The administration of President Lyndon B. Johnson seemed to have been somewhat sympathetic toward the health care reform in 1965, as Johnson signed a bill that amended the Social Security Act of 1935. One part established hospital insurance for the aged, as well as supplementary medical insurance. The other part provides for federal medical insurance for those in the U.S. who lack the means to afford services in the private health care industry.
Medicaid was one of many Great Society programs enacted by the LBJ administration, and during that era, Johnson conveyed to the nation it was possible to afford both the expense of social programs and the expense of the Vietnam War. He used the phrase “guns and butter” when he told America he felt it was possible to fund defense and domestic industries without drastic cuts.
Congress, however, made the ultimate choice between “guns and butter,” and refused to pass a tax increase unless Johnson made substantial cuts from the proposed domestic spending agenda. Federal spending for social programs increased from $54 billion in 1964 to $98 billion in 1968. According to the Congressional Budget Office, Medicaid spending accounts for around 10 percent of the federal budget. And while the states do not spend the same amount of tax dollars for Medicaid, some have opted to not participate in Medicaid expansion.
In 2012, following the U.S. Supreme Court’s ruling on the constitutionality of the Affordable Care Act, then-Gov. Mary Fallin of Oklahoma refused Medicaid expansion, as the concurring opinion of the court gave the states the choice to opt out of the provision that provides health care to anyone in a household earning up to 133 percent of the federal poverty level. Fallin said the Medicaid expansion would be unaffordable for Oklahoma, and also denounced tax credits – which the ACA provides so eligible Americans could afford private health insurance – as federal government overreach.
The Kaiser Family Foundation estimates there are 142,000 uninsured Oklahomans, and over 50 percent fall within the Medicaid coverage gap. President Barack Obama signed the ACA to include Americans who would otherwise not have been covered by Medicaid, yet the 2012 U.S. Supreme Court decision’s flexibility, and Fallin’s unwillingness to budge on Medicaid expansion, means there are now over 80,000 uninsured Oklahomans within the Medicaid coverage gap. According to U.S. Census data, 14.2 percent of Oklahoma residents were uninsured in 2017, and the national average of uninsured persons in the U.S. for 2017 was at 8.7 percent.
It is an unfortunate situation in Oklahoma when billions of dollars in federal funding could benefit so many people, and at the same time, Oklahoma taxpayers have been footing the bill for Medicaid expansion in other states. In 2016, it looked as if Oklahoma might be on the receiving end of Medicaid expansion, but the state House did not have enough votes to approve what would have been a regressive tax on tobacco. Deposited funds would have been channeled into state agencies that receive federal matching funds under the Social Security Act, including Medicaid. Oklahoma’s Democratic lawmakers were not satisfied with the measure, as it lacked any provision that would have expanded Medicaid.
On April 19 this year, it seemed as if Medicaid expansion in Oklahoma had been given a new lease on life, as a ballot initiative was filed with state Supreme Court approval. If our state lawmakers cannot find the remedy to provide health care for tens of thousands of Oklahomans, this plebiscite offers an alternative solution. Remember that in the final analysis, the cost of Medicaid expansion that former Gov. Fallin was so concerned about will ultimately be outweighed by a healthier Oklahoma work force, not to mention the number of medical bankruptcies that will decrease should this initiative pass. The state of Oklahoma can certainly afford both guns and butter.
Brent Been is a Tahlequah educator who is currently teaching at Alice Robertson Junior High in Muskogee.