NORMAN, Okla. — A discussion about a proposed expansion to Oklahoma’s Medicaid program was the subject of a public forum Sunday at the Norman Public Library Central.
Speaking to a crowd of approximately 50, the forum panel included Sen. Mary Boren (D-Norman), Democratic Minority Leader Emily Virgin (D-Norman) and former State Rep. A.J. Griffin, who chaired the Oklahoma Legislature’s Subcommittee on Human Services. Additional speakers included April Heiple, executive director of Food and Shelter Inc.; Jeff Hughes, executive director of Progressive Independence Center for Independent Living; and Dan Sorrells, president of Molina HealthCare.
Panel members all spoke in favor of expanding Medicaid through the acceptance of federal funds matched by state funding, while emphasizing the complexity of providing health care to low-income Oklahomans. They said the health care system for low-income and Medicaid patients contains “tremendous gaps” in coverage, and needs to be overhauled.
Health care facilities and providers that serve low-income populations are overburdened and under financed. For some patients, simple things, such as transportation to and from appointments or a $20 co-pay, make receiving care impossible. Many patients cannot afford medication needed for recovery or ongoing treatment.
“What we find often in these situations is that people wait until their condition is severe, and then they can’t get into a (low-income) clinic, so basically the emergency room doctor becomes their primary care doctor,” Heiple said. “And when we talk about access to prescription drugs or specialized care, such as dental and cardiovascular, there is virtually none.”
Griffin compared Oklahoma’s health care system to a game of Jenga, with many “puzzle pieces” that must be taken into account. She also stressed that having insurance isn’t the same as having health care.
“Medicaid expansion is one piece of a large and complicated issue, which needs to be addressed at the state Capitol and the U.S. Capitol,” she said.
“What gets lost in the politics is that we’re going to pay for these services anyway,” Sorrells said. “Whether that comes in the form of Medicaid expansion up front or emergency rooms that have to care for people, bear these costs, and then end up closing, like the Pauls Valley hospital did in 2018.”
Boren added that there is tremendous burnout among doctors and other healthcare providers who are overloaded by the volume of uninsured patients seeking care. That makes them reluctant to practice in rural areas where they would be one of a handful of providers. Medicaid expansion could help alleviate this crisis, she said, since it would guarantee a higher rate of reimbursement for all Oklahoma hospitals and reduce closure rate. (A 2016 Oklahoma Healthcare Authority study found that 42 rural hospitals in Oklahoma were at risk of closing.)
Hughes said an expansion of the state’s Medicaid program also would re-establish services for two groups which are most disadvantaged – those with disabilities and those with mental health disorders. The audience also heard moving stories from several individuals struggling with these issues whose lives have been directly affected after being cut off from Medicaid services.
One of those, 65-year-old Jude Dean, said he became ineligible for the Medicaid Advantage program five years ago, despite no change in his income or health status. Since that time, he said he has been forced to apply and reapply for much needed services from multiple agencies, while being denied the hearings to which he is legally entitled. Caseworkers also change every six months or so, he said, adding to the difficulty.
“I come out of one rabbit hole and find myself back down in another,” he said. “I think that Medicaid expansion will help some of this. We need to quit politicizing this issue.”
Virgin said that 37 states to date have accepted federal matching dollars for their Medicaid program expansion. Oklahoma could be eligible for as much as $1.3 to $1.4 billion, which the state would match with approximately $140 million, she said.
Griffin, however, noted that there is no “direct link” yet in place guaranteeing that federal dollars would translate to tangible on-the-ground care.
When asked if Oklahoma residents could be guaranteed access to primary care doctors with no increase in their taxes should the expansion be passed, there were no hard answers. Sorrells said the federal Centers for Medicare and Medicaid have stringent service provider requirements that must be met to receive funding. Others noted that many states have gone to a managed care system that includes waivers for specific groups.
Another question asked about other states who’ve adopted the expansion and been forced to raise taxes to cover a massive influx of new patients totaling well above what was anticipated.
“Frankly, in my opinion, other states with problems did a poor job of estimating how many people who would sign up and need these services,” Virgin said. “I have every confidence we would be able to get that right for the long term.”
While ideally the issue will be resolved through legislative action, panel members said they believe the Medicaid expansion approval could well take grassroots organization, of the kind seen in recent years that led to legalization of medical marijuana and prison reform.