Oklahoma Governor opposes Medicaid expansion

Oklahoma Gov. Mary Fallin (R) said Monday that the Oklahoma Department of Health will not participate in a state-based health exchange or to expand Medicaid – key parts of the new federal health care law designed to increase coverage for the elderly and poor.

In a letter to Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, Fallin said she believes there are “market-based solutions that can be found to facilitate greater access” to health care.

Estimates are that an additional 693,000 state residents would be eligible for Medicaid coverage if Oklahoma were to participate in the key provision of the health care law.

Beginning in 2014, the law is set to expand the Medicaid program to cover people under age 65, including people with disabilities, with income of about $15,000 for a single individual. The expansion also aids low-income adults who have disabilities but don’t meet Social Security disability requirements. The expansion also helps those whose income is above their state’s current eligibility levels.

In Oklahoma, the expansion would allow anyone earning at or less than $14,856, to enroll in Medicaid. Tax credits would be available, under the expansion, for those who earn just below $45,000 – roughly four times the poverty level – to help pay private insurance premiums.

“Despite my ongoing opposition to the federal health care law, the state of Oklahoma is legally obligated to either build an exchange that is PPACA compliant and approved by the Obama Administration, or to default to an exchange run by the federal government,” Fallin noted in a press release (See the full statement below). “This choice has been forced on the people of Oklahoma by the Obama Administration in spite of the fact that voters have overwhelmingly expressed their opposition to the federal health care law through their support of State Question 756, a constitutional amendment prohibiting the implementation of key components of PPACA.”

The federal government will pay 100% of the states’ expanded Medicaid costs between 2014 and 2017.  Beyond 2017, states will pick up payment of an incremental portion of the expanded Medicaid program, up to 10% by 2021.

The U.S. Supreme Court ruling in June upheld the individual mandate portion of the federal health care law. It also said states could not be penalized for opting out of a provision calling for expansion of Medicaid, a health insurance partnership between the states and federal government to help poorer citizens.

Governors in Alabama, Alaska, Arizona, Idaho, Louisiana, Maine, Nebraska, New Jersey, Ohio, Texas and Wisconsin have either said they would not participate in health insurance exchanges or are postponing a decision until later in the year.

Arkansas Gov. Mike Beebe (D) has advocated for Legislative approval to create a state-run exchange rather than submit to a federal plan.

Beebe also has advocated for the state to take advantage of federal government dollars from a potential Medicaid expansion as allowed by the federal health care law. According to state Medicaid director Andy Allison, the expansion could actually save $372 million or more over a seven-year period if Arkansas opted in.

Republican Legislators, who now control the Arkansas House and Arkansas Senate, have said they oppose the exchanges and Medicaid expansion.

FALLIN STATEMENT
OKLAHOMA CITY – Governor Mary Fallin today released the following statement announcing that Oklahoma will not pursue the creation of a state-based exchange or participate in the Medicaid expansion in the Patient Protection and Affordable Care Act (PPACA):

“For the past few months, my staff and I have worked with other lawmakers, Oklahoma stakeholders and health care experts across the country to determine the best course of action for Oklahoma in regards to both the creation of a health insurance exchange and the expansion of Medicaid under the Affordable Care Act. Our priority has been to ascertain what can be done to increase quality and access to health care, contain costs, and do so without placing an undue burden on taxpayers or the state. As I have stated many times before, it is my firm belief that PPACA fails to further these goals, and will in fact decrease the quality of health care across the United States while contributing to the nation’s growing deficit crisis.

“Despite my ongoing opposition to the federal health care law, the state of Oklahoma is legally obligated to either build an exchange that is PPACA compliant and approved by the Obama Administration, or to default to an exchange run by the federal government. This choice has been forced on the people of Oklahoma by the Obama Administration in spite of the fact that voters have overwhelmingly expressed their opposition to the federal health care law through their support of State Question 756, a constitutional amendment prohibiting the implementation of key components of PPACA.

“After careful consideration, I have today informed U.S. Secretary of Health Kathleen Sebelius that Oklahoma will not pursue the creation of its own health insurance exchange. Any exchange that is PPACA compliant will necessarily be ‘state-run’ in name only and would require Oklahoma resources, staff and tax dollars to implement. It does not benefit Oklahoma taxpayers to actively support and fund a new government program that will ultimately be under the control of the federal government, that is opposed by a clear majority of Oklahomans, and that will further the implementation of a law that threatens to erode both the quality of American health care and the fiscal stability of the nation.

“Furthermore, I have also decided that Oklahoma will not be participating in the Obama Administration’s proposed expansion of Medicaid. Such an expansion would be unaffordable, costing the state of Oklahoma up to $475 million between now and 2020, with escalating annual expenses in subsequent years. It would also further Oklahoma’s reliance on federal money that may or may not be available in the future given the dire fiscal problems facing the federal government. On a state level, massive new costs associated with Medicaid expansion would require cuts to important government priorities such as education and public safety. Furthermore, the proposed Medicaid expansion offers no meaningful reform to a massive entitlement program already contributing to the out-of-control spending of the federal government.

“Moving forward, the state of Oklahoma will pursue two actions simultaneously. The first will be to continue our support for Oklahoma Attorney General Scott Pruitt’s ongoing legal challenge of PPACA. General Pruitt’s lawsuit raises different Constitutional questions than previous legal challenges, and both he and I remain optimistic that Oklahoma’s challenge can succeed.

“Our second and equally important task will be to pursue state-based solutions that improve health outcomes and contain costs for Oklahoma families. Serious reform, for instance, should be pursued in the area of Medicaid and public health, where effective chronic disease prevention and management programs could address the trend of skyrocketing medical bills linked to avoidable hospital and emergency room visits. I look forward to working with legislative leaders and lawmakers in both parties to pursue Oklahoma health care solutions for Oklahoma families.”