Three years ago, a central provision of the Affordable Care Act kicked in – the option for states to expand their Medicaid programs for the low-income uninsured via a substantial infusion of federal funds. While 31 states and Washington D.C. have expanded coverage to date, Oklahoma is one of 19 states still taking a “wait and see approach.”

The time for wait and see is over. A new report from the Henry J. Kaiser Family Foundation has surveyed dozens of studies and found that expanding coverage yields significant coverage gains, grows access to care and utilization of health services, and improves state economies. Here are the report’s main findings:

Expanding coverage results in lower uninsured rates: This is the most common-sense of the report’s findings, but one that bears repeating. As we’ve written before, the gap in uninsured rates between expansion and non-expansion states is widening, effectively creating two-tiered access to health care depending on state politics. As a result, Oklahoma’s non-elderly uninsured rate is second only to Texas and tied with Georgia – both states that have refused to expand coverage.

This is the most common-sense of the report’s findings, but one that bears repeating. As we’ve written before, the gap in uninsured rates between expansion and non-expansion states is widening, effectively creating two-tiered access to health care depending on state politics. As a result, Oklahoma’s non-elderly uninsured rate is second only to Texas and tied with Georgia – both states that have refused to expand coverage. Expanding coverage increases access to care and utilization of health care services. Although in some cases it may be too soon to determine the exact effects, it appears that expanding coverage leads to improvements in access to care, as well as utilization of important services such as cancer screenings. The study cautions that some states may see reported health status decrease as individuals previously lacking access to medical care discover that they may be less healthy than they thought – but increasing diagnoses of chronic medical conditions with coverage expansions is a feature, not a bug. With access to health coverage, the newly-diagnosed will be better able to manage those conditions rather than discovering them only when symptoms have gotten much worse.

Although in some cases it may be too soon to determine the exact effects, it appears that expanding coverage leads to improvements in access to care, as well as utilization of important services such as cancer screenings. The study cautions that some states may see reported health status decrease as individuals previously lacking access to medical care discover that they may be less healthy than they thought – but increasing diagnoses of chronic medical conditions with coverage expansions is a feature, not a bug. With access to health coverage, the newly-diagnosed will be better able to manage those conditions rather than discovering them only when symptoms have gotten much worse. Expanding coverage has positive effects on multiple economic outcomes. The Leavitt Report commissioned by Governor Fallin estimated that expansion would save the state hundreds of millions of dollars, a finding that is borne out by the experience in expansion states. Although half of expansion states have seen faster enrollment than predicted, two-thirds have found that per member per month costs are at or below expectations. In addition, expansion states have seen reductions in uninsured hospital visits and uncompensated care costs. By comparison, uncompensated care remains a big problem in Oklahoma, where hospitals and safety net providers are struggling to stay in business while caring for large numbers of uninsured patients.

This spring, Oklahoma’s leadership finally indicated a willingness to move forward with expansion via the Medicaid Rebalancing Act of 2020. Although that attempt fell short, lawmakers’ willingness to consider the option was a promising sign, and Governor Fallin has since reaffirmed her support for the measure — if the Legislature leads the charge. As this report shows, they should have every reason to champion this common-sense solution for Oklahoma.

Oklahoma’s fraying health care safety net can’t carry its current load, and multiple agencies are one more revenue failure away from catastrophic cuts. However we decide to go about accepting federal dollars — a riskier, bureaucracy-heavy Indiana model, a private option like Arkansas, or a straightforward expansion of SoonerCare — it will bring with it tremendous opportunity for badly-needed investments in the health of Oklahoma.

Despite naïve talking points to the contrary, the Affordable Care Act and the coverage expansion it offers are here to stay. Oklahoma has the opportunity to bring more than a billion dollars in federal funds home and improve quality of life for thousands of Oklahomans. As long as we refuse that money, Oklahoma is only harming itself.