New Medicaid proposal warrants a close look
OUR VIEWS | PLAN UNVEILED BY OHCA DIRECTOR
TASKED by policymakers with crafting a way to assist Oklahomans who rely on Medicaid, and aware that simply expanding the program is a political nonstarter, Nico Gomez produced a plan he calls the Medicaid Rebalancing Act of 2020. Lawmakers should give it a close look.
Gomez heads the state’s Medicaid agency, the Oklahoma Health Care Authority, and in the past two years has cut his budget by nearly $500 million. Recently he warned that the rates his agency pays to health care providers could be slashed by a whopping 25 percent next year.
“If we continue down this road, we won’t be able to sustain a viable network, bottom line,” he told The Oklahoman’s editorial board last week.
The challenge, as he sees it, is to look beyond just the next quarter or the next fiscal year. “How do we stabilize the system? What’s a responsible rate we need to pay in the market?” Gomez said. “But also, let’s account for how do we invest in the lives of Oklahomans in a responsible way that in my mind supports human dignity, supports personal responsibility and stabilizes the structure of the system?”
He believes the Medicaid Balancing Act provides the potential solution. He calls it an Oklahoma-specific plan that would benefit the needy and health care providers alike. This sentiment is shared by mental health Commissioner Terri White, whose agency is greatly affected by Medicaid cuts.
Gomez proposes creating a new option to Insure Oklahoma, covering adults ages 19 to 64 whose incomes are below 133 percent of the federal poverty level (roughly 175,000 Oklahomans). They would be provided a choice of commercial insurance plans and be made to pay a premium. This program would include potential cost savings for such things as healthy lifestyle choices and preventative screenings. The cost would be about $100 million in state dollars, to be matched by $900 million in federal dollars.
A second leg of this plan would eventually move to the commercial insurance market some SoonerCare members whose incomes exceed 133 percent of the federal poverty level. This would affect about 175,000 people, mostly children and pregnant women, and potentially save $60 million in state funds, Gomez said. Finally, Gomez seeks to get Medicaid provider rates back to the current 86.5 percent of Medicare rates. One way to help pay for this would be to increase the tobacco tax by $1.50 per pack. Gov. Mary Fallin called unsuccessfully this year for a similar tobacco tax increase to help produce new recurring revenues; Gomez and White said lawmakers seem more open to the idea of using tobacco revenue strictly for health-related concerns.
But would they be willing to approve such a tax increase on their own, in order to get those revenues flowing sooner rather than later? Any tax increase would require supermajority approval in both chambers.
Gomez and White said the proposed financing options, which also include a health carrier access fee and the Supplemental Hospital Offset Payment Program, are suggestions only. Their foremost concern is keeping the Medicaid program afloat.
Gomez sees his plan as a way to reduce the uninsured rate in Oklahoma by 35 percent, help protect access to health care in rural and urban areas, and bolster care to Oklahomans with behavioral health and substance abuse issues.
“This is something innovative and positive in the gloom and doom,” he said. We commend Gomez for his effort. He’s done as he was asked — provide policymakers another option. The Legislature’s job is to carefully vet it and determine if the proposal’s benefits outweigh its costs.