As chairman of the Appropriation Subcommittee on Health in the Oklahoma House of Representatives, it has always been my stance that state spending on our Medicaid program should never be larger than spending on education. Medicaid spending, due to rising healthcare costs, has overtaken education spending in some states. Education should be our number one priority because it has been proven time and again that the more educated a person is, the less likely he or she is to be on the Medicaid program. No one is more passionate than I in wanting to provide care for the truly needy and those unable to care for themselves, but the state’s ability to do so is limited by finances.
Oklahoma’s financial guidelines for Medicaid eligibility are more liberal than that required by the federal government and many states, resulting in well over 600,000 of our state’s citizens being on the Medicaid rolls. Our Medicaid program, also known as SoonerCare, is consuming an ever-increasing amount of tax dollars. There are three primary ways to hold down cost: lower the eligibility standards to decrease the number of people on Medicaid, decrease the services provided by Medicaid or decrease the amount paid to those who provide care for Medicaid patients. Even though our eligibility standards are greater than the minimum federal requirements, the federal government will not allow us to roll our standards back, so we are left with the last two choices for cost control. Let’s look at those two possibilities.
In some instances the health policies provided Medicaid recipients have better benefits than the insurance policy that private citizens have the money to purchase. It just doesn’t seem right to me that a Medicaid policy provided to someone by the taxpayer should be better than the taxpayer can afford to buy for him or herself.
Perhaps we should limit emergency room (ER) visits and encourage Medicaid patients to see the primary care physician they are assigned when they are enrolled. It seems to me that a limit of six paid ER visits per year is ample. According to federal law, no one would be denied care in the ER, but Medicaid would only pay for six visits annually.
Most private insurance policies require generic medication because generics are less expensive than brand name prescriptions. Perhaps it is time to require Medicaid to only cover generic medication unless certain medications have gone through a prior approval process. The vast majority of medical problems can be well cared for with the generic drugs that are now available, many of which are on the “$4-$5 list” at the pharmacy.
Overmedication and medication interactions are a major healthcare issue. Perhaps we should reduce Medicaid prescriptions from a maximum of six per month to five per month and eight per month for nursing home residents. In the not too distant past, Medicaid only covered three prescriptions per month so these lower guidelines would be nothing new or unreasonable.
An increasing amount of the Medicaid medication dollars are being spent on controlled narcotics. In a state with a huge prescription drug abuse problem where more Oklahomans die from prescription narcotic abuse than car wrecks, it is time to think about stopping coverage of controlled drugs by Medicaid. There are now more non-narcotic pain pills for doctors to prescribe than ever.
In the area of provider reimbursement, Oklahoma hospitals and doctors receive one of the highest rates for caring for Medicaid patients in the nation, which is important to allow access to health care, particularly specialty care, for Medicaid patients. If the rate is too low, doctors will be unable to afford to see these patients. However, we could reduce our payment rate by two percent and still be in the top four states in the nation and save millions of taxpayer dollars that could be used for education.
It is time we also look at a competitive bidding program for the providers of durable medical equipment, such as oxygen machines, wheelchairs, etc., and diabetic supplies for the Medicaid program rather than paying a flat rate.
The Oklahoma Health Care Authority does an excellent job of administering the Medicaid program with low administrative expense. They have excellent programs for disease management to decrease costs. In spite of this, costs are continuing to rise, making it time to consider the options I have discussed above.
My suggestions will be met with much opposition, most of it coming from the pharmaceutical industry, hospitals, physicians and medical equipment suppliers—all powerful political forces with a large army of lobbyists at the Capitol. In addition there will be resistance from the Medicaid population, as it is no fun to give up free benefits.
Tough times call for tough measures. I am not sure that the Health Care Authority has the courage to make the politically tough choices above. I am also not sure the Legislature has the political courage to force them to do so. However, it is time to start having these conversations unless we want to see education and all other state services struggle because tax dollars are being increasingly consumed by Medicaid.
Thank you for allowing me to serve as your state representative. I can be reached at dougcox@okhouse.gov or 405-557-7415.