By M. Scott Carter
The Journal Record
OKLAHOMA CITY – When Republican Gov. Kevin Stitt delivered his first State of the State speech Monday, he spoke about the need to increase teacher salaries, reform Oklahoma’s criminal justice program and boost funding for other state programs.
But at the same time Stitt spoke of funding increases for many areas of state government, he reversed course and walked back his earlier comments about expanding the state’s Medicaid program.
“While Medicaid expansion currently stops at a 90 percent federal match, we cannot assume that it will remain this high forever,” the governor said Monday. “The estimated $150 million price tag today for Oklahoma to expand Medicaid could leave us down the road fronting more than $1 billion when the federal government pulls back on its commitment. They’ve done it before and they will do it again.”
That change didn’t go unnoticed.
Just days prior to the opening of the legislative session, Stitt told reporters at a forum sponsored by the Associated Press that he was open to the concept of expanding Medicaid if the state was given enough flexibility.
“I’m going to be very careful where I don’t put Oklahoma in a tough situation,” he said. “Where we’re stuck with providing more government services and a billion-dollar price tag.”
Last fall, during his campaign for governor, Stitt – in an echo of former Gov. Mary Fallin – opposed the idea of Medicaid expansion.
The governor’s back-and-forth has left some state leaders concerned.
“It’s been a little difficult to figure out the governor’s position,” said David Blatt, executive director of the Tulsa-based Oklahoma Policy Institute, a progressive think tank. “He was opposed, then last week he seemed to suggest the door was open under certain conditions, then in the State of the State he seemed to be opposed again.”
Oklahomans, Blatt said, need a definitive answer on Medicaid expansion. He said more than 100,000 need health care coverage and that many rural hospitals are struggling or facing bankruptcy.
“Oklahoma continues to see a decline in health care provider networks, particularly in rural Oklahoma, where we have seen hospital after hospital close,” he said.
Blatt isn’t the only one worried. Across the state, many lawmakers are dealing with struggling rural hospitals and a lack of physicians in their legislative districts.
In Lawton, state Rep. Trey Caldwell said one his biggest worries centered on rural health care. “We’re looking for additional money for health care in rural areas,” Caldwell, R-Lawton, said. “We need a better partnership with communities with hospitals. We need to recruit more doctors to come to rural Oklahoma.”
Medicaid expansion, Blatt said, could help many of those rural hospitals.
“Every hospital has its own situation,” Blatt said. “And I realize you can’t claim Medicaid expansion would be a panacea, but just having an influx of paid customers would definitely stabilize hospitals that are in a difficult situation.”
Blatt said the governor’s argument that the federal government would cut back on the 90 percent funding was a red herring because the funding level was set by federal statute.
“The federal government has never reneged on that type of statutory commitment,” he said.
Blatt said the state could also protect itself by putting a “circuit breaker” into law. That clause, such as the law passed in Arizona, would allow the state to pull itself out of the program if the federal government changed its funding level. “There are clear and simple ways to avoid that situation.”
Echoing Blatt, Democrats in the House of Representatives urged Stitt to address the issue and work to protect rural hospitals.
“It’s hard for our caucus to understand how we can have a conversation about health care without first taking about the rural hospitals that have shut down or filed for bankruptcy,” state Rep. Emily Virgin, D-Norman, said.
Virgin, the House Minority Caucus leader, said not accepting federal Medicaid funds based on what might happen in the future with another governing body was “a ridiculous stance to take when Oklahomans were dying.”
“If the governor is against expanding Medicaid, he should own it and offer a different vision for insuring the 200,000 Oklahomans that the expansion would cover,” she said.
Still, while the debate over Medicaid expansion continues, some pundits say the governor’s shift in position could be more about negotiation and less about policy.
Using Medicaid expansion as a bargaining tool in the debate over whether or not the governor gets more appointive authority at the Oklahoma Health Care Authority would be a smart idea, University of Oklahoma political science professor Keith Gaddie said.
“It’s certainly a sound negotiating move,” Gaddie said. “If I’m the governor, I’m not going to risk capturing extra money and then create a situation where it would appear that the state is wasting, abusing or defrauding the system.”
Because Gov. Stitt has made transparency in government a large part of his platform, Gaddie said the push for more appointive authority and the debate over Medicaid expansion could help in negotiations with lawmakers.
“If I’m the governor, I don’t want to take extra money and not be able to oversee its use,” he said.