"We are supportive of Oklahoma pursuing an Oklahoma plan, but we are utterly convinced that any Oklahoma plan ... is still going to be a partnership of both the federal government, state government and, we think, the private side," said Craig W. Jones, president of the Oklahoma Hospital Association, which lobbied hard for Fallin to support the Medicaid expansion. "We still need to impress upon our legislative leaders the important role that federal funding plays in providing funding to hospitals to provide care for those who are uninsured or underinsured. That's just a simple fact."
Most health experts point to Insure Oklahoma as an ideal program for providing health coverage to more uninsured Oklahomans. Insure Oklahoma, which targets working adults earning up to 200 percent of the federal poverty level, is a partnership in which the health insurance premium costs are shared between the state (60 percent), the employer (25 percent) and the employee (15 percent). The state's share is funded with tobacco tax revenues and matching federal dollars.
But the program, which provides coverage to about 30,000 Oklahomans, is scheduled to lose its federal funding at the end of the year because most of those eligible for the program would have been absorbed under the expanded Medicaid option.
Jones said one option would be to seek a federal waiver that would allow the Insure Oklahoma program to continue.
"I just think it's such a good model that it deserves very serious consideration," Jones said. "What we're hearing is that the federal administration wants to accomplish certain objectives, and they're willing to be flexible if those objectives are met. I'm hopeful they'll allow that to be considered."
Still others suggest the Medicaid expansion, which would immediately provide more than $500 million in federal funding annually to the state for the first three years, is the only realistic solution for addressing the needs of the uninsured.
"I don't think there is any good option for tackling the challenge of the uninsured in Oklahoma that does not involve accepting the Medicaid expansion," said David Blatt, director of the Oklahoma Policy Institute, a think-tank that promotes funding for programs targeting low-income Oklahomans. "Anything else would either fall far short in terms of the number of people that would be covered or the expense that would end up being assumed by the state itself."
The incoming director of the Health Care Authority, the state agency that oversees the Medicaid program in Oklahoma, acknowledges that developing solutions for targeting the uninsured won't be an easy task, but said he's confident there are other solutions available.
"I'm never going to be in a position to say there are no other options," said Nico Gomez, who was chosen last week to become the agency's new chief executive officer. "It could be tough, but I'm never going to be in a position where I say there are no other options. Let's push. Let's think. Let's be innovative."