EDITORIAL: Medicaid expansion debate continues in Oklahma

May 01-- May 1--The issue of Medicaid expansion in Oklahoma is bubbling to the fore, with a group laying the groundwork to take the issue directly to voters in 2020 and Gov. Kevin Stitt reiterating his opposition to the idea. This will be a tug-of-war to watch.

The Affordable Care Act allows states to add able-bodied adults to their Medicaid rolls, with the federal government covering 90 percent of the cost and states picking up the remaining 10 percent. One total cited as Oklahoma's share is $150 million per year, although others have pegged the cost at $374 million.

Proponents contend that expansion would help to improve many of Oklahoma's poor health outcomes and give an assist to rural hospitals that are struggling to stay afloat. If the question goes to voters, you can expect to be bombarded with poignant ads looking to bolster those arguments and others.

We're among those who have cautioned against expansion over concerns the price tag will only continue to grow. This has happened in other states where the number of people who enrolled far outstripped estimates -- in some cases, more than double the number of people expected to sign up actually did.

Researchers with the Oklahoma Council of Public Affairs, a conservative think tank, noted in The Oklahoman last year that the projected cost per enrollee was well off the mark. "Each new enrollee cost 76 percent more than expected from 2014 to 2016," they said. "These compounding costs take a toll on state budgets, diverting resources away from core services."

Several states have turned to tax increases to help pay for Medicaid expansion. Such increases are an easier sell elsewhere than they are in Oklahoma, whether at the Legislature or among the public.

We also worry about the federal government eventually changing the amount of its pay-in, something supporters of expansion say hasn't happened and won't. But there is no guarantee of that. It wouldn't be the first time the government has changed a federal matching rate.

And it's hardly a slam dunk that expansion of Medicaid will improve health outcomes. Indeed, considerable research has found little real improvement. Researchers looking at expansion in California said in a report last year that they didn't find "significant improvements in patient health, although the expansion led to substantially greater hospital and emergency room use, and a reallocation of care from public to private and better-quality hospitals." That's hardly a ringing endorsement.

Stitt says that if the planned initiative petition seeks to expand Medicaid without including work or training requirements for recipients, he will "absolutely" encourage voters to reject it. Meantime, he says he understands the need to come up with an alternative proposal.

"We have to say, 'Here's a better way to do this,'" he told The Oklahoman last week. It'll be interesting to see what that might be, and whether it's enough to satisfy those who insist straight expansion is the only choice.

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