EDITORIAL: Oklahoma lawmakers look to tackle Medicaid

Aug. 4--Since being named co-chairman of a legislative working group that will study an Oklahoma-specific plan to expand health care coverage, Sen. Greg McCortney says he hasn't slept all that well. He was joking -- or perhaps not.

The challenge ahead is significant, and could wind up being for naught because of a looming state question that seeks to fully expand Medicaid, as many other states have done.

Wednesday was the start of a 90-day window for backers of Medicaid expansion to collect the 178,000 valid signatures needed to put the question before voters in November 2020. The potential state question seeks to amend the state constitution to expand Medicaid to low-income adults ages 18 to 65 whose income doesn't exceed 133 percent of the federal poverty level. If approved, it would expand coverage to at least 100,000 uninsured residents.

Under the Affordable Care Act, states can add able-bodied adults to their Medicaid rolls, with the feds paying 90 percent of the costs and the state paying the rest. The potential cost to Oklahoma has ranged from $150 million per year to $374 million annually.

Proponents say expansion would improve Oklahoma's poor health outcomes and help rural hospitals. Our concern about full-scale expansion has been that the state's costs will only continue to rise, as has happened in other states where the number of enrollees has far exceeded estimates.

Gov. Kevin Stitt opposes the proposed state question, preferring an Oklahoma plan. Crafting one will fall to McCortney, R-Ada, and Rep. Marcus McEntire, R-Duncan, who will lead the working group that includes 18 legislators (nine each from the House and Senate) and two representatives from Stitt's office.

McCortney said the White House under President Trump "has been begging states to create good alternatives" to expansion allowed under Obamacare. "To me, this is our moment," he said.

McCortney would like to provide an incentive to those who will receive the insurance to make decisions that benefit them and the state. "We need to find ways that they have skin in the game ... where the ER is no longer as good an option as going to your regular doctor," he said.

In addition, as with a bill he filed during the 2019 session, McCortney would like to see the private market play a significant role in any state-centric plan, as opposed to government-run health care.

"If you can line those things up, you can be significantly more successful than traditional Medicaid expansion," McCortney said.

This group has much heavy lifting ahead on a complicated subject about which passions run high. Meanwhile, language in the proposed state question is such that if approved by voters, it would supersede whatever the Legislature comes up with.

Thus, we could be left with the Legislature creating and approving a plan that works well for Oklahoma, and then having to hope that voters feel good enough about it that they reject the state question. But without the former, nothing else matters. That is Job One.

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