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When Oklahoma voters choose a governor in November, they'll be voting on the future of SoonerCare

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The Governor's Office
Oklahoma Gov. Kevin Stitt (left) and State Secretary for Health and Mental Health Kevin Corbett (right) speak at a press conference in June 2022.

The contentious governor’s race includes plenty of hyper-partisan issues. But StateImpact’s Catherine Sweeney reports, one of the candidates’ major disagreements doesn’t fall along party lines. The winner will decide what health care looks like for more than one million Oklahomans. Catherine talks with StateImpact editor Logan Layden.

Layden: Okay. Catherine, where does this 1 million number come from?

Sweeney: That’s about how many people are enrolled in Oklahoma’s Medicaid program, which we call SoonerCare. And most of them are kids. Two-thirds of the children in Oklahoma are enrolled in SoonerCare.

Layden: And that program is becoming an issue in the governor’s race. Why is that?

Sweeney: It’s becoming an issue because one of Stitt’s policy proposals — one of the cornerstones of policy throughout his administration — has been really fundamentally altering Medicaid. He wants to basically partially privatize it, bring in private health insurance companies. Joy Hofmeister, the Democratic candidate, she doesn’t want to change it fundamentally. She wants to invest in it as it exists now. Managed care, which is what Stitt is wanting, that’s actually more of the norm across the country. A vast majority of people who are enrolled in Medicaid in the United States are in some form of a managed care program. But the current model that they’re considering has been very unpopular among the medical community, among native tribes. Joy Hofmeister, in opposing that, has nabbed some endorsements.

Layden: So can what is managed care and how is it different from what we have now?

Sweeney: I’ll start with what we have now. Let’s say I have strep throat and I need to go to the doctor. And instead of me getting a bill, the doctor sends a bill to the state Medicaid agency and they pay that doctor directly. It’s called fee for service.

So with managed care, instead of the state directly paying doctors and hospitals and urgent cares and everyone for exactly what it is they do for each service, the state would bring in these private health insurance companies. Each Medicaid member would kind of do what happens when you start a new job. If you’re full time, you get all these options. You say, OK, I’m going to pick this plan. Every year, the state would set how much each of those insurance companies gets per person enrolled. I am not really great at mental math, so let’s just say 100,000 people pick Aetna. Let’s say that they have a contract, and we give that company $1,000 per member. That would mean every year they get $1,000,000, and that is to cover health insurance and health costs for all of those members. So the idea is the better they manage that care, the more they invest in preventative care, the healthier they keep these people, the more of that million dollars they get to keep.

So there’s one example that supporters always give. Somebody has a heart condition and their air conditioner goes out and they can’t afford to replace it. Extreme heat can exacerbate heart problems. It could make them have a heart attack, all these things. So supporters of managed care would say federal regulations won’t let the state Medicaid agency go around buying air conditioners, but these insurance companies would have that flexibility. And there’s a lot of things like that that they could be able to do that address what health experts and policy experts are calling social determinants of health. So all the stuff that happens before you ever get to the doctor, the food you eat, how safe your housing is, access to housing. And states that have implemented this program well, they have connected people with social services or housing nonprofits that can help them secure housing. Something that an opponent would point out is just because they’re capable of doing that doesn’t necessarily mean they will do it. And other states, these insurance companies are in multi-million dollar lawsuits for spending money inappropriately. There’s a debate over whether it could be a good idea or not. And then there is a debate over whether in practicality, it would be a good idea or not.

Layden: And just again, we’re voting in just a few days. Who is for managed care and who’s against it?

Sweeney: Okay. So Governor Kevin Stitt is for managed care. His argument is — and this is true — that Oklahoma has horrible health outcomes. We are consistently in the bottom five. His argument is if we invest more in Medicaid, we do more of the social determinants of health investment. These million people could get healthier and that would drive our outcomes up. What Joy Hofmeister is arguing is that it would not do that. She’s saying that that’s really just funneling money to these insurance companies that are have a track record in other states of kind of sometimes fleecing the state government. That what we should be doing instead of investing and giving money to private health insurance companies, we should be investing directly in our state’s hospitals and our doctors and our urgent cares.

Layden: StateImpact’s Catherine Sweeney. Thank you.

Sweeney: Thanks.

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Catherine Sweeney reports for StateImpact Oklahoma, focusing on health.
Logan Layden is a reporter and managing editor for StateImpact Oklahoma.