tobacco tax
(William W. Savage III)

Those who like to sit back and scoff at the Oklahoma Legislature for perceived incompetence were hand-delivered a lunch pail’s worth of material Wednesday as the Oklahoma House failed to muster the political will to raise a cigarette tax to avoid deep Medicaid cuts and/or expand health coverage for the working poor.

In the end, House Republican leadership needed the votes of House Democrats to even come close to passing the tax, which Oklahoma Senate President Pro Tempore Brian Bingman (R-Sapulpa) has said would face a tough road in his chamber anyway.

But Democrats in the lower chamber stood firm in their opposition to HB 3210 as it was presented. While the $180 million in projected revenue would have gone to the Oklahoma Health Care Authority (which runs Medicaid/SoonerCare) and the Oklahoma Department of Mental Health and Substance Abuse Services, members of the minority party want to force some sort of agreement wherein a Medicaid-expansion plan takes effect, be it called “Medicaid Rebalancing,” “A Plan for Oklahoma,” “SoonerCare Solvency,” “Insure Oklahoma Broadening,” “Access to Care for Adults Making Less Than 133 Percent FPL” or “Screw You, Stop Preventing Billions of Health Care Dollars From Entering Our State.”

It’s a noble enough effort for a party whose 2014 gubernatorial nominee campaigned strongly on Medicaid expansion being a correct decision for health care reasons and economic reasons.

But complex tax-vote rules combined with a conservative core of House Republican membership and a joint (but surprisingly ineffective) lobbying campaign from pretty much every Oklahoma health care advocacy group and trade association conspired Wednesday to leave the vote on HB 3210 open for more than two hours before a final roll call of 40-59. As a tax increase, 76 votes were needed for passage. (And, oh yeah, powerful tobacco interests oppose it, too.)

The Tulsa World’s Randy Krehbiel summarized the confusing situation by saying how “upside down” it seems for Republicans to be begging Democrats to pass a tax increase for Medicaid:

House Republicans bitterly denounced Democrats for refusing to vote for the tax, saying without it most of the state’s nursing homes and many of its rural hospitals will close.

Rep. Doug Cox, R-Grove, who is carrying the bill, urged voters to call these “locked up Democrats” and predicted that some Democrats would lose their elections because they voted against a tax increase — a suggestion some Democrats found ironic.

“Laughable” is how Minority Leader Scott Inman, D-Del City, put it.

“For the Republican governor and the Republican majority to stand up and say any rural hospital closing is our fault when they have cut $41 billion worth of income taxes, left $900 million on the table for health care, cut $400 million in gross production taxes, and refused to do the right thing when it comes to tax credits,” he said.

Inman pointed out that Democrats weren’t the only ones voting against the bill. At its 49-vote crest, less than two-thirds of the Republican caucus was ever on the tote board in favor HB 3012.

Another vote on the bill possible

Of course, HB 3210 could still be recalled today through the end of session, which is scheduled for not later than 5 p.m. May 27. (At this rate and with no clear budget picture, however, leadership may well threaten a session extension.)

As a result, advocacy groups fired up their email lists and their Twitter feeds Wednesday evening, sending out quick and frantic requests for people to “call their representatives” and relay various messages of dubious clarity.

For example, the Oklahoma City-County Health Department’s Wellness Now campaign blasted out an email at 6:09 p.m. as the vote appeared well stalled. In it, recipients were twice asked to contact their “Legislatures” to discuss (apparently) the “health care costs of tobacco.” Among many statistics listed, advocates were supposed to point out things like:

  • 14.3% and 28.8% increases in HealthChoice current employee-only monthly premiums for Basic and High, respectively, since 2009 have increased personnel costs for the state as whole with 23,303 employees using HealthChoice as their health insurance provide

  • 49% increase since 2009 in State Department of Education’s insurance costs.

Got it? Good. That should swing some votes.

But only a month ago, the same Wellness Now coalition sent out far different talking points for the full Medicaid rebalancing proposal, a linguistic workaround intended to backdoor the acceptance of federal money for Medicaid expansion without Gov. Mary Fallin or other Republican leaders having to offer a mea culpa.

Those talking points from April 13 opened with how the Medicaid rebalancing proposal would cover 175,000 people.

A lot can change in a month.

Meanwhile, the Oklahoma Hospital Association offered direct and frightening estimates Wednesday evening on the effects of not passing the tobacco tax, saying: “As many as four out of five hospitals will not deliver babies,” and “Nine out of 10 nursing homes will be forced to shut down.” Last, “More than a dozen hospitals will close within one year.”

Talk about frightening prospects.

The OHA was joined by the Oklahoma Association of Health Care Providers in its 6:16 p.m. release, which opened by saying the House would keep the vote on HB 3210 open until midnight.

The vote closed, however, 10 minutes later with a motion that it may be reconsidered at a later time. After making statements to the press, House Republican leaders were already headed to an end-of-session party at an Oklahoma City ranch, according to News 9’s Aaron Brilbeck.

Meanwhile, for individuals and families

Wednesday, the Tulsa World also ran a story highlighting Oklahoma’s 14.8 percent uninsured rate. In it, reporter Mike Averill summarized a report from the federal Centers for Disease and Prevention:

The report compared Medicaid expansion states to nonexpansion states, showing that uninsured 18- to 64-year-olds in expansion states fell to 9.8 percent compared to 17.5 percent in nonexpansion states.

Some states, including Oklahoma, have refused so far to accept federal money through Obamacare to expand their Medicaid programs.

If the state’s leading health care organizations can’t convince the Oklahoma Legislature to compromise with a path forward that preserves provider-payment rates and covers the 130,000-odd people who live daily without health insurance, God help us all.