Not Just Numbers

Punching Down, Oklahoma style

Institutional callousness was averted last month when the State Senate Committee on Health and Human Services voted against HB 2665, an inexplicably heartless piece of legislation that would have eliminated Medicaid benefits for any “non pregnant able-bodied adults under sixty-five years of age.” 

I shudder to think how ‘able-bodied adults’ would have been defined.

But I digress. 

Authored by Rep. Doug Cox, Senator Brian Crain and Representative Jason Murphey (all Republicans), the bill would have removed—count ‘em—111,000 Oklahomans from receiving Medicaid coverage, including 80,000 single mothers making less than $9,000 per year.

This wasn’t just bad math. This was mean.

111,000 people, neighbors.

For the love of God.

So how did we get to a point in Oklahoma where something like this was even considered? HB 2665 was actually a request for a waiver by which Oklahoma could change the rules on who participates in the Medicaid program, so even if it had been passed by the Oklahoma Senate and signed by the governor (the House already approved it), the U.S. Department of Health and Human Services would have had to sign-off on it before the provisions could take effect.

And that was never going to happen.

The Department of Health and Human Services, however, allows waivers for demonstration projects that promote Medicaid’s overall objective — namely, to provide health coverage to vulnerable populations that can’t afford health care. Saving money isn’t a proper purpose for a demonstration project, and eliminating coverage for poor parents doesn’t further the objective of Medicaid.

So why would any state legislator pursue such horrid public policy that had almost no chance of becoming law? Why would any of them waste time on a bill whose optics were so justifiably cruel? Why would any feel the need to tap-dance on the poor and the uncertainty with which they live every day?

Forget it, Jake, it’s Oklahoma.

Cox said that if all went according to plan, HB 2665 would have saved the state $130-million, meaning the present budget deficit, now a bloated $1.3-billon, would have been reduced to a more manageable $1.17-billion.

Yeah, that’s what we were talking about.

And all was never going to go according to plan.

Such a move would save the state an estimated $130 million a year, according to the bill’s fiscal impact statement, but cost $203 million in federal matching funds. 

Read that again. If we went ahead without HHS approval (anyone want to bet there wouldn’t have been someone in the GOP caucus who would have insisted on doing so anyway because who’s the federal government to tell us we couldn’t?) HHS would have almost certainly withdrawn $200-million in federal reimbursements, resulting in not only 111,000 people walking around without healthcare, but $70-million less to insure those who still do. 

Even we weren’t stupid enough to do that, right? … Right? Well, until the senate committee voted it down, that’s exactly what was being planned.

More to the point (and this has always been the point and Cox knows it), Oklahoma could have accepted (and could be accepting) ACA funds, aka free money, which would save a lot more than that, but we won’t because, you know, Obama.

A report by the health consulting group Leavitt Partners commissioned by the state two years ago showed that while the direct cost to the state of Medicaid expansion would be $850 million over the next decade, the infusion of revenue through billions of dollars in federal money and the improved health of its citizens would result in a net gain to the state of nearly $500 million over 10 years. The same report projected that between 187,000 and 275,000 uninsured Oklahomans would receive health coverage under the expansion.

How about that? We’d gain revenue, insure more people, and have healthier residents by expanding Medicaid and what do we do? Waste time on things like HB 2665.

(This was the state, let’s remember, that returned $54-million the federal government gave us just to study setting up healthcare exchanges.)

Cox is not a monster, but he was too easy on himself throughout the process.

“I don’t know how to say this. It’s probably the best of all the bad choices,” Cox said.

Really? Had he called House Minority Leader Scott Inman, he could have gotten some better ones.

“We’ve cut taxes in this state by $1 billion over the last decade. We’ve increased tax credits and exemptions by $2 billion, right? We did those things and we didn’t expand Medicaid because we said it would cost too much. So we passed $1 billion worth of income taxes, we gave $2 billion of tax credits and exemptions and we refused to expand Medicaid under what premise? Under the premise the economy would grow and we’d have so much money coming in that we wouldn’t have to do stuff like this. But it hasn’t happened.”

That HB 2665 was even on the table—that somehow we should cut Medicaid payments to those in need before we rescinded tax breaks and before we canceled tax cuts we can no longer (and never really could) afford—was despicable, not to mention disingenuous.

Cox is a doctor, so he should have known better than most what these health cuts would have meant. Secondly, what was he doing playing to the cheap seats by punching down on a group of Oklahomans that are already on the mat? He’s always been one of the saner members of the GOP asylum, too, so why now join the dark side? 

Here’s what he said in 2013.

First, the Affordable Care Act is now an unavoidable reality; states would be worse off turning down the federal dollars due to the uncontested problem that all states face with access for the working poor. My colleagues and I in the Legislature need to think in terms of how to solve this issue, not how to stop it.

Doug Cox, have you met Doug Cox?

Good news, then, on HB 2665, but this is a victory in the midst of a long statewide health losing streak.

Then there’s this: 

To cope with mid-year budget cuts, the state Department of Health announced that it had eliminated the Uncompensated Care Fund, which covered some of the health care costs for low-income, uninsured Oklahomans at the state’s federally-qualified community health centers.

And this:

As a result of state budget cuts, more than 73,000 low-income Oklahomans with mental illnesses and substance use disorders are expected to lose some access, if not all access, to the state-funded services they depend on.

And this:

The Oklahoma Health Care Authority announced its plan Tuesday to slash by 25 percent the amount it reimburses to hospitals and physicians for treating patients on Medicaid, which is called SoonerCare in Oklahoma. Oklahoma Hospital Association President Craig Jones said the cuts will result in serious operating problems for both smaller rural and larger urban hospitals, many of which already are struggling.

In Oklahoma, the lives of the poor, which are already impossibly difficult, are now unfathomably so. 

HB 2655 was just piling on.

It’s the state we’re in.

For more from Barry, read his article on Tulsa's acquisition of the Bob Dylan archives.