Black Jet Theory – Volume 2020-7 – Do We or Don’t We Expand Medicaid?
June 12, 2020 by Marshall Snipes
In Oklahoma, 821,803[1] citizens were on Medicaid as of April 2020 representing 21% of the population. Of those, 541,780[2] were under 21 years of age, our future workforce, representing a staggering 57% of our children. It is estimated that 233,000 additional people would be eligible if Oklahoma expanded Medicaid.[3] Estimates project 160,000 people would actually sign up if Medicaid were expanded.[4] However, those estimates were before the unemployment rolls skyrocketed after COVID 19 emerged.
On June 30, the citizens of the state of Oklahoma will vote to approve or reject State Question 802 (“SQ802”). SQ802 proposes to change the Oklahoma constitution to require Medicaid to expand to those people not currently insured who are below the Federal Poverty Level. The expansion provisions in the law are part of the Affordable Care Act. The effective date of expansion would be July 1, 2021.[5]
Funding for Medicaid expansion would come through a process for every dollar the state agrees to pay, the federal government matches with 9 dollars.[6] If the state expanded Medicaid the additional cost is estimated to be $150 million.[7] The estimate was calculated before the impact of COVID 19 which presumably will increase the cost beyond $150 million.
Oklahoma is one of 14 states that has NOT expanded Medicaid. SQ802 is backed by the Oklahoma Hospital Association, Oklahoma State Medical Association, Oklahoma Osteopathic Association, Oklahoma Nurses Association, and Saint Francis Health System all who stand to gain from its passage[8]. Opposition is from the Oklahoma Council of Public Affairs and Oklahoma’s Governor Kevin Stitt who sees SQ802 as a challenge to his vision and plan.[9]
In 2018 Governor Stitt appointed a Health Care Policy Group as part of his transition team. The charge to the Policy Group was to make recommendations to the Governor that would achieve top ten status in the United States in healthcare for Oklahoma, a tall order since the current ranking is 46th.[10] The Policy Group was made up of the leading members of the healthcare community in Oklahoma. After six months of weekly meetings that included over 100 healthcare leaders, the Policy Group recommended a comprehensive set of reforms that would improve the health of Medicaid beneficiaries and lower the cost of the Medicaid program. Those recommendations became part of the basis for the Governor’s plan, SoonerCare 2.0.[11]
SoonerCare 2.0 differs from SQ802 in several significant ways. SoonerCare 2.0 would require a waiver from the federal government to allow reforms for co-payments, monthly premiums and work/education requirements. SQ802 would prohibit those reforms. SoonerCare 2.0 included many other reforms to the delivery of healthcare. SQ802 has no reforms. SoonerCare 2.0 would NOT change the constitution. SQ802 would change the constitution. Neither the SQ802 nor SoonerCare 2.0 included a funding mechanism. If the SQ802 passes, funding will be the responsibility of the FY21 budget process next spring.[12] [13]
No one is quite sure what the impact of passing SQ802 would have on SoonerCare 2.0. Many believe SoonerCare 2.0 would be dead. Others believe that a modified version of SoonerCare 2.0 would play out in the FY22 budget discussion in the legislative session next year. Sadly, a golden opportunity to reform the Medicaid system slipped away in the last session, an opportunity that was lost in the broader discussion of the FY21 budget. The Policy Group believed those reforms would have paid for expansion.
Those who favor SQ802 believe:
- Expanding Medicaid will bring approximately one billion[14] federal dollars into the economy and the impact of those additional dollars would offset the additional cost to the taxpayers.
- Expanding Medicaid will improve the health of its citizens, will move the state forward economically and will achieve progress toward reaching top ten state status.
- The free medical services being provided to the uninsured population would be paid for under SQ802. Medical providers currently bear the burden of those costs.
- Additional revenues created by SQ802 are necessary to allow marginally profitable hospitals to stay in business, particularly in rural areas.
Those who oppose SQ802 believe:
- The state cannot afford the $150 million or greater price tag. Since there isn’t a funding mechanism in SQ802, the result would be an unfunded mandate in the constitution.
- Since most elected leaders and the public oppose a tax increase to fund expansion, other state services such as education would have to be cut to balance the budget.
- A constitutional change is not necessary if the legislature and the Governor can agree on a funding path forward for SoonerCare 2.0.
According to a poll conducted by CHS & Associates, public opinion favors SQ802 53% to 31%. Other polls have similar results. When asked why one favors SQ802, the response is almost solely based on helping those in need versus previous thoughts around the economic benefit. Although a third of the those in favor could not articulate why.[15]Further, the public does not understand that paying for expansion is problematic. Unless those behind the NO vote are willing to fund a serious campaign to fight against passage, then the Black Jet Theory[16], (common sense and critical thinking) tells us SQ802 will pass.
If you believe that taking care of the poor, leveraging federal dollars and supporting rural hospitals is more important than the additional cost to the taxpayers and putting an unfunded mandate in the constitution, then you should vote YES.
If you believe that the costs are too high, are probably higher than projected and are unaffordable, and if you believe that putting an unfunded mandate into the constitution is a slippery slope, then you should vote NO.
Don’t take my word for it. Think for yourself.
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[1] “SoonerCare Fast Facts April 2020” Oklahoma Health Care Authority www.okcha.org
[2] Ibid.
[3] “Oklahoma and the ACA’s Medicaid Expansion” Louis Norris June 1, 2020. www.healthinsurance.org and “The Implications of Medicaid Expansion in the Remaining States: 2018 Update by Matthew Buettgens Urban Institute of the Robert Wood Johnson Foundation.
[4] “Projected Impacts of Medicaid Expansion on Medicaid Eligibility and Enrollment by State, 2017” The Urban Institute of the Robert Wood Johnson Foundation HIPSM 2016.
[5] “Oklahoma State Question 802, Medicaid Expansion Initiative (June 2020)”. www.ballotpedia.org/Oklahoma_State_Question_802,_Medicaid_Expansion_Initiative_(June_2020)
[6] The Affordable Care Act. www.hhs.gov/healthcare/about-the-aca
[7] “Oklahoma will submit Medicaid expansion request Friday, Gov. Kevin Stitt says”. By Carmen Forman March 6, 2020 The Oklahoman
[8] “Oklahoma State Question 802, Medicaid Expansion Initiative (June 2020)”, www.ballotpedia.org
[9] “State’s Medicaid plan against SQ802”, The Norman Transcript January 30, 2020, www.normantranscript.com/news/stitts-medicaid-plan-against-sq-802/article_7ad6f9ce-9f80-5173-ace3-c9656ebd978b.html
[10] “America’s Health Rankings 2018 Annual Report” by the United Health Foundation www.americashealthrankings.org
[11] “Oklahoma Turnaround Plan” Governor Kevin Stitt’s Healthcare Policy Group 2019
[12] www.okhca.org/soonercare2/
[13] See Footnote 5
[14] “Oklahoma will submit Medicaid expansion request Friday Gov. Kevin Stitt says”. By Carmen Forman March 6, 2020 The Oklahoman
[15] “Survey of 500 Registered Voters in Oklahoma, May 4-7, 2020 conducted by CHS & Associates, Pat McFerron, President
[16] The Black Jet Theory is “the notion that most of what currently happens, when viewed through the filter of common sense and critical thinking, leads to a different conclusion, than the widespread view of current thinking by those who control the dissemination and content of information (academia, the media, politicians and other “experts”)”. “Black Jet – Volume 2020-1, May 1, 2020 by Marshall Snipes.