Medicaid reform could face heavy lifting
Capitol Report for dailies for week of April 9, 2006
By Jim Campbell
OPA Capitol News Bureau
Capitol Report for dailies for week of April 9, 2006
By Jim Campbell
OPA Capitol News Bureau
Lexington Democrat Cal Hobson said his Senate colleagues should "throw bouquets" to the Republican House chairs of a Medicaid reform task force for producing a bill, especially, he said, since they had to work under "crazy restrictions."
Hobson, former Senate president pro tempore, called the issue important enough to come back in special session, if necessary, and "stay until election time."
Sen. J. Paul Gumm, D-Durant, asked whether the goal was to "save money, or save lives?"
Senate author Tom Adelson, D-Tulsa, stripped 30 pages from the House version. In committee, he fended off an amendment to earmark a $93 million state appropriation for doctor and hospital reimbursement, to bring rates to the task force's goal of 100 percent of the Medicaid reimbursement rate.
House Bill 2842 ultimately was advanced by a unanimous vote by members of the Senate Appropriations Committee. But opinions about merits of various provisions were not shared unanimously, indicating further heavy negotiations may be needed before sweeping reforms proposed in House Bill 2842 become law. 
The restrictions Hobson criticized were the target set by House Speaker Todd Hiett, R-Kellyville, of finding $100 million in fraud and waste in the Medicaid system that could be redirected to health care services. 
The original bill was produced by Rep. Kris Steele, R-Shawnee, chairman of the House Health and Human Services Committee, and vice chairman Doug Cox, R-Grove. Before House passage, Steele said the task force had even exceeded the target savings.
Hobson noted the appropriations committee had burned a lot time during a long agenda on a vicious dog bill before it got to Medicaid.
"This is one of the three or four most important bills of the session," he said. "What to do?  Even if it calls for a special session, and I hope it doesn't, we should stay until election time."
Hobson said the Legislature acted 'irresponsibly" last year by opting for a state appropriation toward a federal Medicaid match over a voluntary fee proposed by hospitals.
"I appreciate that the rural hospitals live and die" on Medicare reimbursements," he said.
"We should throw a bouquet to Steele and Cox who produced a bill under crazy restrictions," he said. "Those ground rules were impossible."
Sen. Brian Crain, R-Tulsa, tried unsuccessfully to amend the bill to require that the $93 million appropriation go to doctors and hospitals, to achieve the 100 percent of Medicare reimbursement rate. That rate has been criticized as being too low.
"Then you don't intend to meet the 100 percent of Medicare rate?" Crain asked.
Adelson said he was "a little offended" that doctors and hospitals should have a proprietary right to all of the funds. They'd have a better argument for it if they had put up the money as proposed last year, he said. 
Where else should it go? Crain asked.
"How about access to health care, nursing homes, alternatives to long term care? There are more constituents out there than just doctors and hospitals," he said.
Gumm was concerned diabetic supplies coverage had been taken out.
 "They can take them out in the House but I'm not going to be a party to it," he said.
"Is the purpose to save money or to save lives? I maintain the purpose is to save lives." Gumm said the provider fee would "have solved the problem forever."
"Now we have to use smoke and mirrors," he said
Adelson called the $100 million savings "an eleventh-hour revelation."
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Steele says he is "intrigued" by the Massachusetts plan to mandate health coverage for all of its citizens.
"I'm personally going to do some further research on it," he said. "It's a bold step. It looks like they would treat health insurance like auto insurance. That's a debate I think warrants exploring."
Massachusetts had $380 million in federal matching funds for Medicaid at stake unless moved to cover more of the uninsured, whose numbers are similar to those in Oklahoma.
The Massachusetts law is the first in the nation that requires every citizen to buy medical insurance. It also requires businesses not offering health coverage to help cover the uninsured with a mix of state money, tax incentives, insurance subsidies and expanded government programs.
Hawaii is the only other state that requires employers to provide health insurance.
Republican Gov. Mitt Romney, a potential presidential candidate, indicated he would sign the bill.
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Oklahoma has 360 police chiefs with about an 80 percent turnover rate every year so, some leaving because they were never trained to deal with management problems that can lead to costly lawsuits, Rep. John Nance, R-Bethany, told the House.
Nance's SB 516 passed, 71-19, only after overcoming objections that it usurped local control.
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