No matter how much political cover Gov. Mary Fallin seeks on the issue from her fellow Republican governors, her decision to reject an expansion of Medicaid in our state is a cruel decision, leaving thousands of low-income Oklahomans without health insurance.
That, in turn, will mean many low-income Oklahomans will avoid seeking medical help for developing illnesses, causing needless suffering and even death.
Fallin announced her decision Monday in a news release. She also has decided the state will not create its own state health insurance exchange, leaving that up to the federal government as outlined in the federal Affordable Care Act, also known as Obamacare. The ACA also expanded Medicaid to people under 65 who have incomes at 133 percent of the federal poverty line. The U.S. Supreme Court later ruled, however, that states had the option to not participate in that aspect of the ACA.
The Oklahoma Policy Institute has estimated Fallin’s decision could leave approximately 150,000 low-income Oklahoma residents without health insurance.
Fallin previously had delayed her decisions on the health exchange and the Medicaid expansion until after the election. More recently, she said she wanted to wait until she met with other Republican governors, ostensibly to get political cover from other politicians who have exaggerated the negative impact of ACA and turned it into an issue of partisan politics to oppose President Barack Obama.
Under the Medicaid expansion, the federal government would pick up all the costs the first three years, and then states would eventually pay 10 percent of the expansion cost.
Here’s why Fallin decision on the Medicaid expansion is terribly wrong for Oklahoma:
- Suffering. There’s no way around this issue. Many of those people who remain uninsured will decline to seek medical attention for developing illnesses, some of which will develop into major medical problems. People will suffer needlessly. Beyond the cost of this medical cycle, there’s the actual physical pain of those who are sick and the impact on their families, especially if they are wage earners and can no longer work. Some of these sick people will no doubt die because of poor or no medical care. As we debate this issue in terms of cost and the ACA, what often gets overlooked is how much pain and suffering our current medical system creates. Fallin and her fellow Republican governors, who have also rejected the Medicaid expansion, may score political points with their right-wing base, but their decisions lack basic human compassion.
- Bargain Deal. OK Policy cites figures from the Oklahoma Health Care Authority that show the state’s costs for Medicaid will be from $28 to $37 million in 2020. That’s a bargain when compared to a budget that is almost $7 billion. OK Policy also notes, “. . . Medicaid expansion could well save the state money, since Medicaid would pick up expenditures currently paid for with state-only dollars by the Department of Mental Health and Substance Abuse Services and Department of Corrections.” Increasing the number of insured people in Oklahoma-there are about 600,000 uninsured people here-will also reduce hospital emergency room visits, which could stabilize insurance prices here. In her news release announcing the decision, Fallin said the expansion would wind up “costing the state of Oklahoma up to $475 million between now and 2020, with escalating annual expenses in subsequent years.” Fallin didn’t explain how she arrived at this number, but she really needs to do so.
- Other States Win. By opting out of Medicaid expansion, Fallin has created a situation in which Oklahoma federal tax dollars will go to support states, such as California, that do participate in the new program. Beyond the simple unfairness of dilemma is also the more important issue of creating a state health care system that improves the overall quality of life. It goes without saying that healthier people are more productive and contribute more to state’s economy. As some states move forward, Oklahoma will remain mired in the old, broken medical system primarily based on the profits of health insurance companies. This is not good for individuals or the overall economy.
Fallin’s decision to not create a health insurance exchange, which people will use to buy insurance under the ACA, means that action will now be taken over by the federal government. Frankly, the federal government will probably do better job creating the exchange since the Republican power structure here is so negatively obsessed with Obamacare. Who can say whether Republicans here might create a system designed for failure, anyway?
In her statement, Fallin said she would support Oklahoma Attorney General Scott Pruitt’s “ongoing legal challenge” of Obamacare. But the U.S. Supreme Court has ruled the individual mandate in ACA is constitutional and American voters, given a chance to repudiate Obamacare, have clearly spoken. (Note Fallin’s own assessment about this in the above video clip.)
As we all know, the archaic Republican vision on the national level was soundly rejected on our recent Election Day, and demographics and other signs show the GOP brand is in serious decline. Fallin and her fellow Republican governors may want to placate the Obama haters, but as other states reap the benefits of Obamacare, their political calculations will seem increasingly shallow and craven.