Now that Gov. Mary Fallin has rejected the Obama administration's Medicaid expansion proposal, she has asked Health Commissioner Terry Cline to help her devise an “Oklahoma solution” for addressing the state's health needs.
In an interview at the University of Oklahoma Health Sciences Center, Cline discussed why state officials said no to Washington, why Oklahoma ranks near the bottom of many health indexes, and why he's ready to take on tobacco industry lobbyists when the Legislature convenes this month.
An Ardmore native, Cline has a doctorate in clinical psychology and served as President George W. Bush's director of the Substance Abuse and Mental Health Services Administration. He also is Fallin's secretary of health and human services.
Q: Why did the state turn down the Obama administration's Medicaid expansion?
A: There are people who say our health care system is a sick care system. That's the way it's structured. All of our money is going into that. If we just expand our current system, it doesn't solve the problem.
Let me give you an example. We're sitting here in the Health Sciences Center. We have the highest concentration of health care in the state of Oklahoma all around us … hundreds of doctors, hundreds of nurses, numerous hospitals. Anyone can access services here because it's a sliding-scale fee. This is a teaching hospital environment. It's already being subsidized by the state.
But if we go two blocks over, I can show you some of the worst health outcomes in the entire state. Two blocks. The infant mortality rate is twice as high as it is two miles in the other direction. If the answer is just increasing access to health care, then why do all these individuals who are living within walking distance have the worst health outcomes?
I've had my share of medical care, and I'm grateful for that. It's very important. It is one piece of the picture. But right now, it's 99 percent of the funding, and our current expansion discussions don't address the true problems with the system.
All the dollars in our system go to pick up the pieces, and frankly there's not enough money. We're ranked 49th in the country in the number of primary care physicians. If all of a sudden we give everyone in the state an insurance card, is that going to change? Not necessarily.
Q: Did you advise Gov. Fallin to reject the Obama plan?
A: She took advice from a number of individuals. And as she's prone to do, she's looking at the funding that's available to us here in this state.
We had the ability to expand Medicaid five years ago, 10 years ago. There's nothing that would have prohibited us from doing that other than the cost. ... As a state, politically and financially, we decided not to do that. That's consistent.
So what's changed is the deal from the federal government. People think that they can get a free ride. Well, there is no free ride.
We're looking at a “fiscal cliff,” which has yet to be resolved. We have a federal government that everyone acknowledges is on an unsustainable trajectory in terms of the deficit.
Q: Did you concur with the decision she made?
A: I think that's a complex question that has a complex answer. It gets boiled down to simply Medicaid expansion. I think it's a much more complicated answer than that. I can't boil it down to I concur with this or I disagree with that.
The good news in all of this is that there has been more discussion about health and health care than I have ever seen in my entire career. And that's a good thing, because we need to be talking about that. That's the only way we can really begin to change the trends and change the outcomes in this state.