Coburn, Parman: Medicaid 'rebalancing' plan is Obamacare by another name

Coburn, Parman: Medicaid 'rebalancing' plan is Obamacare by another name

by Tom Coburn and Larry Parman

The Oklahoma Health Care Authority's Medicaid “rebalancing” plan is being considered by lawmakers. The plan is simply Obamacare Medicaid expansion rebranded. As conservatives concerned about fiscal responsibility, we urge lawmakers to reject it.

The rebalancing scheme is a policy that expands the scope and size of the federal government and increases dependency on government programs. It removes one more state barrier that separates us from a single-payer system in the United States. And of course it would further balloon state taxpayer spending by $1 billion (at a minimum) over the first 10 years and would increase the federal debt by $10 billion.

According to OHCA, the plan would add some 175,000 to the Medicaid rolls while promising to shift a similar number to the flawed Obamacare private market in the future (though it's quite unlikely that portion of the plan will ever happen). Yet one study suggests that half or more of those targeted for expansion are already covered by job-related health insurance.

As the Congressional Budget Office noted, this creates an incentive not to work. The 175,000 targeted by OHCA are able-bodied adults. The proposal would increase from 27 percent to 33 percent the number of Oklahomans dependent on health care entitlements in addition to Medicare.

A core element of the OHCA proposal is qualifying for Obamacare funds that would require gutting the Insure Oklahoma program by removing enrollment caps, work requirements and accountable cost sharing. This plan would simply force more Oklahomans onto the welfare rolls. Can anyone sensibly suggest that our strapped state or federal budget can afford another vast entitlement program?

Nor can OHCA provide reliable cost estimates. The numbers keep increasing, meaning our liability is open-ended and guaranteed. Not one state using a similar plan has seen a reduction in costs to the state. All have increased.

In fact the OHCA proposal is similar to an unfunded pension liability, except that the cost will have to be funded each year. Oklahoma has finally taken steps to address that pension budget hole; the state can't afford to open the spigot for yet another costly program.

Supporters argue this is not expanding Medicaid because participants would be insured by private carriers. That's somewhat disingenuous because the funding mechanism — and more important, the financial responsibility — will be that of state and federal taxpayers.

Oklahoma rejected the Obamacare exchange grant, saving the state hundreds of millions of dollars in state-based exchange cost overruns being experienced by other states. Now we're being urged to accept funds from the federal government along with their requirements to run a health care program, according to their rules.

Gov. Mary Fallin had it exactly right in her 2014 State of the State address: “We cannot plunge this nation further into debt, or place Oklahoma on a fiscally unsound path, by expanding Medicaid. Both the president's plan and alternative proposals that rely on federal dollars in the Affordable Care Act amount to the same thing: a dramatic growth in unsustainable government spending.”

Coburn, a former Republican U.S. senator from Muskogee, has served thousands of Medicaid patients as a medical doctor. Parman, an attorney, has served as secretary of state for Oklahoma and secretary of commerce.