EDITORIAL: Medicaid cost concerns are valid

Feb. 10--Under the Affordable Care Act, states can add able-bodied adults to Medicaid with the federal government covering 90 percent of the cost. States provide 10 percent. But that 10 percent is not insignificant and, as Stitt noted, there's good reason to think the state's share will only grow with time.

"While Medicaid expansion currently stops at a 90 percent federal match, we cannot assume that it will remain this high forever," Stitt said. "The estimated $150 million price tag today for Oklahoma to expand Medicaid could leave us down the road fronting more than $1 billion when the federal government pulls back on its commitment. They've done it before and they'll likely do it again."

Oklahomans need look no further than this year's budget to see examples. To maintain existing programs to train doctors and provide health care to children, lawmakers must spend $77 million more. That new spending doesn't provide new benefits. It simply fills holes created by federal funding changes.

Changing federal matching rates and broken federal promises are both routine. Former President Barack Obama championed Medicaid expansion, but also proposed Medicaid cuts in his 2011 and 2012 budget proposals. Former U.S. Sen. Tom Coburn, R-Muskogee, often noted the federal government promised to cover 40 percent of the cost of the Individuals with Disabilities Education Act when it passed; actual payments covered around half that.

Even if the state's portion of Medicaid expansion costs doesn't rise, the $150 million price tag is still significant. That $150 million is more than twice the amount required to provide a proposed $1,200 pay raise for every teacher this year. It's more money than what would be saved if roughly 12,400 inmates were released from state prisons, according to one estimate. It's more than four times the amount required to eliminate a backlog of local government reimbursements for emergency responses.

Every dollar spent on Medicaid expansion is a dollar that doesn't go to other needs like schools, roads or public safety. And voter rejection of a 2016 sales tax increase shows limited public appetite for the kind of broad-based tax increases required to avoid such tradeoffs.

The real debate is not simply whether one supports Medicaid expansion, but whether one believes Medicaid expansion should be a higher priority than school funding increases or other causes. And, beyond fiscal considerations, debate should also focus on this question: Does Medicaid expansion improve health outcomes? Much research has found little real improvement.

One doesn't have to agree with Stitt's argument, but any response should involve more than whistling past the graveyard.

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