The Oklahoma Policy Institute says Medicaid expansion “would have a very modest fiscal cost to the state and would bring in over twelve new federal dollars for every additional dollar of state spending.” However, since Oklahomans pay both state and federal tax, they're not netting $11 by expanding Medicaid; they're getting two separate invoices for a combined $13.
In comparison, Jonathan Small, fiscal policy director for the Oklahoma Council of Public Affairs, notes a review of the most recent state Comprehensive Annual Financial Report shows Medicaid spending in Oklahoma continues to rise and is now 28.79 percent of total state spending, compared with 23.45 percent in fiscal year 2005. Small notes that Medicaid now “exceeds state spending on both common education and higher education.” Further expanding the program would exponentially increase the state's financial challenges.
Oklahoma hospital officials are among those urging Gov. Mary Fallin to reverse course and embrace Medicaid expansion. They argue expansion is necessary to offset the losses they face due to federal cuts in Medicare payments and reductions in federal “disproportionate share” payments to hospitals serving the uninsured. Both cuts, by the way, are the result of Obamacare's passage.
But the federal government's failure to fund one set of programs shows the folly of increasing providers' dependence on another federal program — especially when the federal government is simultaneously touting Medicaid provider-rate cuts as an important cost-control tool.