When The Oklahoman’s editorial board discusses health care issues — and specifically Medicaid expansion — it often makes incongruous statements that support a political position without being grounded in reality.
The public deserves better than to be treated as if it were stupid.
On Wednesday, the seven-member board of “the state’s most trusted news” published an editorial titled, “Oklahoma budget reality may require Medicaid changes.”
While that headline statement is sadly true, the piece quickly deteriorates into an illogical argument about how Oklahoma — and its clinics, hospitals and providers — would be worse off financially had leaders expanded Medicaid under the Affordable Care Act.
Had Oklahoma expanded Medicaid, lawmakers would now be scrambling to find additional funding for the program during a time of dramatic shortfall. That would have made the budget situation even worse.
Furthermore, Medicaid’s low rates are often less than the cost of service, which has left many hospitals in precarious financial positions. When hospitals have a large share of patients on Medicaid and Medicare, they often struggle to stay afloat. Those hospitals need more patients with private insurance that actually covers the cost of treatment, not more patients who are a net drain on hospital finances.
Anyone with a cursory understanding of how hospitals work would look at this statement and laugh (or cry). The Oklahoman editorial board is either pathetically ignorant on the topic of health care financing, or it’s intentionally misrepresenting reality.
But let’s unpack the ridiculous claim, first.
If you ask your local hospital CEO — or doctor — what type of patient is actually the biggest “net drain on hospital finances,” the answer is simple: the uninsured. If that’s over the head of board members Gary Pierson, Christopher P. Reen, Kelly Dyer Fry, Christy Gaylord Everest, Scott Briggs, Owen Canfield and Ray Carter, then perhaps some basic math is in order.
Here is a list of Medicaid reimbursement fees for primary care, readily available on the Oklahoma Health Care Authority’s website. One can also see fee schedules for other types of care here, including ASC codes (or procedures billed by ambulatory surgery centers.)
Choosing from ASC codes randomly, let’s look at 11042, 11043 and 11044. All three have to do with debridement — the removal of infected skin. Oklahoma Medicaid reimburses them at $119.67, $119.67 and $349.36, respectively.
Perhaps The Oklahoman editorial board can guess how much surgery centers are guaranteed to collect for exclusional debridements on uninsured patients? (Hint: If you divide by it, the answer is undefined.)
In conclusion: $119.67 > $0.
So it’s an embarrassing display for The Oklahoman’s editorial board to say hospitals are “in precarious financial positions” owing to “low” Medicaid reimbursements without noting that hospitals treat hundreds of thousands of uninsured patients annually — for whom they often receive no reimbursement beyond “loss” write-offs. Many of those patients, of course, would be covered under Medicaid expansion.
Ironically, if The Oklahoman wanted to make legitimate criticisms of Medicaid, Medicare, hospitals or the U.S. health care system as a whole, there’s plenty of red meat on that bone.
For instance, as we’re discussing debridements, why are there so many different codes (paying different amounts) for these types of procedures? Why are physicians and hospital billing departments having to figure out whether a debridement was exclusional, selective or non-selective? Why are different values reimbursed for different depths of debridement? Why do some sets of debridement codes reimburse different amounts than others? Why do some reimburse the same? Why is this all so complicated?
Those are the questions about which an informed editorial board should be writing. Those are the critiques that a system as complex as U.S. health care reimbursement demands.
But to sit around and write political fantasies wherein struggling rural hospitals are harmed more by Medicaid patients than by uninsured patients — who would have coverage if they lived in other states — is asinine, disingenuous and lazy.
Call in your own health reporter for perspective. Ask some questions, such as why the Oklahoma Hospital Association supports accepting federal money for Medicaid expansion (or an alternative therein).
Visit with an uninsured patient, or a Medicaid patient. Visit a hospital. Visit the free clinic run by Gov. Mary Fallin’s aunt in Shawnee. Get to the bottom of how billing rates are set, negotiated and utilized by providers. Analyze how much uninsured patients cost hospitals that are required to treat them by federal law.
But for the love of God, don’t feed the public a bowl of bullshit and tell ’em it’s creamed corn.
Things we saw (and heard)
As legislators weigh school cuts, a rising outcry from parents and advocates — Oklahoma Watch
Should hospitals learn from Donald Trump and Bernie Sanders? — Hospitals & Health Networks
Enid lawyer makes recommendation for U.S. Supreme Court nomination — Enid News & Eagle
The Parmesan cheese you sprinkle on your penne could be wood — Bloomberg.com
Quotes to note
We need to get people out of hospitals, we need to create a rich set of community-based alternatives. (The goal is) normalizing the entire lifespan instead of separating and stigmatizing one part as something different.
— Dr. Bill Thomas to the Washington Post about his efforts to redefine how Americans view aging, 1/23/16
Whenever we allow government to pick winners and losers, we impede progress and move further away from a society of mutual benefit. This pits individuals and groups against each other and corrupts the business community, which inevitably becomes less focused on creating value for customers. That’s why Koch Industries opposes all forms of corporate welfare — even those that benefit us. (The government’s ethanol mandate is a good example. We oppose that mandate, even though we are the fifth-largest ethanol producer in the United States.)
— Charles Koch in a Washington Post op-ed discussing an issue on which he supports presidential candidate Sen. Bernie Sanders, 2/18/16
If they want to throw hashtags around with my name in it, that’s up to them. My goal is not to have Oklahoma consumers not be able to drink Budweiser, but my goal is to make sure that everyone has to play by the same rules.
— Sen. Clark Jolley (R-Edmond) to KOCO regarding an Anheuser-Busch ad being run against his bill to change Oklahoma liquor laws, 2/18/16
Video of the Week
Highlights from NonDoc
“Fake plastic trees: OU baseball field goes synthetic” by Jeremy Cowen
“Lack of mental health parity creates ‘walking wounded’” by Paul Fairchild
“Charlie Christian should be in Oklahoma Hall of Fame“ by William W. Savage Jr.