I was privileged to attend a recent town hall here in Duncan on the topic of surrendering control of Oklahoma’s Medicaid program to private insurance companies. I say privileged because it was encouraging to hear so many insightful questions and comments about this patently bad idea.
Audience members who stood to speak weren’t just hospital leaders like me. They included Medicaid providers and community members who simply wanted a better understanding of privatized Medicaid or an explanation to the claims that this plan can save the state money while improving health outcomes for Medicaid patients.
The bottom line is that it can’t.
The authority’s actuary partner, Mercer, uses assumptions that during year one, hospital care will be reduced by 40 percent and behavioral health by 20 percent. There’s only one way the four chosen insurance companies can make the profits demanded by their shareholders: by routinely denying services that Medicaid recipients need and that their health care providers have determined to be medically necessary.
“Medically necessary” is the key phrase. In so-called “managed-care” Medicaid states, insurance companies determine the care you need and what you can get by without. This bears repeating: Critical health decisions aren’t made by you and your doctor, but by an insurance company with very different motivations than you and your doctor have. This is what happened during the state’s last try at privatized Medicaid nearly 25 years ago, and it absolutely will happen again.
What also occurred last time in Oklahoma -- and in other states that have attempted privatized Medicaid -- was that the pool of health care providers shrunk. Rural areas are hit especially hard when this happens, because finding a new doctor or dentist typically requires far more travel for rural Medicaid patients.
Ask yourself: Does it make sense to shift to managed care during a pandemic, when Oklahomans are struggling not only with COVID-19, but with the isolation, depression and joblessness that has accompanied the spread of this disease? What will be the outcome of this ill-timed experiment? Can we afford to find out?
Some background on this issue is crucial: The governor pushed through this change, bypassing the state Legislature, after Oklahomans voted last year to expand Medicaid services. The Oklahoma Health Care Authority board awarded contracts totaling more than $2 billion to the four insurance companies that will take over the jobs that state employees have been performing.
Hospital administrators throughout Oklahoma support measures to improve access to high quality and affordable health care. We know these goals can be accomplished within the existing framework.
Fortunately, our elected leaders have the power to stop the ill-conceived change to managed-care Medicaid before it begins. The House and Senate can simply vote to withhold funding for a privatized system.
I would like to thank Rep. Marcus McEntire, Rep. Brad Boles, Sen. Chris Kidd, and Sen. Jessica Garvin, who have all been supportive of hospitals and providers on this issue. Please join me in protecting rural health care by contacting your state legislators. Locate them at www.oklegislature.gov/FindMyLegislature.aspx. Please ask them to ensure that patients and their health care providers continue to make the decisions regarding their health and join me in thanking them for their support.
Jay Johnson is the President and CEO of DRH Health and board chair of the Oklahoma Hospital Association. To contact Johnson, email to firstname.lastname@example.org or call 580-251-8552.