adults with incomes at or below 133 percent of the federal poverty level: $14,856 for an individual or $30,657 for a family of four.
The estimated $286.3 million cost to insure the newly eligibles will be borne completely by the federal government for two years. By 2020, Oklahoma will be responsible for 10 percent of the cost (roughly $28 million). Using the nationally recognized IMPLAN (Impact Analysis for Planning) input/output model, the $286.3 million yields 4,187 direct health care jobs and 5,158 indirect jobs that would, in turn, spur $29.8 million in state tax collections. Acknowledging added administrative costs, this comes close to offsetting the state’s portion of the expansion.
But let us also not lose sight of the fact that Oklahoma continues to languish near the bottom of all states ranked according to their “health status.” A major contributing factor is a lack of access to primary care, except through the most expensive setting: hospital emergency rooms. Yes, Oklahoma hospitals operate as the de facto safety net for more than 670,000 uninsured Oklahomans, at a cost each year of hundreds of millions of dollars — a “hidden tax” for those who are insured. In 2005, Families USA reported the uninsured population costs Oklahomans $954 million annually in cost-shifting.
So, is history repeating itself? It certainly is with regard to the expansion of Medicaid, similar to the mid-1960s.
Yet, for years thereafter, the Medicaid program has been continually reviewed, revised, expanded, constrained and reformed, as is typical of most social programs. Why should we think any political action, from either side of the aisle, aimed at providing increased health coverage to uninsured Americans will be responded to any differently?
The expansion’s benefit to Oklahoma is obvious; yet, legitimate concerns remain. Can the federal government afford this added expense?
Will the eventual state’s share remain at 10 percent? Shouldn’t we first make other reforms to Medicaid? But what about the 200,000 Oklahomans? If not now, when?
The state of Oklahoma took a bold, controversial step for what was right for Oklahomans in 1966. Will history repeat itself? Only if politics yield to effective policy.
Jones is president of the Oklahoma Hospital Association and a fellow in the American College of Healthcare Executives.
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