GOV. Mary Fallin has rejected expansion of Oklahoma's Medicaid program under Obamacare, saying the long-term costs are unaffordable for state government. This hasn't stopped Democrats and some health officials from continuing to push for expansion. Their argument, boiled down, is that Medicaid expansion will increase health care access and therefore drive down Oklahomans' medical expenses.
In real-world application, however, it appears Medicaid expansion could create a two-tiered health system where some citizens are shifted to lower-tier providers while those with private insurance retain doctor access. And the effect of the increased “access” provided by Medicaid expansion may be negligible. The liberal Nirvana of California shows why.
The Los Angeles Times reports that California is facing a major obstacle to implementing Obamacare: a doctor shortage. As a result, some California state lawmakers want to redefine who can provide health care. Their plan would funnel many patients away from primary care physicians to physician assistants and nurse practitioners. Even pharmacists and optometrists could become primary care providers for things such as diabetes and high blood pressure.
Doctors warn that those changes could jeopardize patient safety and even drive up costs, because assistants and nurse practitioners tend to order more tests and prescribe more antibiotics.
Still, proponents of the plan see few alternatives. California state Sen. Ed Hernandez, a Democrat, puts it bluntly: “We're going to be mandating that every single person in this state have insurance. What good is it if they are going to have a health insurance card but no access to doctors?” Oklahoma would likely face the same problem, and to a larger degree.
In a recent editorial board meeting with The Oklahoman, state Commissioner of Health Terry L. Cline noted that Oklahoma ranks 49th out of 50 states in the number of primary health care physicians per 100,000 citizens. As a result, adding people to Medicaid would technically make them “insured” without any guarantee of actually seeing a doctor. Cline points out that many people would still likely have to visit the emergency room for routine medical treatment.
The situation could easily lead Oklahoma officials to water down health care standards, just as California is considering. While Oklahoma ranks 49th for primary care physicians, California ranks 20th.
Even if doctor access weren't an issue, Medicaid expansion is still unlikely to improve health outcomes. Cline notes the OU Health Sciences Center in Oklahoma City provides the highest concentration of health care in Oklahoma with much of it offered free through the teaching hospital. Despite that “free access to the highest concentration” of health care, he notes that within a few blocks of the center are some of the “worst health outcomes in the entire state.”
Cline said research shows just 10 percent of health outcomes are the result of access; 40 percent are driven by personal behaviors such as diet and exercise. “If you simply expand Medicaid, cover more people and have fewer people who are uninsured, but you have the same system, that's not going to solve the health challenges of our state,” Cline said.
The health care challenges facing Oklahoma are significant. But they won't be solved by simply dumping people into Medicaid. Without true health care reform, that's simply a plan to increase state costs and water down health standards — and still fail to significantly improve citizens' health status.