McEntire moves against Managed Care of Medicaid expansion, Stitt stays solid, and the End is near
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Published: 18-Apr-2021

Pat McGuigan 

Special to the Southwest Ledger: 
https://www.southwestledger.news/news/mcentire-moves-against-managed-care-medicaid-expansion-stitt-stays-solid-and-end-near

Oklahoma City – On July 1, voter-mandated Medicaid Expansion to more Oklahomans will begin. Expansion comes in the context of a state government health system that already draws down around one-fourth of state government spending. 
The ballot initiative to expand Medicaid (State Question 802) passed, barely. But in its name, many powerful forces are aligned to assure that the status quo in Oklahoma health spending gets on steroids, rather than face greater oversight as envisioned in the Managed Care (SoonerSelect) plans of the state’s chief executive and his ally in charge of the Oklahoma Health Care Authority.
As his weapon of choice against the plan from Governor Kevin Stitt, state Rep. Marcus McEntire, R-Duncan, employed a not-so-venerable avoidance of customary deliberation about the details of proposed new laws.

Senate Bill 131 originated in a proposal from Senator Jessica Garvin, also a Duncan Republican, as a 15- page outline for adapting, in light of experience in recent years, the state’s laws governing “the sale, manufacturing or packaging of dangerous drugs.”

On April 8, in the House Public Health Committee, McEntire transformed S.B. 131, turning it into a plan to expand Medicaid without meaningful oversight. He did this through an “amendment” to strike “the Title, the Enacting Clause, the entire bill, and by inserting in lieu thereof” an entirely new proposal.
McEntire gave his old-new idea a nice title, garnered the necessary votes and continued on his mission.
Referencing Big Medicine’s attack on Oklahoma’s envisioned “SoonerSelect” system for management of expansion, Rep. McEntire says he is as anxious “to hear what the state Supreme Court has to say.” But just in case the state High Court (with an unfortunate history of slamming down some parts of our chief executive’s agenda) didn’t get the memo, McEntire is ready to undercut the most reform-minded governor of Oklahoma since the 1990s.

Managed Care a ‘Hold-up?’

McEntire is not alone.

Kandice Allen, CEO at Share Medical Center, wrote in an opinion piece for Alva Review-Courier (April 4), “The timing of the governor’s plan is a recipe for disaster for vulnerable Oklahomans, health care providers and hospitals who rely on the stability of SoonerCare.”
There it is. Oklahoma’s early move toward voter-mandated Medicaid Expansion, to include Managed Care policies drawn from practices already regnant in the vast majority of the 50 states, is allegedly a “hold-up” (the term widely promoted by Big Medicine’s leadership) – akin to a robbery.

This righteous rhetoric comes from a no-doubt caring and professional representative who is part of an industry which has some capable people who work hard each and every day of each and every year to ... hide the ball.
How do they hide the ball? I could count the ways, but here is a notable high-tech example.

Kaitlyn Finley, health care analyst with the Oklahoma Council of Public Affairs (OCPA) recently wrote a superb distillation of an important investigative report from The Wall Street Journal:
“As of January 1, 2021, hospitals are required to publish online their negotiated prices with all payers, including insurance companies, for many common services and procedures in accordance with federal regulations put forward during the Trump administration.”

Understanding Embedded Codes

But Finley reports that the trio of Journal reporters found that “a special embedded code” prevents “Alphabet Inc.’s Google and other search engines from displaying pages with the price lists, according to the Journal examination of more than 3,100 sites.”

The Journal reported, “The code keeps pages from appearing in searches, such as those related to a hospital’s name and prices, computer-science experts said. The prices are often accessible other ways, such as through links that can require clicking through multiple layers of pages.”
And so it goes. CEO Allen declares that if Stitt and OHCA don’t back down, “the House and Senate can simply vote to withhold Medicaid funding” for what she deems a “privatized system.” Rep. McEntire’s proposal is aptly deemed a “Hail Mary,” while the Big Medicine lawsuit to strangle Managed Care is perhaps an even bet (despite the magisterial argumentation of the executive branch’s lawyer before the justices).

An inconvenient truth: Everyone involved in American health care in 2021 knows that the entire structure of the contemporary system whether or not something is deemed “private” is laced with rapidly rising costs, subsidized by federal dollars (read: money extracted from the private sector through taxation).
Yup, even though some defenders of the status quo won’t like me saying so –  as related in the previous installment of this series -- we “already have socialized medicine.”
The question is what can be done to make the current system more efficient, more transparent and more beneficial to all of us, and perhaps slightly less accommodating to financial pressures coming from “nonprofit” hospitals whose annual return could make at least some private sector CEOs blush.

After some bumps and bruises, Governor Kevin Stitt is still popular 

An online dispatch from The McCarville Report – named for the venerable Mike McCarville, radio icon of fond memory – included this:
“A recent survey by Amber Integrated measured the opinions of Oklahoma voters on several issues, and they seem to continue to support Governor Kevin Stitt. The poll shows Stitt has an overall approval rating of 53 percent. Among Republicans, his approval rises to 70 percent and 60 percent among Independent voters. Of the Democrats responding, only 27 percent gave Stitt an approval rating.” 
Over all, not too shabby for a guy who has rattled the cage since Day One.

When the governor and Kevin Corbett at the Oklahoma Health Care Authority announced their plan to create a managed care system for voter-mandated Medicaid Expansion, the chief executive said, “A healthy Oklahoma is a prosperous Oklahoma. As leaders we have a moral obligation to make life better for the people that we serve.”
Stitt is not out on a limb. Forty states partner with Managed Care Organizations (MCOs) to administer some or all of state-run Medicaid programs.
In an overview, Medicaid Health Plans of America put a fine point on available data with this nugget: “69 percent of all Medicaid beneficiaries receive their care through MCOs. (That’s ac- cording to KFF – also known as The Henry J. Kaiser Family Foundation. That American nonprofit organization – headquartered in San Francisco – goes by the KFF these days to, among other things, avoid confusion with Kaiser Permanente.)”

Stitt is in the mainstream of American governors who seek a managed care framework to promote better health outcomes and ameliorate some tax burden. He is trying to manage an ever-burgeoning portion of the Oklahoma state budget.
However, some spots on the tree of Republican support for his move have had some bark stripped away, as witness the actions of McEntire and colleagues.

Previously, I described the ultimate result of this particular debate as a “jump ball” in a game that intensified in the midst of March Madness. 
In an effort to promote understanding of what is in play, I turn again to a hopefully instructive story.

Back Then, and Right Now: Cui Bono? 

Back in the Reagan era in Washington D.C., I learned from Paul Weyrich that a modern usage for an old term traditionally applied to criminal cases. These days, it can inform a study of political players in high-stakes fights.
The term, in Latin, is: Cui Bono? In plain English, “Who benefits?”
Weyrich often said, “there is always more to the story than meets the eye.”
This seems truer as government gets bigger and bigger, and Big Media scrutiny of actions from Big Government gets weaker and weaker, as more and more players figure out how to hide the ball, as government at all levels becomes less transparent, and as more reporters become selective in the ways they use existing tools.

Another Weyrich tale. I once went with him to a meeting with a “K Street Bandit.” That street is the traditional home of powerful private sector interests interested in growing government. The “bandit” term was and is used to describe at least some of those who labor (for hundreds of dollars per hour) at firms with high-powered lawyers, public relations/communications expertise and a habit of lobbying the government for ... increased taxation along with mandates guiding more tax money to their firm(s).
Weyrich was a small-government guy, but the man we visited was his friend.

Despite profound differences on a range of cultural and political issues, they had been pals for several decades. From time to time, they would call on each other for counsel, with no money exchanging hands.

Weyrich had been asked, by a supporter, to help push a certain bill. So, he asked his K Street friend to study the massive bill and give him an honest opinion.
When we met, the old fellow paged through the legislation. He told Weyrich: “This is terrible public policy.” He added with a grin, concerning his own interests, “But it will be good for business.”
Paul decided not to engage in the battle that lay ahead.

McEntire’s proposal, at a comparatively modest three pages when it cleared committee in early April, is terrible public policy. Republicans should oppose it, but some won’t.

If it passes, Governor Still should veto it, and he probably will.
As summer nears, we’ll see who wins this round of the Big Fight.

In that sense, the end is near, but the story won’t be over.

NOTE: Oklahoma journalist Pat McGuigan has been reporting on the Oklahoma rollout for voter-approved Medicaid Expansion. The analysis first appeared in The Southwest Ledger, April 15, 2021 print edition and online: https://www.southwestledger.news/ . Southwest Ledger, 7602 US Highway 277, Elgin, OK 73538, (580) 350-1111. It is reposted here with permission. 

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