* Since this article was printed in the August/September 2020 issue, Oklahoma withdrew its Medicaid proposal.
Recently, I received one of those urgent emails beseeching me to take quick political action. You know how it goes. The email explains an issue, then it tells you to click to add your name to a petition or sign a template letter and enter your zip code so it can be sent to your Senators and member of Congress.
I’m usually happy to oblige, since all that’s required to fulfill my civic duty is to give a quick click. Often, I don’t even read past the headline. More money for the arts? Save the bees? Sure, why not? I can click for that.
Giving states “flexibility” means giving them greater freedom to make cuts when the money runs out, by doing things like restricting or eliminating funding for services traditionally covered by Medicaid.
The alerts with template letters usually ask you to write your own original version. But I never do, because it doesn’t withstand my rigorous cost-benefit analysis. I figure I’m going to get the same canned response from my Senators and member of Congress, whether I spend hours researching and composing a letter or half of a second clicking.
Sometimes, just reading the alert headline is enough to convince me not to click. I immediately decline if the headline begins with, say, “Tell Mitch McConnell.” I know that’s a total waste of time because Mitch McConnell will never do anything that has the taint of common sense and decency. Even though it only takes a half of a second to click, that’s a half of a second of my life I can’t get back.
This latest action alarm was sent out by The Arc, a national organization with more than 600 local chapters that advocates for and serves people with intellectual and developmental disabilities. It concerned a dubious effort being undertaken by the state of Oklahoma. Normally, just seeing the word “Oklahoma” would be enough to move me to issue a firm and resolute oppositional click (and maybe even to write an original letter). But I read on.
The alert was about Oklahoma’s dangerous new plan for administering Medicaid dollars and services, for which it is seeking federal approval. The plan is ironically called the Healthy Adult Opportunity Demonstration Waiver.
The email said the waiver “creates a precedent with nationwide implications” by putting a “per capita cap” on some of that state’s Medicaid spending. The idea is also known by other names, such as block grants. But whatever you call it, the idea is the same.
The alert also said, “In addition to the per capita cap, the Oklahoma proposal includes several provisions that would make it harder for people to get coverage and easier for people to get kicked off. [It] severely limits access to nonemergency medical transportation, limits the benefits available, and raises premiums and co-pays on low income beneficiaries.”
The email urged me to submit comments on the Oklahoma proposal to the Centers for Medicare & Medicaid Services (CMS), urging them not to give Oklahoma the go-ahead.
In January, CMS unveiled what it calls the Healthy Adult Opportunity initiative. This is a federal program that invites states that have expanded Medicaid coverage under the Affordable Care Act to design Medicaid pilot projects that operate under a per capita cap. In exchange, the state receives greater “flexibility” to design the program to operate within the financial constraints of the cap.
Giving states “flexibility,” in this context, means giving them greater freedom to make cuts when the money runs out, by doing things like restricting or eliminating funding for services traditionally covered by Medicaid.
That’s why any move toward per capita caps triggers action alerts like the one I received. It’s a sneaky way of beginning the process of cutting Medicaid into oblivion.
Medicaid has always been an open-ended program, where the state and federal governments share the annual medical expenses of each state’s Medicaid program. But a per capita cap means the state can spend only a fixed annual amount on Medicaid—if it’s not enough, well then some cuts will have to be made.
The idea of capping Medicaid, instead of keeping it open-ended, makes the squatter currently occupying the White House slobber. He’s tried unsuccessfully to convert Medicaid to block grants in his previous budget proposals. This was also a key part of failed GOP attempts to repeal the ACA.
Earlier this year, Oklahoma Governor Kevin Stitt declared that his state would be one of the first to apply for the federal government’s Healthy Adult Opportunity initiative.
“Our whole outcome is healthier Oklahomans and taking our population from one of the highest in uninsured populations to improve health outcomes in Oklahoma,” Stitt said.
Of course that is not what would happen.
Still, I was ambivalent about taking the action called for in the alert. First, it’s hard for me to believe that anybody at CMS cares what I think.
Digesting reams of comments seems like the kind of job that could be done easily and much more efficiently these days by a robot specifically programmed to be the ultimate über-efficient policy wonk. Feed my comments into its slot and within seconds it spits back out a canned response. It sure seems like my Senators and member of Congress do it like that.
But maybe, as I’ve been told, the people reading these comments are required to read them all before they can proceed. In that case, submitting a tsunami of comments might at least be a good political stalling tactic.
Perhaps the most effective way to accomplish this would be to submit a thousand pages of gibberish like, “To Whom It May Concern: Pooka lub crykma flaj mu trop cuolm blith. And furthermore, aelmok fwip mougabu.”
Or you could just let your cat walk across your keyboard and submit whatever that spells.
Another problem with submitting comments to CMS was that the deadline was only a few days away. I didn’t think I could craft even gibberish that quickly. I might have felt differently if I had a cat. I could get it all jacked up on catnip and turn it loose.
Well, in the end I wrote something up anyway. But, instead of wasting my time with CMS, I decided to send it to a much more empathetic audience.
And so, Dear Reader, if you would be so kind as to indulge me, here are my comments on the Oklahoma Healthy Adult Opportunity Demonstration Waiver.
“Dear CMS folks (or robots, as the case may be):
I’m writing to tell you that the Oklahoma Healthy Adult Opportunity Demonstration Waiver really stinks. But I can’t believe that you need me to tell you that. Can’t you see that it comes from the government of the state of Oklahoma?
And I also can’t figure how the hell either CMS or the government of Oklahoma thinks that by doing this you are creating a healthy adult opportunity. How does limiting how much you will spend on a person’s health care make them more healthy? Such math is mighty curious. (However, I suppose not paying for nonemergency medical transportation will increase the amount of healthy walking that Medicaid recipients get, since they will be walking a lot more often to the doctor’s office.)
But it’s heartening to see that apparently the people of Oklahoma are a lot smarter than their government. On June 30, 50.5 percent of the voters approved a ballot initiative that requires the state to expand Medicaid under the ACA.
That means about 200,000 additional adults in Oklahoma will now be eligible for Medicaid. Let’s hope this screws up the governor’s best-laid plans.. It’s clear that his citizens want Medicaid without all the “flexibilities,” whether he likes it or not.
In conclusion, let me say, pooka lub crykma flaj mu trop cuolm blith. And furthermore, aelmok fwip mougabu.”