Oklahoma House of Representatives
October 30, 2003

By MIKE W. RAY
House Media Division Director
OKLAHOMA CITY -- The health care infrastructure in rural Oklahoma will continue to deteriorate unless the State of Oklahoma helps communities and counties staunch the financial hemorrhage.

That was the heart of a presentation Thursday to a House appropriations subcommittee on health and social services by Opportunity Oklahoma. The meeting was directed by Rep. M.C. Leist, D-Morris, the subcommittee chairman. The presentation was requested by Rep. Bill Mitchell, D-Lindsay, chairman of the House Committee on Appropriations and Budget.

Founded by former state finance director Tom Daxon, Opportunity Oklahoma is a private sector organization that focuses on economic development and provides research assistance to legislators and others who are working to improve the state economy.

Steve Anderson, research director for Opportunity Oklahoma, asserted that access to medical care is vital to the economic health of rural Oklahoma. "No hospital means limited potential," and certain industries such as meat packing plants require emergency care access, he explained.

Continued deterioration of the rural health care infrastructure has a "two-pronged effect" on local health, said Anderson, a native of Oberlin, Kan., who was a budget analyst in the Office of State Finance for two years when Daxon was the state finance director under then-Governor Keating. Reduced access to emergency care places all local residents at risk, Anderson said, and preventive health care is not available, a situation that is "especially worrisome" for pregnant women and elderly citizens.

The difficulty in providing and maintaining adequate health care in rural Oklahoma can be attributed in part to the impact of Medicaid, the public health care program for indigent citizens. Oklahoma devoted $2.45 billion in state and federal funds to Medicaid programs in Fiscal Year 2003, ledgers reflect.

Despite an outlay of that magnitude, though, hospitals, for example, are reimbursed only 60 percent, on average, of the total costs they incur when treating a Medicaid patient, Anderson said; nevertheless, they cannot refuse to provide medical care when it is required. And many needy citizens go to a hospital emergency room for most or all of their health care requirements, even routine matters, he noted.

Similarly, an excessive number of Medicaid patients -- 20 percent or more of the patient base, Anderson said -- can jeopardize the solvency of nursing homes. Because of the bureaucratic "red tape" and the relatively low reimbursement rates, many dentists will not accept Medicare and/or Medicaid patients. Of the 2,050 dentists registered to practice in
Oklahoma, only 359 have contracts with the state Health Care Authority to treat Medicaid patients, according to agency spokesman Nico Gomez.

Increasing Medicaid reimbursement rates to physicians, hospitals and other health care providers would help stem the erosion of rural health care, Anderson and Daxon said. They also suggested using local sales and/or property taxes to
attract additional federal matching aid for health care. According to Anderson, 71 of Oklahoma's 77 counties earmark ad valorem taxes for operation of a county health department, and 26 municipalities and counties support hospitals with local sales taxes.

For every $1 that Oklahoma devotes to Medicaid programs, the federal government currently contributes $2.78, Gomez said. Raising provider reimbursement rates would require a waiver from the federal Center for Medicare and Medicaid Services. The Health Care Authority would need permission from the Legislature to seek such a waiver.
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