Oklahoma Critics of Obamacare Skeptical of Medicaid Recommendations

Published August 1, 2013

An evaluation of Oklahoma’s health-care provisions for the poor conducted by a prominent health care consultancy found much to applaud, particularly in the insurance premium-assistance program the state pioneered in 2004. But after spending $248,000—half from state government coffers, the other half from federal matching funds—the Leavitt Partners’ bottom line recommendation was to find a way to expand Medicaid coverage without fully buying into the Affordable Care Act’s strictures.

Leavitt Partners is a Utah-based consultancy headed by former Health and Human Services Secretary Mike Leavitt, who is also a former governor of Utah and was the head of former Gov. Mitt Romney’s 2012 transition team.

The Leavitt report said Oklahoma could expand health coverage to about 200,000 low-income residents and “save” $400 million over a decade, but that assertion was based on the assumption of an additional $10.5 billion to $13.3 billion in federal debt.

The Leavitt report is not a direct copy of provisions in the ACA, widely known as “Obamacare,” and would rely on a mix of private insurers and federal subsidies.

In a key proviso, the Leavitt report envisions a demonstration project, which would require Obama administration approval, to expand coverage to Oklahomans not currently covered by SoonerCare—the existing Medicaid program administered by the Oklahoma Health Care Authority (HCA)—or Insure Oklahoma, the premium-support program for the working poor.

The Obama administration previously rebuffed Oklahoma’s proposal to retain and enhance Insure Oklahoma.

Endorses Medicaid Expansion

After Leavitt Partners briefed HCA officials last week, Gov. Mary Fallin’s spokesman, Alex Weintz, said the governor would study the Leavitt document and meet with legislative leaders. Weintz said officials would “explore where consensus can be found and how the state can best move forward.”

The authority’s CEO, Nico Gomez, thanked Leavitt Partners, saying, “Their ability to turn around such an enormous undertaking in a short timeframe is a testament to their expertise.”

“Where do we go from here? Well, the Oklahoma Health Care Authority will be reviewing the SoonerCare evaluation piece to look for ways to improve our program. We will also be taking the full report to state leadership,” said Gomez.

“I believe it is important that we allow our state’s leaders time to process all the information, analysis, and recommendations that have been offered. SoonerCare and Insure Oklahoma are critically important to the health and economy of the state, and the significance of the decisions that will be made should be given their due diligence. I, as well as the staff of the Oklahoma Health Care Authority, look forward to working with state leadership in our effort to provide the citizens of Oklahoma access to quality, affordable health coverage.”

Report Frustrates Obamacare Opponents

Advocates of “Obamacare,” including the Oklahoma Hospital Association, applauded the Leavitt report, even while making it clear they preferred the full-bore Medicaid expansion envisioned in the Affordable Care Act.

Critics of Obama’s law remain dubious. Matt Ball, state director of Americans for Prosperity-Oklahoma, expressed frustration with the Leavitt Report’s thrust.

“While the recent report from the Leavitt Partners is perhaps well-intended, it nonetheless recommends the state of Oklahoma accept federal Medicaid expansion dollars under the provisions of Obamacare—period. Americans for Prosperity and our more than 25,000 citizen activists across the state are opposed to Medicaid expansion in all its forms,” Ball said.

“While proponents of this report will undoubtedly tout these findings as a ‘private option’ or an ‘Oklahoma plan,’ it is important for Oklahomans to know that this proposal does nothing to change that we are expanding a broken health-care program and placing state taxpayers at risk by taking the federal government’s word that it will cover the program cost over time,” said Ball. “Oklahomans know better than to believe the same federal government which now projects Obamacare to cost twice as much as initially projected and continues to deficit-spend at record levels.”

Costs, Transparency Remain Problems

Jonathan Small of the Oklahoma Council for Public Affairs (OCPA), a free market think tank, critiqued the analysis soon after its release.

“The goals of the Leavitt Partners report effort are noble. But, unfortunately, taxpayers were forced to pay for a report that recommends Obamacare’s costly Medicaid expansion, and the report ignores the chief problem in health care, which is costs and lack of transparency for consumers,” Small said.

Regardless of the Leavitt report, Oklahoma Republican Sen. Tom Coburn, a physician, still opposes the expansion. He joined recently with Louisiana Gov. Bobby Jindal, a former Assistant Secretary at HHS, for a joint op-ed pleading with policymakers to fix Medicaid rather than expand it.

The two Republicans, prominent in the health policy field, pointed to a Harvard/Boston University study that concluded, “The Medicaid expansion provisions of [Obamacare] will shift workers and their families from private to public insurance without reducing the number of uninsured very much.”

A recent survey from the Liberty Foundation of America found a majority of likely voters in Oklahoma agreed with them, opposing the Medicaid expansion until existing waste, fraud, and abuse is corrected.

Patrick B. McGuigan ([email protected]) is bureau chief at the Oklahoma City bureau of Watchdog.org, where a version of this article originally appeared.