After the passage of State Question 802 last summer mandated the expansion of Oklahoma’s medicare to, “include those individuals over age 18 and under age 65 whose income does not exceed one-hundred thirty-three percent (133%) of the federal poverty level,” the Oklahoma Health Care Authority sent out Requests for Proposals (RFP) to private companies to help manage the Medicaid expansion in Oklahoma. After receiving those proposals, the OCHA then signed the contracts with several private managed care organizations (MCOs) to manage SoonerCare’s (Oklahoma’s Medicaid program) expansion without the Legislature having a chance to review the proposals or contracts.
In response, earlier this year the OHCA by the Oklahoma State Medical Association, Oklahoma Dental Association, the Oklahoma Osteopathic Association, the Oklahoma Society fo Anesthesiologists, Inc., and the Oklahoma Chapter of the American Academy of Pediatrics, Inc., alleging that the OCHA violated state law by attempting to, “implement a species of managed care not validly authorized by statute and without conforming to the requirements of the Administrative Procedure Act.”
Though the contracts themselves have not been made available to the public, the RFP’s bring deep concern as to the direction that OHCA is taking SoonerCare…and for good reason. In an interview with Fox 25, Kevin Corbett, Governor Stitt’s appointed CEO of the OHCA, stated, “There is much work to be done and countless problems that must be fixed, but the first step to addressing any of these issues is to acknowledge they exist. As a white male, I have been ignorant for too long about the privilege I have been afforded due to the color of my skin and my gender.”
These views seem to have found their way into the RFP as to the expectations for what the MCO’s were to incorporate into their contracts. On page 193 of the RFP, under the section titled Cultural Competency, the contractors are required to, “develop a cultural competency and sensitivity plan for review and approval by OHCA at the time of Readiness Review. The plan shall include guidelines for evaluating and monitoring disparities in membership and service quality, especially with regard to minority groups.” In short, it is implementing the standards of Critical Race Theory to determine who gets service under the state’s Medicaid plans, and who doesn’t.
CRT’s influence is further see on page 189 of the RFP under the Health Disparities section, where it requires the contractor to, “maintain health equity representatives who are actively involved in improvement initiatives to reduce disparities.” So if you happen to be a struggling “white” Oklahoman that relies on SoonerCare to provide healthcare for your family, you could be discriminated against based upon those standards alone.
Sidestepping Abortion Bans
The RFP also, on page 154, would permit the funding of abortion along federal guidelines…not state guidelines. As such, SoonerCare would still be permitted to pay for abortions where rape or incest have occurred, regardless of whether the anti-abortion laws just passed by the legislature goes into effect on November 1st or not. By using the weaker language federal language for the “life of the mother exception” it allows doctors to perform abortions if in their judgement the believe that, “the life of the mother would be endangered if the fetus were carried to term.”
The language in the anti-abortion bills just signed into law require a much higher burden of proof for a doctor to use this exception. HB 2441, the “medical licensing bill” signed into law a couple weeks ago, stated, “an abortion may not be performed based solely on the mental or emotional health of the mother, notwithstanding a claim or diagnosis that the woman may engage in conduct which she intends to result in her death.”
The Legislature’s Solution
In addition to these concerns, members of the legislature have expressed deep concerns about what outsourcing SoonerCare to out-of-state MCO’s could do to healthcare costs in Oklahoma. In an interview Friday with Ignite Liberty, Senator Rob Standridge (R-Norman) pointed to nearby examples of what policies like this can do. “To believe the likely increase in costs to taxpayers, look no further than Texas or Kansas where the costs have skyrocketed since outsourcing to MCOs.” Meanwhile, Sen. Standridge pointed out that during that same period “Oklahoma’s cost per recipient has remained flat.”
To address this issue, Senator Jessica Garvin (R-Duncan) authored Senate Bill 131, the “Oklahomans Caring for Oklahomans Act”, which would immediately invalidate the contracts signed by the OCHA without the legislature’s approval, and would slow the rush for outsourcing SoonerCare. The Act requires the creation of a “program that controls costs and improves health outcomes for Medicaid recipients.”
The program does not come without its costs, as the estimated fiscal impact is in excess of $263M per year for the first 5 years. The money would go to, “continue building and sustaining infrastructure and maintaining a statewide staff…additional personnel, upgraded IT systems, data analytics, infrastructure needs, web portals/tools to reach members, etc.”
The price tag and new government program has caused some in conservative circles to balk. Jonathan Small, the President of OCPA (Oklahoma Center for Public Policy), has organized a rally next Tuesday against the passage of SB 131. In am email sent out Friday, Small claimed, “Instead of reforming Oklahoma’s Medicaid program and cutting waste from the medical welfare program—like Gov. Stitt’s plan would do—SB 131 would create a new government program that would cost up to $277 million and require hiring 1,200 welfare workers.”
Small also accused liberal Democrats and special interest groups of being behind SB 131, however the measure does have support from the vast majority of the conservatives in the legislature. Additionally, as has been pointed out by Ignite Liberty President, Bryan Armstrong, the Democrats lack the political power in Oklahoma to get anything passed.
SB 131 initially passed the Senate 45-0, and passed the House 73-17. The bill now heads back to the Senate for final approval. Due to changes in the bill from the original language, the vote is expected to be much closer the second time around.
The Big Question
Big question remain about the measure. For instance, who should be in charge of Oklahoman’s healthcare? Oklahomans or private out-of-state companies? The deep concern among conservative Oklahomans is that the out-of-state MCO’s will see this as a way of sidestepping the huge leaps that the Oklahoma Legislature has taken this term to eliminate abortion and Critical Race Theory from our state. From the looks of it, it appears like it is a concern that is well-founded.
However, is an expansion of state government a good idea? The conservative position is usually no, especially if the government is expanding in an area that it shouldn’t. However, the reality is that State Question 802 was passed by Oklahomans. The real concern is should healthcare be weaponized against conservatives, like disabled veterans, who need to use SoonerCare to provide healthcare to their families?
Would SB 131 increase the tax burden on Oklahomans? Yes. As has been seen in our neighboring states, allowing out-of-state MCO’s to manage SoonerCare will undoubtedly cause all Oklahomans healthcare prices to skyrocket, whether they use SoonerCare or not. Such policies can be devastating to any attempts to grow Oklahoma’s economy to the level that it can compete with for jobs and businesses with our neighbors to the south. That affects all Oklahomans in a very real way.
Perhaps the biggest question of all is if we, as Oklahomans, can afford to allow a state agency to bind the state to contracts which that agency had no authority to sign. Doing so would essentially invalidate the legislature’s authority and turn Oklahoma into nothing more than a massive bureaucracy where we are governed by unelected bureaucrats shoving their godless world views down our throats.
While all of these are an uncomfortable concepts, for most conservatives the latter is far more repulsive.