The Oklahoma Council of Public Affairs is the state’s largest and most powerful conservative think tank. While its policy positions are often more nuanced and less evil than many critics want to admit, OCPA’s anti-Medicaid-expansion advocacy has consistently ignored unfortunate health care realities while railing against government insurance and stumping for a free-market insurance system that has failed a great deal of Americans for decades.
This OCPA Medicaid message reared its pernicious head July 17 when think-tank board members former Gov. Frank Keating and Dr. Doug Beall authored an op-ed in the Wall Street Journal asking Congress to “return Medicaid to its rightful role.” While the now-paywalled piece says Medicaid — expanded or not — is wrecking state budgets, it virtually ignores the basic reason Medicaid (particularly expanded) is important for the U.S. health system: Ensuring primary care access for lower-income children and adults is the only way to reduce immediate system costs, improve the population’s health outcomes and lower future Medicare costs.
Limiting Medicare costs is something the equally conservative Heritage Foundation has called for repeatedly over the past decade, but the dichotomy of limiting Medicaid coverage yet somehow shrinking Medicare costs is simply incongruent.
Owing to GOP leadership’s decision not to expand Medicaid in Oklahoma, the social safety net program covers disabled individuals, lower-income children and parents with income under 37 percent of the federal poverty level (FPL). Other lower-income adults — either without children or who earn more than 37 percent FPL — do not qualify for coverage, except through a relatively tiny Insure Oklahoma program that could have grown by accepting federal dollars for a hybrid Medicaid expansion.
Estimates indicate that more than 100,000 Oklahoma adults would gain health insurance under Medicaid expansion, but in its “rightful role,” the program offers them no health benefits. That means many of those Okies lose their Medicaid at age 19 and risk remaining uninsured until they turn 65, thus gaining eligibility for Medicare.
Once on Medicare, they are almost inherently more sick than they would have been had their basic health care needs been covered for the past four decades. In addition to making those patients more costly for Medicare, that situation also means hospitals will have eaten enormous costs in treating those uninsured patients for emergent care along the way.
In short, such a system is good for no one, except those who are comfortable saving a quarter in taxes to ignore a dollar’s worth of social ills. As such, Keating and Beall’s mock editorial outrage over Medicaid’s “dramatic cost” to Oklahoma’s education budget is laughable, considering OCPA’s education rhetoric.
Private insurance’s shrinking coverage
But Medicaid as an investment in public health is not how Keating, Beall and OCPA view things. They ignore the concept of long-term system savings — and the value of improving the lives of the working poor — in deference to an implied false assumption: that smaller Medicaid rolls, cash-only clinics and a deregulated private health insurance market would provide a panacea for poor patients.
Unfortunately, Oklahomans have ample evidence to the contrary. Not only did private health insurers spend much of the past decade fighting to avoid covering autism treatments, Blue Cross Blue Shield of Oklahoma has begun taking hardline positions in its negotiations with hospitals, which bear great blame in their own right for troubling health system costs.
BCBS of Oklahoma has now allowed its contracts with at least four state hospitals to expire this summer, meaning people in and around Muskogee, Prague, Fairfax and Stroud who are fortunate enough to have private insurance have been confronted with higher out-of-pocket costs at their local hospitals.
That saga stands as simply another example of how private health insurance models produce results that often fail to support their patients’ best interests.
If OCPA board members would like to author columns discussing that problematic element of American health care as well, we would encourage them to do so.
Otherwise, arguing for the removal of health coverage for the least among us by discussing the “rightful role” of Medicaid seems particularly harsh and one-sided.
Yes, prudent Medicaid reform options exist — tiny co-payments by certain recipients, for example — but the goal of any reform should be to maximize health outcomes, increase system efficiencies and create long-term cost savings while ensuring all Americans have basic access to care.
Saying that Medicaid’s main problem is providing the public with too much health care simply doesn’t make sense, especially considering the high deductibles and evaporating networks offered by the private-sector alternative.