OCPA column: Many Oklahomans "uninsured" only on paper

Many Oklahomans “uninsured” only on paper

By Jonathan Small

An often-overlooked aspect of the Medicaid-expansion debate is that lawmakers are being asked to expend hundreds of millions more in state spending to insure people who are, effectively, already insured.

Oklahoma’s topline uninsured rate of 14.2% gets headlines, particularly since that’s the second-highest uninsured rate in the country. What goes unnoticed is that many of those people can get coverage or treatment today for little cost, and often for free.

Members of the bicameral Healthcare Working Group were recently informed that an estimated 85,000 uninsured Oklahomans currently qualify for significant federal subsidies. Those individuals already have the ability to buy a policy off a federal exchange with little or no out-of-pocket expense.

Another 19,000 uninsured Oklahomans are already qualified for Medicaid.

Put together, those two groups represent more than 100,000 uninsured Oklahomans. But they are uninsured by choice, not as the result of any financial challenges.

Also, policymakers should not ignore the reality that many Oklahomans can also access treatment through Indian Health Service (IHS) facilities and tribal government programs. While access to those facilities is not counted as being insured, federal officials felt the IHS system was good enough that those who used it were not required to pay the federal Affordable Care Act’s penalty for being uninsured.

According to the Census, 9.3% of Oklahoma’s 3.9 million people are American Indian. Admittedly, many of those individuals have insurance, but that figure includes many who do not. The Self-Governance Communication and Education tribal consortium has estimated more than 129,000 uninsured Oklahomans may be American Indians who can access IHS facilities and care. A speaker at a recent legislative hearing estimated 10 percent of Oklahoma’s uninsured are American Indian

As a result, it is feasible that as many as 200,000 technically uninsured Oklahomans already have access to insurance and/or low-cost health treatment. And that doesn’t even account for all the people who obtain care through Federally Qualified Health Centers, free clinics, and similar facilities. So how does it make sense to spend hundreds of millions more in state tax dollars on Medicaid expansion to insure the (effectively) already-insured?

There are better ways to address Oklahoma’s challenges than Medicaid expansion, particularly in the area of rural infrastructure, such as directing Oklahoma’s tobacco settlement funds to rural hospitals and doctors. And it’s worth noting what is occurring in Texas, which has a higher uninsured rate than Oklahoma but also a higher rate of people with private insurance. An official from OU Medicine recently conceded to legislators that Texas’ booming economy has increased private coverage, which has resulted in better-funded hospitals in that state.

Oklahoma should follow Texas’ lead in this area, and focus on adopting policies that result in greater private-sector job growth, rather than follow the ever-bigger government model of failed states like Illinois and California.

Jonathan Small serves as president of the Oklahoma Council of Public Affairs.