In the last five years, the number of Oklahomans receiving health care help through Medicaid has increased by almost one-third.
Just over 1 million were listed as enrolled in what's known as SoonerCare or Insure Oklahoma for the 12-month period beginning July 2011.
"It's not been this huge growth in pregnant women," said Community Service Council Associate Director Jan Figart, referring to one group often getting medical help funded with public dollars. According to state health officials, SoonerCare covers about two-thirds of all births in Oklahoma.
"We're not having more pregnancies. That's relatively stable. What you see is, when families can't afford healthcare for anyone else, they'll make sure their kids are covered," said Figart.
The state numbers seem to at least back up the idea that young people rely on Medicaid more than others: just over 60 percent of all Medicaid recipients were under 21 during the 12-month period beginning July 2011, according to state health authorities.
Medicaid is and isn't many things. The safety net combines federal and state public funds to help specific populations, like low-income pregnant women and children from poor families.
However, most low-income working adults don't qualify for Medicaid. Often, that leaves them without any kind of insurance.
Dr. Gerard Clancy, president of the University of Oklahoma-Tulsa, recalled when OU opened up what's known as its Bedlam clinic, which offers health care to the uninsured and underinsured.
"We opened in the summer of 2003. And the first individual I saw was a laborer who had had a separated shoulder for the past four months. Shoulder out of socket, going to work every day," Clancy said.
In some states -- but not Oklahoma -- Medicaid expansion will kick in very soon as part of the Affordable Care Act, also known as Obamacare. In that plan, "most Americans with household income up to 133 percent of the federal poverty level" would be covered, according to the official Medicaid website.
However, Tulsa health care providers know that Gov. Mary Fallin and state leaders have declined to take part in such expansion, citing long-term costs and administrative expenses.
Figart's a leader with the nonprofit council, which has made family health care a focus since 1987. The council offers planning services and a "neutral table" for health care interests in Tulsa to come together, she said.
"We don't have a dog in the fight," Figart said. But she spoke bluntly. At the state level, "we don't have the leadership," she said.
So, local health care agencies and hospitals are struggling to prepare for nationwide change that Figart explained will siphon away funds from how public health care dollars have traditionally been spent.
In the past -- and still currently -- hospitals received "special premiums" from the government for taking care of the uninsured, based on a formula that involves estimates of the numbers of people uninsured, Figart said. This is known as the Disproportionate Share Hospital program.
"But the thing is, under the Affordable Care Act, Disproportionate Share will disappear over a period of time," Figart said. "It will be cut in half by the time we get to 2016. That is going to be a critical problem for rural hospitals, in particular, but it's also going to have an impact on our urban hospitals that have been using Disproportionate Share to pick up the costs."
One growing group that uses Medicaid currently is older Oklahomans with "very minimal assets," Figart said.
"We're just a poor state. Many folks are coming into their retirement with no assets and no way of being taken care of, so they find themselves in the Medicaid system," Figart said.
Jim McCarthy, chief executive officer for Community Health Connection, oversees the business-side for clinic operations such as those at E. 3rd Street and S. Lewis Avenue.
He estimated that just under 40 percent of the clinic's patients are Medicaid eligible, "primarily pregnant women and children," he said.
But another 40 percent have no health insurance of any kind -- putting a financial strain on the clinic's resources, McCarthy said, noting that the clinic recently discontinued Saturday services to cut costs.
"Oklahoma is at the wrong end of the list for uninsured patients," McCarthy said.
He is an advocate for Medicaid expansion.
"The opportunity to make such a dramatic shift in accessibility for a population that is so at risk and so undertreated, underserved medically, just is a tremendous opportunity. It affects the business climate, it affects overall health," McCarthy said.
He said he didn't understand the reasoning behind the state's rejection of Medicaid expansion. "I'm at a loss as to how to find a way to explain why this makes sense from any kind of a fiscal responsibility standpoint."
Yet Oklahoma isn't alone. At least 20 states plan to reject Medicaid expansion, according to The Pew Charitable Trusts.
Figart said one hope for local health care providers lies in what are known as "waiver requests" involving Medicaid funds. She said Oklahoma in the past has been innovative in offering support for groups that need help, such as with its Insure Oklahoma program that funnels health care aid to "people who are unemployed temporarily -- they recently lost their job -- or who are self-employed." It makes use of a mix of employer resources, federal funds and money from the individual to provide health care coverage.
"Arkansas was planning on putting forth a program that looked like very much Insure Oklahoma," Figart said, describing how the federal government's response to such a waiver request "would have been a great signal" as to whether a program like Insure Oklahoma could perhaps be grown in lieu of Medicaid expansion. Currently, only about 36,000 Oklahomans receive health care coverage through Insure Oklahoma.
But state legislators in Arkansas have not moved forward with the idea, Figart said. It's unclear if Insure Oklahoma will survive after the state legislature here could not hammer out a way to continue to the program with state funds.
"January 1 is a key date. Insure Oklahoma has not at this time been approved" for federal funding, Figart said. "So it would not continue."
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