April 27, 2016

An Open Letter to Governor Mary Fallin

From David R. Brown, M.D., Chairman
and Jonathan Small, President

Here at the Oklahoma Council of Public Affairs, we value those elected officials who stand for
promoting fiscal responsibility while still helping the most vulnerable among us.
Currently, there are efforts to backdoor a Medicaid expansion in Oklahoma under the guise of
a rebalancing plan. Being overlooked in this discussion are the thousands of truly needy aged,
children, pregnant women, and adults with intellectual and developmental disabilities who rely
on the services they use from Medicaid. Under the rebalance plan, single, able-bodied adults
will be given first preference with higher reimbursement rates and preferential care.
Oklahomas Medicaid program (which includes Insure Oklahoma) is already spending at near
all-time highs. From FY-1995 to FY-2015, our Medicaid and Insure Oklahoma enrollment has
increased 124 percent to over 1 million enrollees, totaling nearly 27 percent of our population.
Over the same period, the state share of Medicaid has increased 553 percent from $317 million
to over $2 billion. The rebalance proposal would increase to 33 percent the number of
Oklahomans dependent on state and federally subsidized health care entitlements.
Beginning with your vote against Obamacare in 2010 as a member of Congress, and extending
through the first efforts by the federal government to force a costly Medicaid expansion on our
state, down to your more recent battles . . . you have been there for vulnerable Oklahomans and
have been steadfast as a voice of fiscal sanity.
That is why, on behalf of the OCPA board of trustees, we want to express our deep appreciation
for your principled stand against various proposals to expand Medicaid in Oklahoma as part
of the ever-expanding Obamacare takeover of the health care system. You, along with former
U.S. Senator Dr. Tom Coburn and other leaders, have opposed any and all forms of Medicaid
expansion or accessing Medicaid expansion dollars. We know you understand whether by way of
the Leavitt Proposal, rebalancing, or other Obamacare Medicaid expansion attempts dressed
up as program re-design, its all just the Obamacare Medicaid expansion.
Such an expansion would be unaffordable, you said in 2012 and on many occasions
since. You clearly saw that with the ever-burgeoning federal debt it was irresponsible
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to borrow more trillions from our grandchildren. You rightly warned that once Oklahoma took
on the burden of an expanded Medicaid system, in whatever form, the promised federal dollars
to underwrite that action could, and almost certainly would, eventually dry up, leaving state
taxpayers with an unpayable bill. And you clearly saw that under Oklahomas constitutional
requirement that our budget always be balanced, an ever-expanding Medicaid budget
would inevitably draw funds away from essential state services like education, public safety,
transportation, and human services. In fact, you wisely pointed out to the media in a media
advisory during the summer of 2015 some of the states now experiencing budget woes from
whatever form of Obamacares Medicaid expansion they had implemented.
The Obamacare Medicaid expansion rebalance plan will add more than $10 billion to the
federal debt and cost Oklahoma taxpayers hundreds of millions of dollars.
As an alternative to expansion, we ask you to look to the experiences of other states and
encourage reforms to mend Medicaid so it can serve those who need it most. Given that it
would cost just $10 million to protect nursing homes, and that any actual cash shortfall for
rural hospitals could be paid for by the state for much less, any form of Obamacares Medicaid
expansion or use of Obamacare Medicaid expansion dollars is unwise.
In Maine and Arizona, costs turned out to be more than double the estimates. In California
and Illinois, taxes had to be increased and provider reimbursements decreased. In states such
as Tennessee, which tried expansion even before Obamacare, the TennCare program nearly
bankrupted the state and thousands of individuals were cut from rolls. The Congressional Budget
Office found that Arkansas attempt to expand Medicaid by using Obamacare expansion dollars
to purchase private health insurance had significant cost overruns exceeding $800 million. The
Arkansas Medicaid expansion is now known for its significant enrollee fraud problems. States
that have expanded Medicaid to single, able-bodied adults have had to cut vital services for other
Medicaid enrollees in order to afford their burgeoning Medicaid rolls.
Todays budget crisis is real; a future one driven by soaring Medicaid costs would be
catastrophic. We at OCPAand hundreds of thousands of Oklahomans who would ultimately
foot the bill for whatever form of Medicaid expansionthank you for your firm stand on behalf
of fiscal sanity. Your leadership will be essential in this continuing battle, one we must win for the
truly needy that currently rely on Medicaid services and for Oklahoma taxpayers.
We commend you for your leadership in taking the long-term view of how detrimental the
Obamacare Medicaid expansion will be to Oklahomas most vulnerable citizens and to other
core services of government. At our upcoming Citizenship Award Dinner, we look forward
to recognizing your continued steadfastness in opposing any and all forms of the Obamacare
Medicaid expansion and in opposing attempts to access Medicaid expansion funds.