EDITORIAL: Declining Medicaid expansion in Oklahoma proving to be a wise decision

Dec. 05--DURING the 2016 legislative session, there was a strong push to expand Oklahoma's Medicaid program to obtain funding from the Affordable Care Act. Ultimately, lawmakers declined to take that step. It's proving to be a wise decision.

Supporters of Medicaid expansion argued the costs would be mostly borne by the federal government because Obamacare covered 100 percent of expenses initially, and then at least 90 percent of expansion costs thereafter. But as has often been noted, that law could easily be changed and states could have a greater share of cost burden shifted back to them in the future.

Last week provided a reminder of that fact when President-elect Donald Trump announced that U.S. Rep. Tom Price, a physician and Georgia Republican, would be nominated as Health and Human Services Secretary. Price has called for repealing Obamacare and eliminating the Medicaid expansion, preferring to instead provide tax credits to help low-income individuals buy insurance. For Oklahoma to have embraced Medicaid expansion just as the whole system is being overhauled would have been a logistical nightmare, if not worse.

But even if that were not the case, other states that did expand Medicaid are facing far higher costs than initially estimated. A recent report by the Foundation for Government Accountability notes that expansion enrollment exceeded projections by 322 percent in California, 276 percent in New York, 134 percent in Kentucky, 90 percent in Illinois, 60 percent in Ohio and 51 percent in Arkansas.

That means the cost of the 10 percent state share for Medicaid expansion will be commensurately higher as well. And federal data shows that Medicaid expansion spending was 49 percent higher per enrollee in 2015 than what was predicted when the law passed in 2010.

At the same time, Medicaid expansion isn't generating the savings supporters promised, such as lowering the use of emergency rooms for routine care.

A study in the New England Journal of Medicine found that Medicaid expansion in Oregon increased ER visits by 40 percent in the first 15 months. Researchers found no evidence that Medicaid coverage led people to make doctor's appointments instead of using the ER for non-emergency care. That study also found "that Medicaid's value to recipients is lower than the government's costs of the program, and usually substantially below."

A side effect of overcrowding in the emergency room is that those with serious medical emergencies wait longer before receiving needed care.

Moreover, Oklahoma already struggles to cover the cost of the existing Medicaid program even without expanding it. According to the Oklahoma Health Care Authority's most recent annual report, average monthly enrollment in the state's Medicaid program surged from 620,266 in 2009 to 819,193 in 2015. At the same time, the federal match for Medicaid declined, meaning Oklahoma taxpayers were not only paying to cover more people, but also paying more per person.

Should congressional Republicans repeal Obamacare as promised in the coming year, it has been suggested any replacement may include giving states more flexibility to manage Medicaid programs to control costs.

Oklahoma lawmakers would do well to begin devising plans for that possibility and otherwise be relieved they didn't take the bait on Medicaid expansion.

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