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Reform Medicaid in Oklahoma, don't expand it

BY MATT BALL Published: May 3, 2013
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The hospital lobby continues to argue that Oklahoma must expand Medicaid, a key component of the president's health care law. Their flawed arguments serve as a thin veil for their real agenda: increasing their bottom line.

They argue that Oklahoma must devise a state scheme to “recapture” Medicaid dollars. If Oklahoma doesn't expand Medicaid under the health care law, our tax dollars will go to pay for Medicaid expansion in other states. This simply falls flat. The money isn't in a pot being competed for by states. It's based on a formula. If Oklahoma opts not to expand this broken, costly program, then the money isn't spent. Period.

Additionally, the hospital lobby argues, if Oklahoma continues to reject Medicaid expansion, we'll be turning down $8.6 billion over 10 years in “free” money that would help keep uninsured Oklahomans out of emergency rooms. This is difficult to argue, considering that 25 percent of Medicaid patients still use the emergency room as their primary care doctor.

While uncompensated care is clearly a burdensome problem, this argument assumes Medicaid is an effective, efficient program. It isn't. Oklahoma has the 11th-highest rejection rate for new Medicaid patients in the country, with more than 33 percent of Oklahoma doctors refusing to see them. Ironically, expanding Medicaid places further strain on emergency rooms, particularly in rural Oklahoma where physician recruitment is extremely difficult and the Medicaid population is often higher.

What are hospitals up to? They're simply trying to lobby their way out of a terrible deal they cut with the federal government.

Hospitals accepted cuts to Medicaid's Disproportionate Share (DSH) program — a program that reimburses hospitals for high levels of uncompensated care — in exchange for what was initially designed as a federally mandated Medicaid expansion. Because the Supreme Court struck down the portion of President Obama's health care law mandating states expand Medicaid — it can only be voluntary — hospitals are now scrambling to find ways to offset the costs they believed would be covered under mandated expansion. Now the same lobby that wrongly trusted the word of the federal government is asking Oklahoma taxpayers to do the same.

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