Expansion a threat to most vulnerable
As Oklahomans who are younger than 25, when we think about public policy, we want solutions that work for the long run. This is especially important in two areas: health care and government’s tendency to pile up debt.
In politics, it’s tempting to go for a ‘‘political win’’ by expanding entitlement programs while ignoring the fiscal woes that follow. This is the case in debates over expanding Medicaid to able-bodied adults, which usually focus on coverage rather than providing care or figuring out how to pay for it all. The reality is that expansion can threaten vital services for the most vulnerable, including low-income pregnant women, children and the disabled — while simultaneously draining state coffers.
According to available state data compiled by the Foundation for Government Accountability, early enrollment projections for states that expanded Medicaid under Obamacare were blown out of the water. New Jersey’s initial estimates were short by 200,000 people. Ohio signed up 265,000 more able-bodied adults than expected. In all, available data show more than 6 million more people signed up for Medicaid than anticipated across the first 24 states that expanded their programs.
The projected cost per enrollee was also way off. Each new enrollee cost 76 percent more than expected from 2014 to 2016. These compounding costs take a toll on state budgets, diverting resources away from core services.
If the federal government holds up its end of the Obamacare bargain, states will be reimbursed for 90 percent of costs created by new able-bodied enrollees in perpetuity starting in 2020. States will continue to receive a reimbursement rate on average of 59 percent for traditional Medicaid enrollees.
Some claim Oklahoma is foolish to walk away from “generous” federal reimbursements for new enrollees. But there is no special pot of money from which the federal government covers new Medicaid expansion costs. Federal spending on Medicaid is based on the costs associated with each current enrollee. If Oklahoma expanded Medicaid, it would mean more state and federal spending. All of the federal share would be added to the annual deficit and thus the national debt. Expanding Medicaid would simply mean Oklahomans, and everybody else paying the federal credit card bill, would pay more.
In our state, Obamacare’s Medicaid expansion could add as many as 628,000 able-bodied adults to Medicaid, bringing the total enrolled to about one-third of Oklahomans. Even without accepting Medicaid expansion, Oklahoma’s Medicaid costs and enrollees continue to skyrocket. Nearly 1 in 4 Oklahomans were on medical welfare through Oklahoma’s Medicaid program (SoonerCare) in 2017. Since 1997, total annual enrollment in SoonerCare has grown 132 percent. During this period, Oklahoma’s total population increased by only 17 percent.
Oklahoma legislators need to focus our state’s finite resources on reforming Medicaid, not expanding what is already one of the state’s largest welfare programs. Recent legislative reforms, such as Medicaid audits, are positive steps. More will be necessary. And some strategies, like allowing greater competition and transparency in order to lower health care costs, can save money in Medicaid while helping all Oklahomans afford our medical bills.