The Norman Transcript

January 15, 2013

Matter of compassion vs. politics

By Doug Cox
The Norman Transcript

NORMAN — Thirty-three year old Jane is lying on the emergency room bed complaining of stomach pain. This is her third ER visit in two weeks. She is worried about losing her job from missing work.

We know what is causing the pain. Jane has a bad gallbladder that is full of stones. It is easy to fix. In the hospital Friday morning for surgery, home Friday afternoon, back at work Monday morning.

Like hundreds of thousands of hard-working Oklahomans, Jane has no insurance and no way to pay for the surgery. With two kids, she and her husband work at minimum-wage jobs for small companies that do not provide health insurance.

They would be covered by the expansion of Medicaid under the Affordable Care Act. Oklahoma has decided not to participate in this expansion, leaving Jane and her family in the lurch.

By now, you are well aware that Gov. Mary Fallin has decided that Oklahoma will not participate in expansion of Medicaid, which would provide health care insurance for all Oklahomans making less than 133 percent of the federal poverty level. For a family of four, this comes out to $30,657. The cost of health insurance for this family averages $5,167 a year. It is simply unaffordable.

I have no doubt that the governor made the right decision from a political standpoint. Emails and calls from constituents are overwhelmingly against the Affordable Care Act. Fact is, now it is the law, whether we like it or not.

I would have made the opposite choice from the governor. But then, again, my decision would not have been made based on politics but rather on the predicament many of my constituents find themselves.

Contrary to popular belief, people who would have been affected by the expansion of Medicaid are not deadbeats but hard-working Oklahomans trying to raise their children and make a better life for themselves. They have lower-wage jobs, without employer-provided insurance.

The federal reimbursement for expansion of Medicaid would have been 100 percent of the cost through 2016, and then gradually decreasing to 90 percent by 2020. This means the estimated cost to Oklahoma, if 75 percent of those eligible participate (some estimate that only 57 percent will sign up), would be $27 million in 2017 and increase to $56 million by 2020. This is a do-able number. 

Oklahomans will still have to pay federal taxes and penalties for not having health care insurance. With the governor’s decision, our money will now be used to expand the program in other states while our own citizens continue to be uninsured and lack access to care. 

Presently, Oklahoma hospitals receive supplemental Medicare money, called disproportionate share (DSH) payments to offset the cost of caring for the uninsured. These payments are going to be decreased or eliminated as a way to finance the federal share of the health plan.

Since the governor chose not to participate, Oklahoma hospitals will still lose the DSH payment and not be able to recoup the loss through the Medicaid expansion. Hospitals will face closing or raising prices to those with insurance, or paying with cash to make up for this lost revenue. 

I respect Gov. Fallin’s decision, but I work on a daily basis with good people who need but cannot get access to medical care. Right or wrong, my compassionate heart overrules my political mind.

 Rep. Doug Cox M.D., R-Grove represents Delaware and Mayes County in the Oklahoma House of Representatives. He is a practicing emergency room physician at Integris Grove General Hospital on Grand Lake.

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