1 million Oklahomans may go on Medicaid

BY CHRIS CASTEEL Published: March 28, 2010
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/> 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.”



Timeline

Key dates and events as the law is implemented:

This year
→Tax credits of up to 35 percent of premiums to small businesses.

→$250 rebate to seniors who hit the Medicare prescription drug gap — referred to as the doughnut hole.

→Prohibits lifetime caps on coverage or denying coverage to children with pre-existing conditions.

→ National high-risk pool to provide health coverage to adults with pre-existing medical conditions.

→Up to age 26 covered by parents’ insurance.

→10 percent tax on indoor tanning.

2011
→Nutritional content must be posted at chain restaurants and vending machines.

→States get grants to develop malpractice reform.

→Drug makers’ 50 percent discount on name-brand drugs sold to people in the Medicare prescription drug doughnut hole.

→Preventive services free under Medicare.

→Individual and small group market insurance plans must spend 80 percent of premiums on medical services; large group market plans must spend 85 percent.

2013
→50-state co-op program created to encourage non-profit, member-run health insurance.

→Subsidies begin for name-brand drugs in Medicare prescription drug doughnut hole.

→Two-year increase in payments for Medicaid primary care services.

→Medicare Part A tax increased from 1.45 percent to 2.35 percent for earnings over $200,000 by individuals and $250,000 for married couples filing jointly; 3.8 percent tax levied on unearned income.

→2.3 percent tax on medical devices.

2014
→Individual mandate to buy insurance — lower-income people who don’t purchase will have to pay a fee of $325 in 2015 and $695 in 2016, while higher-income people will have to pay 1 percent of income in 2014, 2 percent in 2015 and 2.5 percent in 2016 and thereafter.

→Exchanges in all states to serve individuals and businesses with fewer than 100 employees.

→Subsidies to people with income up to 400 percent of the federal poverty level (about $88,000 for a family of four).

→Businesses with more than 50 employees must offer coverage or pay penalties if an employee gets federal insurance subsidies.

→Medicaid expanded to everyone under 65 whose income is up to 133 percent of federal poverty level (about $29,000 for a family of four).

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