Ok­la­homans watch health bill de­bate closely

The Oklahoman (Sunday) - - NEWS - BY JUSTIN WINGERTER Staff Writer jwingerter@ok­la­homan.com

Five years ago, the Af­ford­able Care Act al­lowed Ken­dall Brown to un­dergo a surgery that would have cost $250,000 out of pocket and re­ceive chemo­ther­apy in­jec­tions nec­es­sary to keep her Crohn’s dis­ease in check.

It re­quired in­sur­ers to cover her pre-ex­ist­ing con­di­tion — one that dates back to child­hood — and to pro­vide what are known as es­sen­tial med­i­cal ben­e­fits. A re­peal of the ACA be­ing con­sid­ered in the Se­nate would al­low states to choose whether in­sur­ers must pro­vide those same ben­e­fits.

With­out health in­sur­ance, Brown said she would forgo her costly chemo­ther­apy in­jec­tions. Her Crohn’s would worsen, bring­ing about ex­treme pain, and Brown would quit work­ing. She said she would wait for the mo­ment just be­fore her in­testines burst, then rush to an emer­gency room eth­i­cally re­quired to care for her. If she mist­imed it, her in­testines would rup­ture, likely killing the 30-year-old.

“I know peo­ple think ‘mat­ter of life and death’ is a talk­ing point but it’s re­al­ity for me,” she said.

Tara Tobin, 25, is un­able to walk, speak or use her hands, symp­toms of a de­bil­i­tat­ing neu­ro­log­i­cal dis­or­der called Rett syn­drome. A Med­i­caid waiver cov­ers the cost of her wheel­chair, phys­i­cal ther­apy, di­a­pers and med­i­ca­tions.

“That al­lows her to stay in our home,” said her mother, Ta­mara.

Though she uses a wheel­chair and is frail, Lori Tay­lor is able to re­main in her Nor­man home through Med­i­caid. That in­de­pen­dence comes at a sig­nif­i­cantly lower price than a nurs­ing home. With­out it, Tay­lor fears she will be forced into a nurs­ing home, where she will slowly die.

Richard An­der­son, 49, has cere­bral palsy but lives in his Nor­man home with the as­sis­tance of Med­i­caid. It pays for his elec­tric wheel­chair, his vis­its to three doc­tors, his surg­eries. It also pays an as­sis­tant to grab his gro­ceries, cook for him, bathe him and shave him.

“With­out a per­sonal care as­sis­tant, I’d have to go to an in­sti­tu­tion or a nurs­ing home,” he said.

Un­der the Bet­ter Care Rec­on­cil­i­a­tion Act, an ACA re­peal bill crafted by Se­nate Repub­li­cans, Med­i­caid spend­ing would be $772 bil­lion less over the next decade than it will be un­der cur­rent law. States could ei­ther make up the dif­fer­ence with their own tax dol­lars or cut ser­vices. Some Ok­la­homans de­pen­dent on Med­i­caid ser­vices fear the lat­ter will oc­cur.

‘A his­toric threat’

Nico Gomez, who over­saw the state’s Med­i­caid pro­gram as head of the Ok­la­homa Health Care Author­ity, is now pres­i­dent of the Ok­la­homa As­so­ci­a­tion of Health Care Providers, which rep­re­sents the state’s 304 nurs­ing homes. He says two pro­vi­sions in the Se­nate bill, taken to­gether, rep­re­sent “a his­toric threat” to Med­i­caid in Ok­la­homa “like some­thing we’ve never faced.”

Be­gin­ning in 2020, Med­i­caid would cease be­ing an open-ended pro­gram and would in­stead be placed on a bud­get, grow­ing an­nu­ally in line with in­flat­ing med­i­cal costs. Be­gin­ning in 2025, pay­ments from the fed­eral gov­ern­ment to states would grow at a lower rate — that of tra­di­tional in­fla­tion.

Gomez fears the chang­ing growth rate won’t bring in enough money. Sixty-five per­cent of nurs­ing home fund­ing in Ok­la­homa comes from Med­i­caid and as the baby boomer gen­er­a­tion ages, the cost of car­ing for it in­creases. If Med­i­caid’s growth rate fails to keep up with costs, nurs­ing homes will have fewer fed­eral dol­lars to care for a grow­ing pop­u­la­tion.

“There won’t be enough fund­ing in the sys­tem to keep nurs­ing homes open,” Gomez pre­dicts.

Nurs­ing homes ac­count for a far larger slice of Ok­la­homa’s Med­i­caid bud­get than any other ser­vice, more than $50 mil­lion in May alone to care for 13,204 se­niors. By com­par­i­son, doc­tor vis­its for the state’s 150,261 chil­dren on Med­i­caid cost $27.6 mil­lion, ac­cord­ing to OHCA fig­ures.

Im­pact on hos­pi­tals

Ok­la­homa Hos­pi­tal As­so­ci­a­tion Pres­i­dent Craig Jones, who has been con­cerned about the ef­fects of Med­i­caid changes on the state’s hos­pi­tals, said, “I think the long-term health care im­pact on nurs­ing homes is even worse than on hos­pi­tals.”

A sec­ond pro­vi­sion that con­cerns Gomez is a de­crease in health care provider taxes — fees as­sessed on hos­pi­tals and nurs­ing homes to help pay the state’s share of Med­i­caid spend­ing. Cur­rently, states can ef­fec­tively levy a 6 per­cent tax on a health care provider’s rev­enue. Un­der the Se­nate bill, that would de­crease to 5 per­cent.

Gomez es­ti­mates those two pro­vi­sions — slow­ing the growth rate and de­creas­ing provider taxes — would cost each Ok­la­homa nurs­ing home an av­er­age of $433,000 an­nu­ally in Med­i­caid fund­ing. Statewide, the an­nual to­tal would be just un­der $132 mil­lion, ac­cord­ing to Gomez’s es­ti­mates.

“There are go­ing to be less fed­eral funds avail­able to the state. The state will have to de­cide whether to make other cuts in gov­ern­ment or raise rev­enue to fund Med­i­caid,” he said.

The other op­tion would be to pro­vide less care to Med­i­caid pa­tients. That’s what Melissa Sublett, ex­ec­u­tive di­rec­tor of the Ok­la­homa Dis­abil­ity Law Cen­ter, is con­cerned will oc­cur. She con­sid­ers the Se­nate bill to be “a gi­ant step back­ward.”

“This leg­is­la­tion would seg­re­gate peo­ple with dis­abil­i­ties into dif­fer­ent in­sur­ance that is more ex­pen­sive and cov­ers less, force them to live in poverty, and in­flict on them a great worry over how they will get health care the next time an is­sue arises,” she said.

Cost-cut­ting mea­sure

In a state­ment Wed­nes­day, the ad­min­is­tra­tion of Pres­i­dent Don­ald Trump de­fended slow­ing the growth rate as a cost-cut­ting mea­sure that will en­sure Med­i­caid re­mains a pro­gram for the most vul­ner­a­ble pop­u­la­tions.

“The struc­tural Med­i­caid re­forms — capped al­lot­ments com­bined with ad­di­tional state flex­i­bil­ity — will help pre­serve the pro­gram for those who truly de­pend on it while pro­tect­ing tax­pay­ers against waste­ful and in­ef­fi­cient spend­ing,” the White House said.

Of the 31,000 births each year in the state, 60 per­cent are cov­ered by Med­i­caid, said Ja­son San­ders, a doc­tor of in­ter­nal medicine and provost of the OU Health Sciences Cen­ter. The fed­eral gov­ern­ment cur­rently sends Ok­la­homa $3 bil­lion each year for Med­i­caid, which cov­ers 60 per­cent of the state’s Med­i­caid bud­get.

“I think ev­ery­thing’s at risk and, un­der this bill, it will be left to states to fig­ure out some very dif­fi­cult choices,” he said.

Jo Stainsby, a spokes­woman for the Ok­la­homa Health Care Author­ity, said the agency is an­a­lyz­ing the ef­fects of the Se­nate health care bill on Med­i­caid in Ok­la­homa but has not yet made any de­ter­mi­na­tions.

The state is ill-po­si­tioned to sup­ple­ment Med­i­caid with state tax dol­lars if fed­eral al­lot­ments are di­min­ished.

On Tues­day, the Ok­la­homa De­part­ment of Hu­man Ser­vices an­nounced it was scal­ing back the Med­i­caid AD­van­tage waiver pro­gram due to state bud­get cuts. The change cur­tails the num­ber of hours for which providers can bill. Cuts to a waiver pro­gram for de­vel­op­men­tally dis­abled adults are ex­pected to cost 1,200 Med­i­caid clients about seven hours of sup­port per week.

Sen­a­tors sup­port­ive

Ok­la­homa’s sen­a­tors have in­di­cated their sup­port for the new bill with­out stat­ing out­right that they will vote for it. U.S. Sen. James Lank­ford, R-Ok­la­homa City, said Thurs­day that he had be­gun an­a­lyz­ing the bill “to de­ter­mine its ben­e­fits for Ok­la­homans.”

“My goal is to vote on health care re­form leg­is­la­tion that will be af­ford­able and prac­ti­cal for Ok­la­homans of all so­cioe­co­nomic lev­els and all health con­di­tions,” he said in a state­ment. “I will fight for a sys­tem that of­fers more choice, lower pre­mi­ums and a stronger, sus­tain­able safety net for vul­ner­a­ble Ok­la­homans.”

Lank­ford said the bill does not cut Med­i­caid.

“Fund­ing for Med­i­caid would con­tinue to grow, yet not at the steep, be­yond-in­fla­tion growth that is pro­jected over the next 10 years,” he said.

U.S. Sen. Jim In­hofe, R-Tulsa, said in a state­ment that re­peal­ing and re­plac­ing the ACA es­sen­tial.

“I am re­view­ing this bill and the lat­est changes and I re­main com­mit­ted to sup­port­ing a re­place­ment that will pro­vide all Ok­la­homans with more and bet­ter health care op­tions,” he said.

Gomez said he has spo­ken with the of­fices of Lank­ford and In­hofe to ex­plain the ef­fects of the Se­nate bill on Ok­la­homa nurs­ing homes. The Nor­man res­i­dents — Tay­lor, An­der­son and Brown — have urged their sen­a­tors to op­pose the bill.

Dur­ing an in­ter­view with a re­porter Mon­day, Brown’s phone rang. She ig­nored it for the rea­son she ig­nores all calls from un­known num­bers — be­cause a med­i­cal debt col­lec­tor was likely on the line. She shrugged, sighed, and sat the phone back down as it con­tin­ued to ring. is

[PHO­TOS BY STEVE SISNEY, THE OK­LA­HOMAN]

Lori Tay­lor and Richard An­der­son pre­pare to go to U.S. Sen. James Lank­ford’s of­fice on Wed­nes­day in Ok­la­homa City.

Lori Tay­lor and Richard An­der­son sit in the lobby of U.S. Sen. James Lank­ford’s of­fice as peo­ple with dis­abil­i­ties protest on Wed­nes­day in Ok­la­homa City.

Tara Tobin, 25, car­ries a sign as peo­ple with dis­abil­i­ties protest in U.S. Sen. James Lank­ford’s of­fice Wed­nes­day in Ok­la­homa City.

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