Because Oklahoma chose not to expand Medicaid, many residents will fall into the “coverage crater,” unable to enroll in Medicaid and barred from getting tax credits to buy coverage in the new health insurance exchange, according to the Oklahoma Policy Institute, a Tulsa-based organization that says it promotes fair funding of state government services.
The impact of cuts to hospitals under the Affordable Care Act has been understated, said Craig Jones, the Oklahoma Hospital Association president.
“The Affordable Care Act provides expanded Medicaid coverage and subsidized private insurance to low-income people partly by reducing Medicare payments to hospitals,” Jones said in a statement. “In Oklahoma, those reductions amount to $1.6 billion through 2020, and additional reductions beyond. The reluctance to expand Medicaid here in Oklahoma means that cuts experienced by Oklahoma hospitals for patient care will be used to provide expanded coverage in other states.”
Hospitals serve as safety nets for their communities, with Oklahoma hospitals providing about $600 million annually in uncompensated care, he said.
“Without increased coverage for the uninsured, such as Medicaid expansion would provide, these costs are shifted to businesses and those who have insurance, contributing to increased health care costs,” Jones said.
An estimated 200,000 uninsured adults would qualify for Medicaid if it were expanded in Oklahoma to include adults below 133 percent of the poverty level, according to the health care authority.
Under Medicaid expansion, the federal government would pay for 100 percent of the state's cost of covering newly eligible enrollees for the first three years, from 2014 to 2016.
After 2020, the state would have paid 10 percent of newly eligible enrollee costs while the federal government would have paid 90 percent.
If Medicaid were expanded and if all 200,000 people signed up, the state's share in 2020, with the federal government matching 90 percent of the cost, would be about $57 million, plus about $8 million in administrative costs.
Support for decision
Meanwhile, the Oklahoma Council on Public Affairs, a conservative think tank, supported Fallin's decision to not expand Medicaid, arguing that states would be “left to pick up the tab for any well-intended, but shortsighted expansion of the program.”
“With the expansion, the cost of the program to Oklahoma taxpayers by 2023 would have been roughly $6.5 billion — almost the exact amount of the entire current state-appropriated budget,” Michael Carnuccio, the organization's president, said in a statement.