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Lawmakers wrestle with expanded health coverage plan

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Photo by Marcelo Leal on Unsplash
Photo by Marcelo Leal on Unsplash

State leaders are meeting daily on a plan to expand health coverage to 100,000 uninsured low-income Oklahomans.

"We know how to pay for it with existing funds," said Sen. Greg McCortney, the author of Senate Bill 605. "The big question now is can it be ready for this session or will we have to wait until next year?"

McCortney, R-Ada, said members of the House, Senate and governor's staff don't want to bring the bill to a vote until the how-to details are firm.

The Affordable Care Act gives states the option to expand their Medicaid eligibility to include people who fall below 138 percent of the federal poverty level. Oklahoma is one of 14 states that has not adopted the expansion.

SB 605 would use those federal dollars instead to expand the Insure Oklahoma program — a private-insurance subsidy program administered by the state — to cover the population Medicaid expansion would have covered. The final plan likely will require participants to pay a small percentage of their premium, unlike Medicaid, McCortney said.

The proposal has support from insurance companies, hospitals, doctors and thousands of individuals who would benefit, he said.

The Coalition to Expand Coverage has scheduled a rally for 10 a.m. Wednesday at the state Capitol to urge lawmakers to vote yes on the plan.

Other supporters of Medicaid expansion filed an initiative petition with the state earlier this week to bring the issue to a statewide vote.

The proposed question would amend Oklahoma’s constitution to expand Medicaid “to certain low-income adults between the ages of 18 and 65 whose income does not exceed 133 percent of the federal poverty level.”

The petition seeks to put the question before Oklahoma voters in the next general election, which would be November 2020.

Under state law, initiative petitions require the signatures of eligible voters equal to 15 percent of the votes cast in the last election for governor.

Some believe the effort to let Oklahomans vote on the issue motivated some lawmakers to develop their own plan.

“Expanding care will help ensure that over 100,000 Oklahomans have access to the care they need, while boosting hospitals and other health care providers in our communities across the state,” said Carly Putnam, with the Oklahoma Policy Institute, the organization coordinating Wednesday’s rally. “It’s time we brought Oklahomans’ tax dollars back home to take care of Oklahomans.”

The Senate plan would access $1.2 billion from the federal government, with Oklahoma paying about $140 million when it is fully implemented in three to five years, McCortney said.

Oklahoma's share can be met through cost savings, he said. For example, the state currently pays 100 percent of mental health services, but would pay only 10 percent under the expansion.

SB 605 would require a waiver from the federal government, which McCortney is confident would be granted.

Sen. Julie Daniels, R-Bartlesville, said she fears the plan could lead to higher taxes and poor outcomes.

"I absolutely recognize we have difficult issues in healthcare, but I'm reluctant to put trust in the federal government to fix them," she said.

Expanding coverage to able-bodied people could be damaging to "the most vulnerable populations" Medicaid was designed to help, she said.

"A waiver can be withdrawn, but once you introduce a program like this there's no going back," Daniels said. Oklahoma would be left to cover the costs, which would mean "a hit to other core services."

"Health care costs are inflated by government's control of the industry," she said. "Government caused this problem and now we want to solve it by getting government more involved."

She supports other measures like asking voters to redirect Tobacco Settlement Endowment Trust (TSET) funds to patients and hospitals in rural areas.

Jeff Hughes, executive director of the nonprofit Progressive Independence, said expanded coverage is critical for Oklahomans living with disabilities, but so is better oversight of the Oklahoma Health Care Authority and state Department of Human Services, which administer the federal funds.

People resort to GoFundMe to get basic necessities like prosthetic devices and communication equipment because they "can't get it through our health care system," Hughes said. "I'm pushing them to be doing a lot more than they do."

He said an advisory board that reports to the governor or the Legislature — made up mostly of people with disabilities — could provide that oversight.

Sen. George Young, D-Oklahoma City, said he supports expanded coverage but doesn't expect the Legislature to approve it.

"My hope is that in 2020 we're going to have a state question on the ballot," Young said. "It would pass."

K.S. McNutt

Kathryn McNutt covers higher education for The Oklahoman and NewsOK. Since joining the staff in August 2000, she also has worked as the Breaking News editor, Metro editor and assistant Local editor. A native of Oklahoma City, she graduated from... Read more ›

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