For the first three years, the federal government is going to pay 100 percent of the costs for the newly eligible, but that doesn’t mean it won’t cost the state anything.
In part because of the individual mandate, the authority has to assume that everyone who is already eligible but not on the program will enroll, and the federal government only pays from 64 percent to 75 percent of those costs. Also, the state must pay half of the new administrative costs, and the state’s share will be nearly $18 million each year for that.
Starting in 2017, the federal payments for the newly eligible Medicaid recipients go down on a sliding scale until they reach 90 percent in 2020 and remain there.
Rep. Frank Lucas, R-Cheyenne, said last week, "For the 2010 fiscal year, the state of Oklahoma has required a 7.5 percent cut to all state agencies, which equals about $385.8 million in cuts to many important programs like our senior nutrition program.
"It is unacceptable that the federal government will now mandate even more costs onto our states to enact a federal law that a majority of the American people oppose. ... And this is just the tip of the iceberg. No one will be able to calculate the impact the new mandates will have on small businesses and the dramatic increase of participants in Medicaid when these businesses either fold or push their employees onto the federal plan,” Lucas said.
Beginning next month, Gomez said, physicians taking SoonerCare patients will have their payment rates cut by 3.25 percent because of the state’s budget woes.
It is unknown, Gomez said, whether more cuts will be necessary.
In his criticism of the new health care law last week, Coburn, a physician, said, "Forty percent of the primary care doctors don’t see Medicaid patients because the price that is paid for the coverage doesn’t cover the cost, let alone any margin. It doesn’t cover the cost of nurses, the rent, the malpractice, and everything else.
"The second point is: Of the specialists who are available, 65 percent of the specialists in this country won’t see Medicaid patients. So when I am taking care of Medicaid patients, I have trouble finding somebody better than me in a specialized area to care for my patients. ... You are not going to be able to find a doctor. You may have coverage, but you won’t be able to get anybody to care for you. Is that coverage? Is that care? Is that prevention? Is that management of chronic disease? No. None of that will happen.”
Gomez said he doesn’t have any Oklahoma figures to support or dispute Coburn’s assertions.
"I can tell you that we have over 10,000 physicians enrolled in the (state Medicaid) program,” he said.
Finding specialists, Gomez said, can be a problem for people with all types of health coverage.
Coburn also predicted that, because the Medicaid payment rates don’t cover health care providers’ costs, the expanded enrollment will "increase the cost shifting from government programs to the private sector” and "insurance rates for everybody else in the country are going to go up.”