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Legislators can stop privatized Medicaid

Legislators can stop privatized Medicaid

Options available to end governor’s plan before damage is done

OKLAHOMA CITY, APRIL 20, 2021- As the Oklahoma House of Representatives considers Senate Bill 131 this week, a coalition of health care organizations today called on the Oklahoma Legislature to vote to stop a flawed plan to privatize health care for 1 million Medicaid recipients.

“In our discussions with legislators, we’ve heard several express opposition not only to the plan, but especially to the way the Legislature was not consulted,” said Jay Johnson, president of Duncan Regional Hospital and board chairman of the Oklahoma Hospital Association. “Despite what some may believe, the plan to outsource Medicaid is not a runaway train. It can be stopped.”

Johnson said his primary concern with the proposed managed care plan is the denial of needed medical treatment to protect the profits of large insurance companies.

“Oklahoma Health Care Authority (OHCA) projections show that to achieve cost savings under the managed care plan, Oklahoma would need to reduce services to Medicaid patients, specifically pregnant women, children and the expansion population, by up to 40 percent,” Johnson said. “This comes from the OHCA’s own actuarial advisor.”

Mary Clarke, M.D., president of the Oklahoma State Medical Association, said managed care will insert insurance companies between doctors and patients.

“We don’t want for profit insurance companies to act as middlemen in the physician/patient relationship,” said Clarke, a Stillwater-based family medicine physician. “Treatment decisions must be based on what is best for the patient, not the insurance company’s bottom line. To make things worse, the governor’s plan allows the insurance companies to auto-assign an insurance plan and doctor to the patient in some circumstances.”

A group of 16 organizations, representing thousands of medical professionals and patient advocates, is opposing privatization. The coalition represents virtually every facet of health care in Oklahoma: doctors, nurses, dentists, mental health providers, hospitals, medical equipment distributors, ambulance services, hospice providers, and patient advocates representing the intellectual and developmental disabilities community. 

These organizations remember the state’s previous attempt to let insurance companies administer Medicaid two decades ago. 

"The last time Oklahoma used managed care, in the late 1990s and early 2000s, we lost 15-20 ambulance services a year, mostly in rural Oklahoma," said Johnny L. Red, vice president of Sinor EMS in Clinton. “The result was that patients previously served by those services had much longer waits before an ambulance could arrive. That delay can be the difference between life and death.”

Legislators could end this attempt to privatize Medicaid through either of two current mechanisms: Senate Bill 131 or the normal appropriations process.

SB 131, authored by Rep. Marcus McEntire, R-Duncan, would require OHCA to develop a program that controls costs for the state while improving health outcomes for Medicaid recipients. 

“Ultimately, Rep. McEntire’s bill seeks to achieve the same goals as the outsourcing plan, but without the harm to Medicaid recipients that outsourcing undoubtedly would cause,” Jay Johnson said.   

Legislators also could stop the outsourcing of Medicaid simply by refusing to pay for it. The OHCA’s contracts with the four insurance companies specifically nullify the deals if legislators vote not to fund privatized Medicaid.  

The harm from privatized Medicaid would be spread statewide, but rural Oklahoma would be hit particularly hard, said Rebecca D. Lewis, D.O., who practices obstetrics and family medicine in Enid.

“Medicaid patients already are an underserved population,” Lewis said. “Undoubtedly, privatization will worsen that. I have pregnant patients who already drive two hours to see me. As services shrink under privatized Medicaid, imagine the additional difficulties these patients will face. How do you improve health outcomes when you are cutting services, especially to children and pregnant women?”

Oklahoman’s access to mental health services also would suffer, said Mimi Tarrasch, creator and chief program officer of Women In Recovery, a program of Family & Children’s Services in Tulsa.

“The OHCA’s own actuarial advisor has projected that a 20 percent budget cut in mental health services will be needed to meet their goals,” Tarrasch said. "The timing is terrible as a result of the COVID-19 pandemic. The mental health system is being flooded with mental health needs ranging from significant increases in depression, anxiety and substance use. Additionally, Oklahoma is experiencing a work force shortage of mental health care professionals." 

Legislators still have time to prevent the significant harm inherent with the governor’s plan, Jay Johnson said.

“We applaud the House Public Health Committee for passing Senate Bill 131 and are hopeful the full House and Senate will take a similar stand,” Jay Johnson said.

To learn more about the wide-ranging effort to stop the “Health Care Holdup,” visit healthcareholdup.com. The website describes the rationale for opposition, dispels myths about the promised benefits of privatized Medicaid and instructs Oklahomans how they can assure their voice is heard.