Oklahoma’s rush to outsource its Medicaid program to private for-profit companies begs the question — what problem are we trying to solve? The state’s Medicaid agency — the Oklahoma Health Care Authority — is already managing Medicaid and is nationally recognized for its work.
With the anticipation that hundreds of millions of federal tax dollars will return to Oklahoma for Medicaid services, the political focus has shifted from expansion opposition to private, out-of-state companies managing Oklahoma’s program. In explaining the accelerated timeline to achieve this, the governor’s communication’s chief, Charlie Hannema, wrote in January, “Oklahoma’s health care outcomes consistently rank near the bottom of all 50 states, and the governor believes continuing to do the same thing while expecting different results isn’t a plan for success,” according to eCapitol News.
That is a false equivalency, of course. Opposing Medicaid expansion a year ago then criticizing those delivering the services only months later, is known as a misdirection play in politics (and football). Courageous legislators, hospital leaders, physicians, dentists, pharmacists, nurses, optometrists, mental health providers, civic and business leaders, and many, many others, have legitimately and publicly questioned the pitfalls of outsourcing Medicaid at all, much less in an unrealistic and compressed timeframe. Even the health care authority board approved the outsourcing plan by just one vote. Legal challenges remain outstanding. Fiscal impacts are being analyzed and show increased management costs for outsourcing to private companies. At a minimum, these issues require more analysis and complete transparency, not a race to the finish line.
A deadly virus that has disproportionately affected the poor, minority populations, and those with underlying health conditions has brought us face to face with societal inequities in our cities and state. Expanded Medicaid insurance for the poor is just one step along a path of essential investment in the health and welfare of those most in need. Yet, changing the entire management structure and delivery of Medicaid services during a pandemic raises more questions than it answers, and potentially undermines the very goals expanded Medicaid envisions.
As a not-for-profit community health center, Morton’s roots lie in the 1921 Tulsa Race Massacre. For much of its history and evolution, Morton (or Moton as it was known) was the only place people of color could get medical services in segregated Tulsa. Its mission remains to provide quality health services to anyone in the community, regardless of their ability to pay. Common health conditions among the majority of Morton’s patients include diabetes, hypertension, obesity, heart disease and COPD. Research shows that medical services integrated with strategies to reduce and eliminate social determinants are the most effective ways to improve health outcomes, especially for those with chronic conditions. These are among the benefits of an expanded Medicaid insurance program.
Currently, 40% to 50% of Morton’s patients are ineligible for health insurance through Medicaid or the open market because of their income. Medicaid expansion in Oklahoma means access to health insurance for these patients and hundreds of thousands of others, which will be life changing for their families and themselves. Population health ties directly to economic health so Oklahoma’s economy will benefit from an infusion of capital invested in its citizens.
If outsourcing Oklahoma’s Medicaid program to private for-profit companies is good policy and makes sound business sense, that decision will stand up to a more thorough examination of management costs, actuarial tables, profit margins, vigorous political debates, and other assumptions. Who really believes that a 20% reduction in behavioral health services as projected in the model will occur over the next year? In Morton’s experience, demand for behavioral health services has increased by 30% in the past six months. What will reimbursements be for providers? How quickly will the out-of-state companies pay their claims? What is the dispute resolution process for rejected claims? How can Morton’s leadership in its fiduciary role reconcile the true costs of patient care with what is determined by for-profit management companies to be reasonable?
So many questions. So few substantive answers. So little time. History reminds us that Oklahoma tried managed care with private insurance companies in the 1990s. It failed. There are lessons to be learned and understood.
M. Susan Savage is executive director of Morton Comprehensive Health Services, former mayor of Tulsa, former Oklahoma secretary of state and a member of the Tulsa World Community Advisory Board. Opinion pieces by advisory board members appear in this space most weeks.