Here are excerpts from recent editorials in Oklahoma newspapers:
The Oklahoman, May 5, 2013
Medicaid proposal by two Oklahoma GOP lawmakers has some appeal, but Obamacare still a bad idea
Inspired by an Arkansas initiative, two Republican lawmakers in Oklahoma want to use federal dollars intended for Medicaid expansion to instead buy private insurance for lower-income residents.
Private insurance is preferable to Medicaid coverage, so the proposal by Rep. Doug Cox and Sen. Brian Crain has some appeal. It could cover up to 150,000 citizens without a welfare program crowding out private insurance. Plus, the proposal calls for work incentives and co-payments, which could deter overutilization and abuse. That's another selling point.
Given that Cox, R-Grove, is an emergency room doctor, there's no doubting his concern for the uninsured or his commitment to addressing Oklahoma's health care problems. In trying to develop a compromise on Medicaid expansion, he and Crain, R-Tulsa, are tackling a major issue that may win them few friends. That's commendable.
But despite their plan's positives, several problems remain. First and foremost, the proposal still requires state dollars that could be used for other things like schools, roads and public safety. Under Obamacare, the federal government is expected to cover 100 percent of the cost of Medicaid expansion (or alternatives) for three years and 90 percent in subsequent years. But that 10 percent can be substantial.
Cox says the state can redirect about $50 million annually in tobacco tax money that is now going to Insure Oklahoma, which is being phased out, to cover the state's share. But the tobacco tax funds may not be enough. It's been estimated Oklahoma's state share could run as high as $1.5 billion over the first seven years under Obamacare. And even without direct expansion, existing Medicaid costs are expected to significantly increase.
From a philosophical standpoint, the plan also requires the Republican-controlled Legislature to tacitly endorse increased federal spending. The 90 percent federal match Oklahoma receives will contribute to federal deficit growth and national debt. Writing in The Wall Street Journal, Goldwater Institute policy analyst Christinia Corieri recently noted that states opting out of Medicaid expansion so far (including Oklahoma) have effectively reduced federal spending by $424 billion over the next eight years. Many Oklahoma lawmakers have railed against federal spending and Obamacare. To embrace both, even indirectly, could be politically devastating.
Then there's the problem of trusting the federal government. The Cox-Crain plan requires a federal waiver. What's to stop the federal government denying a waiver and requiring straight Medicaid expansion in future years?
There's no guarantee the federal government will actually provide the 90 percent match. Corieri points out that the Obama administration has already twice proposed cutting funding to states in its 2011 and 2012 budget proposals. U.S. Sen. Tom Coburn, R-Muskogee, recently noted that when the Individuals with Disabilities Education Act passed, the federal government promised to cover 40 percent of its cost. States never received more than 21 percent.
Furthermore, federal regulations may prevent the use of co-pays or offering low-cost catastrophic insurance policies to recipients instead of high-cost coverage.
Cox argues that Oklahoma can repeal the insurance program if finances become untenable. That's debatable. When other states have tried to roll back previous Medicaid expansions, lawsuits quickly followed. Federal restrictions could also make a rollback challenging.
At the same time, there's reason to wonder if this program will draw many takers. In 2009, then-state Insurance Commissioner Kim Holland said roughly 300,000 uninsured Oklahomans were between ages 19 and 32. Through Insure Oklahoma, many of those individuals could receive guaranteed-issue coverage for less than $40 per month — yet only 6,000 people did so, and most were over age 30. At that time, a healthy 25-year-old male could purchase a comprehensive individual health insurance policy for $1,634 per year. "In Oklahoma, affordability is not the issue for this age cohort," Holland wrote.
That remains the case today. Many people are uninsured because they choose to be uninsured. The young and healthy often prefer to spend money on other things. And they don't cost-shift medical expenses to others because they typically pay those costs out of pocket. Obamacare doesn't change that fact and may actually encourage people to remain uninsured because pre-existing conditions are no longer a barrier to obtaining coverage, and because the personal tax penalty for being uninsured is less than the cost of insurance.
It's possible this proposed Medicaid-expansion alternative could become an unaffordable state burden or an administrative headache with little benefit. Neither option is appealing.
Hospitals are pushing Medicaid expansion (or alternatives like the Cox-Crain plan) because they chose to endorse Obamacare, trading cuts to Medicare and federal "disproportionate share" payments (DSH) for Medicaid expansion. Now that Medicaid expansion is optional, they're scrambling.
But few really expect the Medicare cuts to remain in place, and President Barack Obama's latest budget plan calls for increasing DSH payments by $360 million in 2014, effectively rescinding the proposed cut. In other words, even Obama is backing away from Obamacare's provisions, as are many other congressional Democrats.
Cox and Crain deserve credit for trying to impose market forces on a bad plan, but the fact remains — Obamacare is a bad plan. It's the Ford Pinto of federal laws. Oklahoma lawmakers must decide if they want to ride passenger in a political car that seems destined to explode.
Tahlequah Daily Press, May 6, 2013
Legislative action not encouraging
It's outrageous to advance the argument that it's "fair" for Chesapeake Oil to wind up with a negative tax bill — lower than the average Oklahoman paid last year. Yet that's precisely the message some of that company's protectors in the state Legislature are trying to convey.
This largely irresponsible body also passed a tax cut, set to take effect in 2015. The cut won't help the average middle-class Okie, who will see only a piddling few bucks added to his bottom line. But the damage the cumulative removal of these precious dollars from the state coffers will inflict upon public education and other cherished programs is almost incalculable.
Three legislators who represent segments of the Cherokee County population - Sen. Earl Garrison, D-Muskogee; Rep. Mike Brown, D-Tahlequah; and Rep. Will Fourkiller, D-Stilwell - were on hand at Friday's Legislative Focus to deliver the troubling news about the behavior of their compatriots at the statehouse. As usual, the area's other two elected officials - Sen. Wayne Shaw, R-Grove, and Rep. Kim David, R-Wagoner - didn't bother to show up. A few local Republicans made note of that, and expressed their frustration.
We continue to marvel at the stalwart nature of Brown, Garrison and Fourkiller, who for all intents and purposes are tilting at windmills in Oklahoma City. They know what's happening is wrong, but they're outnumbered by lawmakers who only serve the interests of a tiny snippet of the population. And folks, we're not in that club.
Brown said while he has nothing against tax cuts, no one knows how the state plans to pay for them. Whoever's in office in 2016 will inherit the dilemma, much like Barack Obama inherited a couple of wars from George Bush. And just like Obama hasn't done a spectacular job extricating the U.S. from those quagmires, Oklahoma's next leaders may not have much luck funding the tax cuts without severely damaging programs the state's residents depend on.
Both Brown and Garrison found fault with a hair-brained scheme to combine all public service pension plans into one pool, with a single person overseeing the $20 billion in funds - a person appointed by the governor. Anyone who has been keeping up with financial news over the past two decades, and who has seen how placing all your eggs into one basket can lead to fiscal disaster, should be sounding alarm bells. Though it got a pass for this legislative session, the plan will be back in the loop next year - and given its particulars, one must be forgiven for suspecting a handful of powerful people have set up a system to enrich themselves on the backs of hard-working Oklahomans.
Another problem generated by this Legislature is the so-called workers' compensation reform, which according to Garrison includes at least 30 portions that are likely unconstitutional. But practices that strain the bounds of legality scarcely raise an eyebrow among the current capitol crop, who are all too willing to pass state laws that countermand federal ones - something any schoolchild in a civics class knows to be untenable.
And finally, once again, legislators demonstrated their contempt for public education. Though they allocated $75 million in new funding, a bill passed last fall will cost the schools $66 million. As Garrison put it, "We're slipping backward each year."
Brown and Fourkiller offered similar pithy, if disturbing, comments. The tax cut, Brown said, was merely "kicking the can down the road," and added, "It's totally responsible." But most telling may have Fourkiller's observation, in reporting that the session may end two weeks early: "That's two weeks less damage we can do."
Voters need to remember that statement, as well as the explanations our delegation has given us about what's transpiring in our name, and with our tax dollars. Cherokee County, for years, has done a good job of choosing our legislators, until recent gerrymandering took away part of the privilege. But if the rest of the state doesn't improve its track record at the polls, we're in for a long and difficult ride.
Tulsa World, May 7, 2013
Health-insurance measure a decent compromise
Right on cue, Obamacare opponents have pounced on a proposed compromise to the Medicaid expansion controversy, claiming it will drive up the federal deficit, increase state costs and probably bring about the end of life as we know it.
Rep. Doug Cox, R-Grove, who is an emergency room physician, and Sen. Brian Crain, R-Tulsa, recently drafted Senate Bill 640, which would modify the Insure Oklahoma program to cover more Oklahomans.
Gov. Mary Fallin so far has rejected the Medicaid expansion, citing possible cost increases, and no doubt also because of Obamacare's unpopularity in the state.
But does that mean we sit back and do nothing about the 600,000-plus uninsured in the state? So far, nobody's offered any comprehensive alternative - until Cox and Crain came up with SB 640.
The measure would use federal matching funds resulting from cuts to Medicare providers and hospitals, along with state tobacco tax funds, to expand Insure Oklahoma to cover many thousands of low-income residents. SB 640 calls for the funding to be used to acquire private insurance, and eligible applicants would have to be employed, looking for work, or meet certain other criteria.
The bill does not mandate participation or impose any penalties. It also includes a copay element.
The authors estimate the measure could result in a net savings to the state of more than $500 million through 2020, because of savings realized through competitive bidding, generic drug use, chronic disease management and decreased costs for some state agencies.
The state's share would be covered by placing the tobacco tax in an interest-bearing fund. And the federal matching share, as mentioned, would come from cuts in Medicare and hospital payments.
As it stands now, there's a good chance the feds will grant a waiver to create the system described above.
But it's easier, and more popular politically, to just take potshots at any and every idea that comes along.