The Impact of Fallin’s Medicaid Decision

So Mary Fallin has this thing she does where she forgets that she is governing a state, and pretends instead that she is a national political actor whose job should primarily consist of taking symbolic potshots at federal government programs that the Republican party dislikes. It is not totally clear why she does this: sometimes I speculate that no one has adequately explained to her that she is not a member of Congress anymore.

On most days, Fallin’s grandstanding is just a waste of everyone’s time. As a state governor, she has no real power over federal matters. She does the political equivalent of waving a few Don’t Tread On Me flags, the national media reports on the circus, and everyone goes on with their lives. However, Fallin’s recent decision to reject federal dollars to expand Medicaid in Oklahoma goes beyond symbolic gestures, and delivers a huge blow to uninsured poor people in the state.

According to OK Policy Institute estimates, the rejected Medicaid expansion would have made 130,000-190,000 poor, uninsured Oklahomans eligible for Medicaid. This would have imposed no cost on Oklahoma in the short-run, and imposed very little if any cost on Oklahoma in the long-run. Up until 2020, the expansion would be funded entirely with federal funds. After 2020, the expansion would continue to be 90% funded by the federal government, leaving the state government on the hook for the other 10%. The cost of funding that 10% would be the equivalent of 0.5 percent of state appropriations for 2013. That is a very small amount to pay to insure so many, and is probably overstated because a Medicaid expansion would also permit the state to shift some healthcare costs it already pays for on to the Medicaid program.

So, expanding Medicaid would insure a significant number of poor Oklahomans, but that leaves open the question of what impact that will have on those who receive the insurance. After all, poverty is a harsh existence, health insurance or not, and Medicaid has notably stingy reimbursement rates that many health care providers loathe. Thanks to a ground-breaking study in Oregon, we have a fairly good understanding of what kind of improvements Medicaid brings. Individuals insured by Medicaid are 20 percentage points less likely to have out-of-pocket expenses, 15 percentage points less likely to borrow or skip bills to pay medical expenses, and 4.8 percentage points less likely to have an unpaid bill sent to collection.

On the health side, Medicaid recipients are 7.8 percentage points less likely to screen positive for depression, 13 percentage points more likely to report their health condition as good, very good, or excellent, and 32 percent more likely to report feeling overall happiness. They are also much more likely to have sought out preventative care like mammograms.

How do the uninsured poor not on Medicaid fare? Well you can flip those statistics around to get a sense, or you can read some of the stories the New York Times ran about those individuals who were not lucky enough to win Medicaid access in the above study. Here is just one:

For instance, a year ago, Samantha Kious, a hair stylist, went to Planned Parenthood to seek birth control medication to manage her polycystic ovary syndrome, a common hormonal imbalance.

Ms. Kious, 24, who also has depression and Crohn’s disease, a bowel condition, makes only $1,000 to $1,200 a month and cannot afford insurance. The clinic performed some tests and prescribed Ms. Kious the pills. But they also told her that she had Stage 2 cervical cancer. As of now, the condition remains untreated. She and her boyfriend even considered getting pregnant so that she would automatically qualify for Medicaid.

“It’s scary for me, having cancer and knowing I can’t do anything about it,” said Ms. Kious, her hair in an elaborate plait. “It’s an I-don’t-know-when-my-next-meal-will-be sort of thing. It’s really difficult because health problems make you scared and emotional.”

This is the reality Fallin is creating in Oklahoma by turning down federal Medicaid money. She is doing this, not for any serious fiscal reasons, but because she delusionally believes that she is some sort of national political actor that anyone outside this state cares about. She does not strike any blow against Obamacare when she refuses this money: it will still exist and nothing she can do will ever make that change. This is just the grown-up version of an impotent temper tantrum. Unlike when a toddler does it however, Fallin’s move here will actually hurt a lot of people and the state more generally.

This was originally posted at OK4RJ.