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Commentary: Care giving

Oklahoma could expand Medicaid, but interest groups are fighting to make health care a privilege.

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President Barack Obama’s Affordable Care Act (ACA) provided for expansion of Medicaid on a state-by-state basis, and since 2014, 37 states and the District of Columbia have approved expanding Medicaid coverage to persons making below 138 percent of the federal poverty level. Newly elected Gov. Kevin Stitt, who wants to run Oklahoma like a business, albeit one that offers only junk insurance to its employees, is on record as opposing Medicaid expansion. According to Oklahoma Policy Institute, approximately 150,000 Oklahomans fall into a coverage gap — too poor to qualify for subsidies in the health care marketplace but too wealthy to qualify for Medicaid as it is currently offered in the state. Medicaid expansion should not be controversial, yet its opponents are mounting a battle to preserve Oklahoma’s status as a place most likely to fall through the cracks.

Stitt and his enablers on The Oklahoman’s editorial board’s opposition to Medicaid expansion should be the first sign that we need this. Their kneejerk opposition to any program associated with the Affordable Care Act (ACA) or that smacks of their favorite bogeyman, socialism, is an indicator that powerful interests are fighting viciously against the people who need help the most.

The Jan. 6 editorial by John Tidwell in The Oklahoman is Exhibit A in how the message is being manipulated on Medicaid expansion. Tidwell’s expressed opposition is predicated upon, of all things, need. He outlines several instances in which states have expanded Medicaid under the ACA and seen their budgets overshot by large numbers of sign-ups.

“In Colorado and Kentucky, expansion supporters claimed that fewer than 200,000 would sign up,” Tidwell wrote. “Instead, both states had more than 400,000 enrollees. In Nevada, which enacted its Medicaid expansion in 2014, the state government is reporting a Medicaid deficit of $56 million for fiscal 2019. In New Mexico, enrollment was projected at 149,000 — instead, more than 250,000 signed up. What makes anyone believe Oklahoma will be the one state to guess right?”

First of all, the nerve of all those people applying for a program that, in an era of crushing medical expenses, could pull them out of chronic poverty. Because a state’s budget office did not accurately project public need for a program, then said program should be scrapped or not pursued by other states? Those states did a terrible job of forecasting sign-ups, but underlying that projection failure is the further proof that medical debt is creating a permanent underclass in America whose size is repeatedly underestimated. Medicaid expansion can do much to provide relief for these people.

Tidwell did not mention Ohio, which expanded Medicaid five years ago under Republican Gov. John Kasich. In the past half-decade, Ohio’s Medicaid expansion resulted in the rate of uninsured living at or below 138 percent of the poverty level falling from a high of 36.1 percent in 2008 to just 12.8 percent 10 years later.

Yes, but what about taxes, right? Tidwell goes on to complain that Arizona, Arkansas, Colorado, Illinois, Indiana, Louisiana, New Hampshire and the success story that is Ohio all reported raised taxes to fund Medicaid expansion. I hate to use non-words like “duh” in crafting arguments, but it seems appropriate in this case. Government is funded through the assessment of taxes, and Medicaid expansion can only take place in Oklahoma through either new taxes or cuts to other programs. Responsible people are willing to pay taxes for needed programs. The rest are libertarians who want to, like Americans for Tax Reform founder Grover Norquist, shrink government “down to the size where we can drown it in the bathtub,” but when you ask them about driving on tax-funded roads, they shrug like Atlas.

The Oklahoman regularly gives Tidwell space so that his powerful bosses can push their agenda in Oklahoma. Tidwell is state director for Americans for Prosperity, which sounds nice because there is not a group called Americans Against Prosperity. This is the primary political advocacy group for David and Charles Koch, known colloquially as the Koch Brothers. Tidwell is the Koch Brothers’ man in Oklahoma, and Americans for Prosperity notoriously AstroTurfs on health care reform by creating shell groups with similarly unobjectionable names like Patients First and Patients United Now that have nothing whatsoever to do with actual patients.

Americans for Prosperity’s opposition to Medicaid expansion is part of a larger strategy that, at its core, has relatively little to do with providing medical care to low-income citizens. Tidwell’s national-level boss, Americans for Prosperity president Tim Phillips, is more concerned with thwarting efforts to combat climate change. After all, Americans for Prosperity is the political action wing for Koch Industries, which is primarily a petrochemical and energy company.  In a 2014 interview with The New York Times, Phillips said his group’s opposition to the ACA was a device to crush federal pro-environmental programs.

“We have a broader cautionary tale,” Phillips told the Times. “The president’s out there touting billions of dollars on climate change. We want Americans to think about what they promised with the last social welfare boondoggle and look at what the actual result is.”

Unfortunately for Phillips’ argument, that “last social welfare boondoggle” was a success.

If someone like Tidwell is speaking out about social programs like Medicaid expansion, they are likely more concerned about something else that they are conveniently not disclosing. The Oklahoman is more than happy to give Tidwell cover. Again, Americans for Prosperity sounds nice. Too bad the group is mainly focused on two American brothers and their considerable prosperity.

Sure, Oklahoma is one of the last 13 states to consider expanding Medicaid, which is not surprising given our state’s tradition of trading in phony populism that persuades those with the greatest need to support policies against their own interest. But health care should not be a privilege, and the poorest among us should not have to get approval from David and Charles Koch before getting a heart scan.

George Lang is editor-in-chief of Oklahoma Gazette and began his career at Gazette in 1994. | Photo Gazette / file

Opinions expressed on the commentary page, in letters to the editor and elsewhere in this newspaper are those of the author and do not necessarily reflect the opinions of ownership or management.

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