Concerns about expanding Medicaid

Regarding “Will state expand Medicaid?” (News, Oct. 20): One of the most telling things about the debate over Medicaid expansion is how hard expansion proponents try to downplay the associated cost. As we at the Oklahoma Council of Public Affairs have long noted, expansion could add up to 628,000 able-bodied adults to the system and cost state taxpayers $374 million annually. Where do we get those figures? From a report conducted on behalf of the state's Medicaid agency, a report expansion supporters otherwise cite as authoritative.

Yet proponents continue to predict only 200,000 will be added to the program. This means proponents who say Medicaid expansion is a matter of life and death simultaneously claim nearly 70 percent of those eligible will say, “No thanks.”

There's good reason to be skeptical of such lowball estimates. The first 24 states that expanded Medicaid expected to enroll 5.45 million total. Instead, nearly 11.5 million signed up. The Washington Post reports 13 states have raised taxes or increased fees to cover the extra costs.

Clay Farris of the Mostly Medicaid consulting firm recently warned Oklahoma lawmakers, “Whatever you are being told you will spend on expansion, multiply it by two, three, four, whether that's the per-member level or how many will enroll.”

Perhaps those high costs would be acceptable if Medicaid expansion improved health outcomes. But it doesn't, as admitted by several officials quoted by The Oklahoman.

Why do health outcomes not improve with Medicaid coverage? Because 40 percent of the determinants of health are attributed to personal behaviors and another 30 percent is tied to genetics. Put simply, Medicaid coverage doesn't improve your health if you still use tobacco, have poor diet and don't exercise.

Louisiana expanded its Medicaid program. Oklahoma has not. Yet Louisiana still ranks dead last, several spots behind Oklahoma, on national rankings of health outcomes. If Medicaid expansion was a game changer, Louisiana would have leapfrogged Oklahoma by now.

The disconnect between government spending on welfare health programs and outcomes is already evident in Oklahoma. The America's Health Ranking report shows Oklahoma ranks 26th in public health funding, yet ranks 47th in outcomes.

Too often, those on the left ignore such real-world results and fiscal reality. When massive government spending fails to improve health outcomes, their answer is always, “Then let's spend even more!” But following that advice will only force Oklahomans to pay more taxes and divert funding from needs like schools and roads while achieving no meaningful improvement in citizen health.

Medicaid expansion is a prescription for just one thing: bigger government at higher costs that generates the same old results. As Oklahomans increasingly learn these facts, I expect the majority will reject that plan.