Health Care

Statement from Jonathan Small on Cigarette Tax and Medicaid Expansion

May 18, 2016

Statement from Jonathan Small on Cigarette Tax and Medicaid Expansion

Yesterday, House Democrat leader Scott Inman stated clearly and plainly that his caucus would be willing to vote for a 145% tax increase on thousands of Oklahomans, as long as Republicans would agree to pass Obamacare's Medicaid expansion. Thankfully, many Republican legislators have stated they will not accept that offer because they know the Obamacare expansion will burden Oklahoma taxpayers excessively, as it has in other states where it's been tried.

There are clearly better options available for stabilizing Medicaid provider rates, as well as providing a $5,000 across-the-board salary increase for Oklahoma classroom teachers, without raising taxes on Oklahoma families. At a time when more than 20,000 Oklahomans have lost their jobs because of falling oil prices, raising taxes is not the answer. There's a better path for state lawmakers and for our state as a whole.

For example, it's unconscionable that Oklahoma taxpayers are being asked to pay more in taxes while the state of Oklahoma continues to be on the hook for hundreds of millions of dollars to out-of-state and foreign wind companies that are getting billions from the feds already.

Lawmakers should consider, in a time when many Oklahoma families are being forced to tighten their belts, whether it's of higher priority to continue subsidies for wind energy generation, or to give teachers a pay raise and stabilize Medicaid provider rates.

Below is a list of recommendations on how to stabilize Oklahoma’s health care without expanding Medicaid:

• Decouple and adjust the various provider rates based on need, so that critical services like nursing home care, rural primary care, rural hospital care, and other critical services with limited revenue streams can be prioritized for funding. Given that it would take just $10 million to protect nursing homes from harmful cuts, thorough analysis reveals affordable state-based solutions can be effective.

• Implement the Medicaid reform pilot program which was passed by the legislature in 2015 and which special interests tried to repeal during the 2016 legislative session. Potential state savings estimated over $400 million.

• Restructure OHCA into a cabinet-level agency with the CEO and Medicaid director appointed by the governor and reorganize the OHCA board into an advisory board. This will allow operational decisions to be made unclouded by the pressure special interests currently wield on OHCA and will improve the overall effectiveness of the agency, just as lawmakers improved the Oklahoma Department of Human Services.

• Utilize 21st-century tools to protect program integrity and ensure only those actually eligible are enrolled in the program. Illinois saved an estimated $350 million per year by implementing such a program. Oklahoma’s Medicaid program could save an estimated $20 million per year by implementing a similar program.

• Encourage local communities to increase local support and local financing for health providers that are struggling.

• Extend Medicaid reform efforts to other populations currently enrolled in Medicaid. Further coordination of care, greater use of health plans to better manage care, and increased use of capitation could save more than $80 million, based on other states’ experiences.