The Enid News and Eagle, Enid, OK

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April 20, 2013

State Medicaid option won’t be ready this year

A plan to provide health coverage to 200,000 uninsured, working-class Oklahomans without expanding Medicaid likely won’t materialize before this year’s legislative session ends, and it still isn’t clear how any plan might work.

Gov. Mary Fallin and the Oklahoma Health Care Authority have been seeking ways to extend health coverage to those Oklahomans since shortly after Fallin rejected the Affordable Care Act’s Medicaid expansion last November. The OHCA approved a $500,000 contract with Utah-based Leavitt Partners to look into the matter in January, hoping a plan could be constructed before the legislative session ends in May.

Authority spokeswoman Sasha Bradley told The Associated Press on Friday the company’s final report isn’t expected until late June, however, with only preliminary reports available before state legislators return home for the summer, dashing hopes of giving a proposal to the governor this year.

“I hate to hear that, because I was hoping, if they’d released their plan and it suggested we have an Oklahoma plan, that it’d be ready to go,” said Rep. Doug Cox, R-Grove, a medical doctor who chairs the House appropriations subcommittee for Public Health and Social Services. He said he and several other officials had kept a bill ready to carry the recommendations. “It’s not like it’s the end of the world, because really the ACA doesn’t kick in until 2014. But the more time we have to get an Oklahoma plan before that date, the better.”

After the U.S. Supreme Court upheld most of the nation’s new health care law last summer, red-state governors across the country, including Fallin, found themselves stuck between hundreds of thousands of working-class, low-income voters who can’t afford health insurance and the political peril of accepting funding to expand Medicaid and provide coverage to them. The federal health care law allows states to extend Medicaid benefits to people who make less than 138 percent of the federal poverty line, which comes to about $31,000 for a family of four.

Leavitt hasn’t said what its recommendations may be.

Several Oklahoma officials said Friday the plan could draw from a similar proposal in neighboring Arkansas, where Democratic Gov. Mike Beebe and a Republican legislature united this week around a plan to use the extra Medicaid funding to purchase private insurance for the newly Medicaid-eligible population. The federal Department of Health and Human Services, which oversees the health care law, has given tentative approval to the concept behind the Arkansas plan, sparking wide interest.

“We just know because they’re in a similar position,” Bradley said. “I definitely think that’ll impact (the report), but we definitely don’t know anything for sure.”

Florida, Indiana and other states also are considering plans to funnel federal funding into private insurance plans. The practice, called premium assistance, is allowed under federal law already, but states used it to help provide coverage for only about 130,000 people nationwide in 2010, according to a report from the U.S. Government Accountability Office.

Such a plan potentially could build off of Insure Oklahoma, a program that uses Medicaid funds to help cover low-income Oklahomans who wouldn’t otherwise qualify for Medicaid with private insurance. The program provides coverage to about 30,000 Oklahomans, and is sustained by a federal waiver that ends after this year.

“We certainly encourage them to look very seriously at an option that would either be an expansion of Insure Oklahoma or something along the same lines,” said Craig Jones, president of the Oklahoma Hospital Association. “The state’s ability to expand coverage for the uninsured is definitely going to require some level of additional assistance from the federal government.”

Area legislators said they agreed with the governor’s decision not to accept the federal money.

“You accept that stuff and you start getting roped into what they want you to do,” said Rep. John Enns, R-Enid. “They never pay for everything they say they are going to pay for, and this it is left to put back on the taxpayers in Oklahoma.”

Sen. Patrick Anderson, R-Enid, said the problem of funding the federal programs ultimately would cost taxpayers in Oklahoma.

“The funding is going to have to come out of existing budgets,” he said. “That is less money for education, less money for roads and bridges. That eventually would become a big problem. I think at this point, the governor has made the right decision.”

Enns said if need be, a special legislative session could be held during the summer to solidify a plan.

“I don’t really anticipate it will throw us into a special session,” he said. “If it does, I think it will be really long, maybe a day or two. I say if we don’t have it done, we’ll just wait until next year.”

Fallin spokesman Alex Weintz declined to say what kind of plan the governor would support, but he sharply rejected notions Fallin would reconsider her refusal of the Medicaid expansion. He added Fallin had requested a renewal of the Insure Oklahoma waiver but had been denied, casting an option based on the program into doubt.

“If we had a plan in mind, something that we knew we wanted to do, we’d just be pursuing it,” Weintz said. “We are waiting on (Leavitt Partners’) thoughts and recommendations, and we’ll look at them with an open mind.”

Staff Writer Cass Rains contributed to this Associated Press story.

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