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Free Market Friday: Say no to the OHCA

Jonathan Small

Jonathan Small

Recently, the Oklahoma Health Care Authority announced another scheme to entangle Oklahoma with the Medicaid expansion proposed in the federal Affordable Care Act.

The OHCA has attempted this a few times, and policymakers have wisely rejected the various proposals, refusing to repeat the mistakes of history.

With this attempt, OHCA bureaucrats have tried to box policymakers in by using a set of public relations tactics. First, the OHCA warned the Medicaid program may end. Then, the OHCA declared Medicaid (a taxpayer-funded entitlement program) the largest health insurer in the state. Then, the OHCA warned of cuts to the program, by way of provider cuts of 25 percent. Of course, the media ran with that story, stoking frenzy.

Policymakers have stated that under no scenario, even with the significant revenue declines, will it be necessary to cut provider rates by such a significant number. You won’t see the media rushing to now clarify the panic they helped create.

Nearly 27 percent of Oklahomans were enrolled in the Medicaid program during the most recent fiscal year according to the OHCA. If they get their way with their plan, then nearly 33 percent of Oklahomans will have their health care paid for nearly in full by government. This wouldn’t even take into account Medicare.

Without the ACA Medicaid expansion, Oklahoma’s spending on Medicaid has grown largely because of the number of people on the program and previous expansions proffered by OHCA.

Now, to swindle policymakers into a proposal that will incentivize people to decrease work and drop private health care coverage to gain subsidies, OHCA bureaucrats say their plan should be tried because they will release some currently on the Medicaid program to the treacherous, federally funded Obamacare exchange.

The OHCA rebalance plan will increase dependence on the state and federal government. This plan will grow state and federal taxpayer spending.

The plan is, plain and simple, a wolf in sheep’s clothing. Expanding government health care or welfare programs is bad policy and short-sighted whether oil is $100 a barrel or $30 a barrel. This is just a planted and dangerous distraction from lawmakers prioritizing spending in a tough budget year and providing the pay raise for teachers that they should by the end of this legislative session.

Policymakers should quickly say no to the OHCA’s re-balance scheme.




  1. This article is just throwing stuff at the wall and seeing what sticks! Bottom line: While this plan is better than doing what Johnathan Small suggests which is a 25% provider cut, which would end up closing 90% of our nursing homes. Medicaid re-balancing is making this whole problem more complicated and expensive than it needs to be. A straight up Ohio-style medicaid expansion would insure more people, and it would be cheaper to the state. Mary Fallin said that by rejecting the medicaid expansion Oklahoma had chosen a more sustainable future. Turns out because we didn’t accept the medicaid expansion it’s blown a huge hole in our state’s budget and our medicaid system has collapsed. Why didn’t the new Governor of Kentucky dismantle their medicaid expansion? Because it would’ve been unaffordable. This next election is going to be a referendum on OCPA/Koch brothers radical policies that attempt to ignore realities.

  2. Director Gomez clearly stated more than once during his presentation: if you have a better idea, let’s hear it. No one has any suggestions other than cutting the provider rates! This is not a viable solution. Don’t just criticize, be part of the solution!

  3. Jonathan, I would be interested to know what policymakers have stated that the cuts would not be nearly as severe as 25%. Also, I would love to know your opinion on what % cut is acceptable? Have you talked with anyone about how even a 10% cut would shut Oklahoma owned businesses and deny care to thousands of our state’s most medically fragile citizens?
    Our state’s financial house is on fire. A fire truck has just pulled up and the firemen are preparing to put out the fire and save the house. Your opinion seems to be that we should stop the firemen from putting out the fire because you think it is some kind of trick by the firemen takeover our house. You offer no other solution to the fire. You watch as our house burns to the ground and are happy to have stopped the firemen from making the situation worse. In fact your recommendation is to fan the flames by advocating increases in spending in other areas.

    It is very easy to criticize the ONLY current plan for saving our state’s healthcare system. It is much more difficult to actually provide a solution. Please don’t take the easy path of criticism. Be a part of the solution.

  4. I am against the expansion of Medicaid for many reasons.

    I am a nurse by background but have been an executive in post healthcare since 2007. I have a mother who is a Medicaid beneficiary and I am on the board of a non-profit for individuals with disabilities. I have a national perspective of how Medicaid expansion has impacted different states from my work experience for a national provider. I have a personal experience of how the Medicaid expansion would take away my mothers right to manage her own Medicaid benefits. I have a broad perspective how how the Medicaid expansion would negatively affect the individuals of our state. The Medicaid Waiver 1115a would be most costly to the state of Oklahoma and its citizens.

    I was able to be in attendance of the OHCA meeting on April 17th. To me as a taxpayer it is irresponsible to expand Medicaid services at a time when our state is in great need. The federal funding is only guaranteed through 2022. What happens in six years if the federal funding ceases. Does the state absorb the $951.6M dollars that OHCA has forecasted or do we simply face turning people away from services like we are today? Why are we spending over $1B if the OHCA only need $254M to get back on track per Mr. Gomez’s statement yesterday. Mr. Gomez projects $182M from the proposed tobacco tax which OHCA would get a portion. Why can we not make up the difference with another tax?

    Another reason we do not want this waiver is because it has hidden costs to small providers. Providers will go from dealing with one entity and reimbursement process to multiple. In speaking to other providers in surrounding states, the increase in learning and managing the paperwork of multiple managed care providers has caused an increase in overhead costs. This also puts providers at a higher risk for increased reimbursement audits and denials due to the mandate that dual eligible beneficiaries be enrolled in a managed care policy.

    Further, as a daughter and working in the industry I asked Mr. Gomez specifically about dual eligible beneficiaries like my mom being able to keep their right to manage their own Medicare benefits. Without hesitation his answer was no. This is unacceptable. Medicaid beneficiaries should have the right like other citizens the choice to manage their Medicare benefits separate from their Medicaid benefits. Under the waiver this is not possible and many of dual eligible beneficiaries will lose this right.

    If you look at the results of Indiana you will see how the implementation of the Medicaid 1115 waiver cost the state more money. Mr. Gomez stated yesterday that he “anticipated” that the premiums would stabilize but I know this has not been the case in states that have implemented Obamacare. United Health has threatened to pull out of the ACA due to over $1B loss last year. Why? Because the system is flooded with Medicaid beneficiaries and not enough private pay. The insurance companies cannot make money through ACA so this is why the premiums have actually gone up and been well above the projected rates. So the sliding scale that Mr. Gomez spoke of would either cost the state more or the SoonerCare beneficiaries more. You also have to consider what the deductibles will be as well as co-pays. I find it hard to believe that these will be affordable with the history of the states preceding Medicaid expansion and ask you to consider this.

    Our state needs to take care of our people but this Medicaid expansion waiver is not the answer. It will cost the state more money, it will take away the rights of dual eligible beneficiaries and it will cost the citizens the most. I urge you to read the study of the Indiana Medicaid expansion waiver implementation after one year. I am all for solutions but the Medicaid waiver is taking advantage of our dire situation when we are most vulnerable.

  5. Thank you James Walton. I only wish more Oklahomans could see reality instead of the load of bunk fed by the state in the interests of themselves and certain special interests. Bottom line, hoodwinked. At the expense of the health of the most vulnerable Oklahomans. Insult to injury. What happened to our souls that we do not See the effects these state decision makers are having on our “least of these?” Disasterous.

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