Small: Medicaid-expansion critics proven right

Medicaid-expansion critics proven right

By Jonathan Small

Prior to the 2020 statewide vote on Medicaid expansion, we at the Oklahoma Council of Public Affairs warned that projected costs were unrealistic, lowball estimates and spending would quickly surge, forcing lawmakers to divert millions from other uses, such as education or public safety.

Officials with the Foundation for Government Accountability and Americans for Prosperity also made that argument with reams of data.

Expansion supporters dismissed those critiques. In June 2020, Medicaid expansion was authorized by statewide vote, albeit by the narrowest of margins.

But now there’s no denying critics knew what we were talking about.

A report by the Legislative Office of Fiscal Accountability, a state fiscal watchdog, reported that the Oklahoma Health Care Authority now estimates Medicaid expansion will cost nearly $2.5 billion in the 2025 state budget year with $213 million coming from state government. The remainder comes from federal government spending.

(If you pay no federal taxes and only state taxes that would be a good deal, but we all pay federal taxes, either directly or indirectly. The state-federal split does nothing for the average taxpayer but indicate which pocket gets raided for cash.)

The LOFT report showed from July 2021 through April 2024, the number of individuals added to Oklahoma’s Medicaid program totaled 590,471 with 247,293 of those individuals added as the result of expansion.

From state fiscal years 2013 to 2019, Oklahoma’s Medicaid expenses averaged $5.46 billion per year. By 2023, that total had surged to $9.93 billion. LOFT noted nearly half the increased spending was for the Medicaid expansion population.

That’s in stark contrast to what expansion proponents projected. In 2013, the liberal Oklahoma Policy Institute claimed only 126,000 uninsured Oklahomans would be added to Medicaid by expansion. LOFT shows the actual number is nearly 100 percent higher so far.

Oklahoma Policy also claimed the state share of cost would total only $689 million combined from 2013 to 2022 (if expansion occurred at that time). But LOFT shows the state cost will be at least $2.1 billion per decade, or over 200 percent higher than Oklahoma Policy claimed.

State Sen. Roger Thompson, an Okemah Republican who previously chaired the Senate Appropriations Committee, noted the state cost for Medicaid expansion “exceeds what we originally had talked about as far as the state share.”

But state Sen. Julia Kirt, D-Oklahoma City, praised the program, claiming Medicaid expansion “helped the state weather COVID” and gave Oklahomans “quicker access to the care they need.”

Apparently, we’re to believe cost is no object, that money grows on trees, and we should not consider how other priorities will be financially short-changed due to Medicaid costs overruns. Also, contrary to Kirt’s insinuation, there’s no data showing improved health outcomes have occurred due to Medicaid expansion.

In policymaking, facts matter. When it comes to Medicaid expansion, the data makes it clear: The critics were right.

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