Health care compromise requested
Some key players in the debate over state health care policy have embraced elements of the Leavitt Report, a detailed analysis of the state’s Medicaid system and its options as the Affordable Care Act is implemented.
But an opponent of the federal health care law said the report is fundamentally flawed because it calls for the state to accept federal health care money — and the strings attached to it.
Oklahoma Hospital Association President Craig Jones said he was pleased that the Leavitt report recommends working in partnership with the federal government to fund health care coverage for poor Oklahomans and continuation of the Insure Oklahoma program.
The hospital association has pushed for Affordable Care Act-funded expansion of the state Medicaid system to cover thousands of uninsured Oklahomans living below 133 percent of the federal poverty level.
The Leavitt Report calls for accepting the offered federal funding for Medicaid expansion, but seeking federal permission to redirect the money to purchase private insurance instead of expanding Medicaid — a program similar to one federal officials approved for Arkansas earlier this year.
“It is imperative that we work together to find solutions, as we have done in the past with the Insure Oklahoma program, to use available state and federal funds to lessen the burden of the uninsured on Oklahomans,” Jones said.
Insure Oklahoma uses federal Medicaid funding, state tobacco tax revenue and other funding to subsidize private insurance for working Oklahomans below 200 percent of the poverty level.
Jones said he hopes the Leavitt Report provides a framework for state leaders to deal with the prob- lem of some 639,000 uninsured Oklahomans.
“We all know that care of the uninsured is currently paid for by everyone who pays their hospital bill or has insurance,” Jones said. “Not addressing this pressing problem will only increase health care costs and perpetuate our state’s poor health outcomes.”
Mike Neal, president and CEO of the Tulsa Re- gional Chamber, said the report should push state leaders to save the Insure Oklahoma program.
Federal officials have canceled participation in Insure Oklahoma after Dec. 31, because it does not meet Affordable Care Act standards. About 21,000 of the program’s participants will be eligible for federal subsidies through an Affordable Care Act healthinsurance exchange starting Jan. 1.
Late in the legislative session, Gov. Mary Fallin called for using state money to extend the program for the other 9,000 people, but Speaker of the House T.W. Shannon refused to consider the idea, saying insurance wasn’t a proper role for government and that he opposed creation of a new entitlement program.
Ending the Insure Oklahoma program would exacerbate the number of uninsured Oklahomans and slow the state’s economic growth, Neal said.
“As a result, these employees will be left without insurance, while businesses will face a future of economic uncertainty and increased expenses due to rising premiums,” Neal said. “For our businesses to continue to succeed, we must find creative solutions to remedy these problems and increase insurance coverage.”
Neal applauded Fallin and state leaders for their commitment to develop an Oklahoma plan.
“Failing to create an Oklahoma Plan will undoubtedly result in increased cost-shifting to businesses and untold damage to our health care infrastructure as hospitals and health systems are forced to care for the uninsured on even smaller budgets,” Neal said. “We urge state leaders to review the Leavitt Report and pursue all available op- tions to assure affordable coverage for all Oklahomans.”
Fallin is yet to address the proposals of the Leavitt report, although a spokesman has indicated she will look closely at it.
“Governor Fallin will review the Leavitt recommendations with her partners in the state Legislature to explore where consensus can be found and how the state can best move forward,” said spokesman Alex Weintz. “Her goal continues to be improving access to high quality, affordable care for all Oklahomans. However, like most Oklahomans, she does not believe that the Medicaid expansion outlined in Obamacare is an acceptable way of achieving these results.”
Weintz’s reference to “Medicaid expansion outlined in Obamacare” seems carefully phrased to exclude expansion of eligibility of Medicaid, but potentially not to exclude expansion of the use of Medicaid money to fund private insurance coverage for the poor.
The report shows direct costs to the state of $850 million over 10 years, but then wipes that away with “funny Obamacare stimulus math” to show the state actually saving $464 million.
The report fails to address adequately the actual costs of health care or make any substantive proposals to reduce them, Small said.
Missing from the discussion is any look at the actual costs and revenues of hospitals and other medical providers, he said.
“Really, the report was a pretty big disappointment,” he said. “There’s just been this obsession with who pays for care, and really before you can address that, you have to address the cost and the lack of transparency.”