The Daily Oklahoman du lieu suivant : Oklahoma City, Oklahoma • 7

THE OKLAHOMAN NEWSOK.COM TUESDAY, OCTOBER 23, 2012 7A NATION WORLD OKLAHOMA Coburn warns against Medicaid expansion ROCKS! BY CHRIS CASTEEL Washington Bureau ccasteelopubco.com GROUNDWATER Under the law, the federal government would pay 100 percent of the costs of the expansion for three years, starting in 2014. The federal aid would decline gradually, starting in 2017, until state taxpayers were responsible for 10 percent of the expansion costs by 2020. 2: OkUioMA Rocks! (WrtAtiftkY TitfTni WASHINGTON Sen. Tom Coburn warned Gov. Mary Fallin on Monday against expanding the federal -state health care program for the poor, saying greater eligibility for Medicaid could cost taxpayers more, crowd out private insurers and reduce the quality of health care.

In a letter to the governor, the Muskogee Republican said that focusing on managing the state's current program, SoonerCare, rather than expanding it, would be more "responsible and compassionate." The expansion of Medicaid eligibility to those with incomes up to 133 percent of the federal poverty level was part of the 2010 health care law. Under the law, the expansion was mandatory. However, the U.S. Supreme Court ruled in June that the federal government couldn't force states to expand Medicaid as a condition for participating in the program. Some states, including Texas, have come out against expanding the pro -gram, while others have announced they would increase eligibility.

In Oklahoma, the Legislature and governor would have to approve an expansion. Republican presidential nominee Mitt Romney has said he would approve repealing the health care law if elected, though repeal would have to clear both houses of Congress. Alex Weintz, a spokesman for Fallin, said Mon- day, "The governor's office has received the letter. Governor Fallin appreciates and values Senator Coburn's input. As she has said in the past, the governor does not plan to announce any decision regarding Medicaid expansion until after the election.

She does, however, share Senator Coburn's concern that any expansion could result in additional costs to taxpayers and to the state of Oklahoma." What's at stake Under the law, the federal government would pay 100 percent of the costs of the expansion for three years, starting in 2014. The federal aid would decline gradually, starting in 2017, until state taxpayers were responsible for 10 percent of the expansion costs by 2020. Coburn, a physician who has treated Medicaid patients and is a leading critic of the health care law, said Oklahomans would still be picking up part of the costs of the expansion in the early years since they are also federal taxpayers. The expansion is expected to cost $1 trillion over a decade, he said. Moreover, he said, budget pressures could force the federal government to reduce the share it is promising.

Accepting the federal government's deal would also give Washington more control over the state program, Coburn told Fallin, at a time when states should be given more flexibility. The expansion also could shift people now on private insurance to the government program, Co-burn warned, and ultimately lead doctors to quit seeing more Medicaid patients because of low reimbursement rates. Research has shown Medicaid patients experience "lower health outcomes" than those on private health insurance, Co-burn wrote. Expanding SoonerCare to the new federal guidelines would make about 200,000 more adult Oklahomans eligible for the program, state health care authority officials have said. If the state were to expand eligibility, single adults making up to $15,415 would qualify, and a family of three would qualify with a household income at or below $26,344.

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