Small: “No” vote on SQ802 is a wise decision

“No” vote on SQ802 is a wise decision

By Jonathan Small

Soon, Oklahomans will consider State Question 802, which would increase welfare by expanding Oklahoma’s Medicaid program to cover able-bodied adults. Believing the arguments of SQ802’s supporters requires ignoring mountains of evidence.

Isn’t Medicaid expansion funded by “free” federal money? Nope. The federal government is broke and has a trillion-dollar deficit. Plus, State taxes are required as well. In Oklahoma, Medicaid expansion will cost state taxpayers up to $374 million annually.


Also, Medicaid-expansion costs consistently exceed projections nationwide. The actual cost has been an average 157 percent more than predicted.

Last year Governing Magazine found 13 states had to raise taxes, fees, or cut provider rates to fund the state portion of expansion costs. Indiana initially used a provider tax similar to what has been proposed to pay expansion costs in Oklahoma, but by 2019 the Indiana Hospital Association was calling for tax increases to fund Medicaid expansion because the hospital tax payments were “increasing at an unsustainable rate.”

But, supporters say, it’s still worth it if Medicaid expansion saves rural hospitals. But expansion doesn’t save rural hospitals. Twenty-four rural hospitals have closed in Medicaid-expansion states, including five in Arkansas, Kentucky and Louisiana.

Jay Johnson, CEO of Duncan Regional Hospital and a supporter of Medicaid expansion, told state lawmakers, “On every government payer, we don’t make a profit. At our hospital, whether we’re taking a Medicare or Medicaid patient, our expenses are greater than what we will get paid.”

That is why rural hospitals still close after Medicaid expansion. Medicaid expansion doesn’t increase hospital profits. It increases the number of patients hospitals lose money on.

Expansion can actually make hospital finances worse because it can shift people away from private insurance. It’s estimated 70% of people eligible for Medicaid expansion in Oklahoma already have access to private insurance in some form.

Surely Medicaid expansion produces better outcomes for enrollees, right? Wrong again.

Researchers estimate personal behavior and genetics account for 70 percent of the determinants of health. That’s why if you lose weight and are uninsured, your health outcomes will still be better than an obese person who has Medicaid coverage.

Remember Arkansas, Kentucky and Louisiana? Those three states have citizen demographics similar to Oklahoma, and all three have expanded their Medicaid programs. Yet all three of those states rank alongside or worse than Oklahoma on the annual America’s Health Ranking report.  Those states have spent hundreds of millions on Medicaid expansion to achieve essentially the same or worse health outcomes than Oklahoma.

Rather than repeat the failed experiment of other states that will give more control to federal politicians like Nancy Pelosi and raise working Oklahoma families’’ taxes, Oklahomans should vote “no” on SQ 802.

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