Oklahomans watch health bill debate closely
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.
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.
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
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.