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Medicaid expansion hype meeting funding reality

by The Oklahoman Editorial Board Published: August 4, 2014
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THOSE who support expansion of Oklahoma’s Medicaid program often claim it will increase health care access and treatment. In reality, Medicaid’s financial problems are already leading officials to ration health care treatment nationally, even if this means that people are denied prompt access to life-saving cures.

Consider Gilead Sciences’ revolutionary new treatment for hepatitis C, Solvaldi. The 12-week treatment has been shown to cure the virus in 90 percent of patients, if not more. Given that hep C, a blood-borne disease of the liver, kills 80,000 people annually, this is big news.

But the treatment costs $84,000. That’s a bargain compared to the lifetime costs of treating a chronic disease. A liver transplant alone costs around $580,000. But hep C is more common among low-income citizens who comprise Medicaid enrollees. The upfront cost of Solvaldi has many Medicaid programs balking. To control costs, Medicaid programs in California, New York, Colorado, Pennsylvania and Oregon have already announced that they’ll limit use of the treatment.

In short, for budgetary reasons a life-saving, life-altering cure is being rationed. “Free” health care isn’t really free! Who would have guessed?

To provide Solvaldi to every enrollee infected with hep C, Oregon officials estimated that they’d have to spend $360 million, which nearly equals the $377 million they spent on all prescription drugs for about 600,000 members in 2013.

The human impact of such decisions is immense. Diana Sylvestre, who founded an Oakland clinic treating hepatitis C patients, offered a blunt assessment to The New York Times: “The new policies are going to further restrict access to care for thousands of patients on the basis of no evidence.”

In 2010, Oklahoma’s acute hepatitis C incidence rate was more than three times higher than the U.S. average. Legislation approved by lawmakers this year has since allowed the Oklahoma Health Care Authority to place Solvaldi on the list of drugs requiring prior authorization before Medicaid will cover them. Simply having hepatitis C won’t be enough justification for the state to pay for this treatment.

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by The Oklahoman Editorial Board
The Oklahoman Editorial Board consists of Gary Pierson, President and CEO of The Oklahoma Publishing Company; Christopher P. Reen, president and publisher of The Oklahoman; Kelly Dyer Fry, editor and vice president of news; Christy Gaylord...
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