8 minute read
ODA Talking Points Opposing Managed Care
Protect OK Patients. Oppose Managed Care.
ARE YOU GOING TO STAND WITH THE PATIENTS, HEALTHCARE PROVIDERS AND HOSPITALS IN YOUR DISTRICT, OR ARE YOU GOING TO STAND WITH PRIVATE INSURANCE COMPANIES? YOU HAVE THE AUTHORITY TO STOP THIS VERY EXPENSIVE MISTAKE – PLEASE USE IT NOW!
The governor and the lobbyists for the managed care companies are pushing A LOT of misinformation, but here are the facts:
MYTH: Patients will be the main beneficiaries of the new plan because of the emphasis on preventive care. FACT: Patients will be harmed as access and services are reduced or denied. The OHCA’s own actuarial advisor has said that to achieve cost savings under the managed care plan, Oklahoma would need to reduce services to Medicaid patients by up to 40%.
MYTH: Privatization will lead to more efficient spending of Oklahoma’s healthcare funding. FACT: SoonerCare is a national model with administration costs below 4%. Comparatively, the governor’s plan allows up to 15% in administrative costs for large insurance companies.
MYTH: Privatization will rapidly improve Oklahoma’s national health rankings. FACT: Oklahoma’s current health standings are closely tied to its rankings in housing, education, income, poverty and a lack of health insurance. Corporate middlemen cannot solve these societal causes. The members of the Oklahoma Dental Association support SB 131, the Oklahomans Caring for Oklahomans Act, which keeps Medicaid with the OHCA and directs the OHCA to implement their already-developed plan to identify trends, implement quality improvements and reverse unfavorable trends. This plan offers far greater hope for lasting changes than privatizing health care.
MYTH: The governor was within his authority to privatize Medicaid without legislative approval. FACT: The governor did not follow the Oklahoma Constitution which assigns budgetary duties to the Legislature. Medicaid will account for about one-fourth of Oklahoma’s next fiscal year budget, yet the Legislature and the entire health care community were not even consulted.
MYTH: All states who have expanded Medicaid have also privatized their programs. FACT: At least seven states that expanded Medicaid do not have privatized managed care.
MYTH: There have been safeguards put in place to avoid the problems managed care Medicaid faced in the 90s. FACT: The OHCA CEO and board members, as well as the governor, have all been asked repeatedly to explain those safeguards and no specifics have been provided.
MYTH: The governor’s plan has broad-based support. FACT: Opposition to the governor’s plan includes patient groups as well as EVERY group of healthcare providers and hospital in every part of the state.
MYTH: There is nothing the Legislature can do at this point to stop the governor’s plan because the contracts have been signed. FACT: The contracts with the insurance companies include two provisions that clearly give the Legislature veto power. One !!! instructs the OHCA to cancel the contracts if the Legislature does not appropriate the necessary funding. The other provision is even more direct – it says the contracts are terminated if the Legislature votes to prohibit them.
Protect OK Patients. Oppose Managed Care.
PLEASE ASSERT YOUR INFLUENCE ON BEHALF OF THE PATIENTS, PROVIDERS AND HOSPITALS IN YOUR DISTRICT! MANAGED CARE CANNOT HAPPEN WITHOUT LEGISLATIVE FUNDING AND YOU ABSOLUTELY HAVE THE POWER TO STOP MANAGED CARE MEDICAID IN OKLAHOMA!
• The ODA STRONGLY OPPOSES any attempt to move the Oklahoma Medicaid Program to a managed care system, regardless of legislative action or executive order. And we strongly support the OHCA continuing to administer the Oklahoma Medicaid program. • The ODA is part of a large coalition of EVERY other • The ODA STRONGLY OPPOSES any attempt to move the Oklahoma Medicaid Program to a managed provider group (doctors, nurses, hospitals, pharmacists, care system, regardless of legislative action or executive order. And we strongly support the OHCA optometrists, mental health, nursing homes, etc.) fighting continuing to administer the Oklahoma Medicaid program.managed care Medicaid. • The ODA is part of a large coalition of EVERY other provider group (doctors, nurses, hospitals, • Under Oklahoma’s previous experience with managed care, 90% pharmacists, optometrists, mental health, nursing homes, etc.) fighting managed care Medicaid. of Oklahoma’s dentist providers quit the program altogether and • Under Oklahoma’s previous experience with managed care, 90% of Oklahoma’s dentist providers quit the number of dentists left to see Medicaid children dropped to the program altogether and the number of dentists left to see Medicaid children dropped to less than less than 100 total Medicaid dentists in the entire state. This had a catastrophic effect on our most vulnerable children’s access to necessary health care. Parents, especially in rural areas, were having to drive hours just to get their child’s teeth cleaned. This will absolutely happen again. • Why did the dentists leave the program? The OHCA currently operates at a less than 4% administrative overhead. MCOs operate at an average of 15% overhead. The only two ways that managed care can save the state money while spending THREE TIMES more, are: 1) reducing provider reimbursements to less than the actual costs of providing the care; and 2) rampant denials of necessary dental procedures. • Dental MCOs make empty promises to maintain the provider reimbursement rates at current levels, but in every other state that operates under a managed care system, it has been a bait and switch.
They maintain current reimbursement levels for one or two years and then start significantly slashing rates every year after that. MCOs pay less than the actual cost of providing the treatment. Medicaid dentists do not see Medicaid patients to get rich. They do it because they care about the kids. But they can’t lose money. That business model is not sustainable. • If managed care Medicaid is implemented, oral surgeons will be forced to follow CMS rules and use
CPT medical billing codes to bill hospital-based procedures, which would be an estimated 65% less than current OHCA fees. This will force oral surgeons and Oklahoma’s only oral surgery training program at the OU College of Dentistry to immediately cease treating Medicaid patients. • MCOs will repeatedly tell the dentist that he can’t perform XYZ procedure because it costs too much, which means the doctor is not allowed to provide the health care he knows his patient needs, all in the name of “saving money”. The MCOs claim to be the solution to our low health grade, but how can that possibly be true when they routinely, as a business practice, deny the health care our doctors have determined their patients need? How can a private, out-of-state, for-profit insurance company know more than a patient’s doctor about what health care is needed? • How can sending $2.2 BILLION of our tax money to an out-of-state, private insurance company, that operates with significantly higher administrative costs, save money while maintaining the same level of care and the same number of dentists who provide that care? THE MATH SIMPLY DOES NOT ADD UP.
KCAPITOL CLUB
Dr. Jeffrey Ahlert Dr. Glenn Ashmore Dr. Douglas Auld Dr. Justin Beasley Dr. Brandon Beaver Dr. Tamara Berg Dr. Wesley Black Dr. Elizabeth Bohanon Dr. M. Edmund Braly Dr. C. Todd Bridges Dr. Matthew Bridges Dr. Steven Brown Dr. Adam Bulleigh Dr. Bonnie Burton Dr. Jamie Cameron Dr. Tricia Cannon Dr. Wuse Cara Dr. Bobby Carmen Dr. Cory Chambers Dr. Jennifer Chambers Dr. Llon Clendenen Dr. Adam Cohlmia Dr. Matthew Cohlmia Dr. Raymond Cohlmia Dr. Jeffrey Danner Dr. Russell Danner Dr. Susan Davis Dr. David Deason Dr. Steven Deaton Dr. Thai-An Doan Dr. Brian Drew Dr. Twana Duncan Dr. Heath Evans Dr. Timothy Fagan Dr. Christopher Fagan Dr. Barry Farmer Dr. Michael Gliddon Dr. Shannon Griffin Dr. Mark Hanstein Dr. Leslie Hardy Jr. Dr. Aaron Harman Dr. Richard Haught Dr. Robert Herman Dr. Jeffrey Hermen Dr. Marilyn Hiebert Dr. James Hooper Dr. Brad Hoopes Dr. Moiz Horani Dr. Donald Johnson Dr. Eugenia Johnson Dr. Krista Jones Dr. Michael Kirk Dr. Mitchell Kramer Dr. Robert Lamb Dr. Shannon Lewis Dr. Juan Lopez Dr. Gary Lott Dr. David Marks Dr. S. Ross Martin Dr. Mark Massaro Dr. Alan Mauldin Dr. Stephen Mayer Dr. Janna McIntosh Dr. Robert Miracle Dr. Mohsen Moosavi Dr. Paul Mullasseril Dr. Sam Owens Dr. Karen Reed Dr. Erin Roberts-Svob Dr. Brant Rouse Dr. Miranda Ruleford Dr. Robert Schick Dr. Paul Shadid Dr. Steffan Sigler Dr. Floyd Simon Jr. Dr. Jaymi Simpson-Wert Dr. Lindsay Smith Dr. Brooke Snowden Dr. James Steyer Jr. Dr. Braden Stoltenberg Dr. James Strand Dr. Steven Strange Dr. Jamie Talley Dr. Jim Taylor Dr. John Thomas Dr. Kara Tims Dr. Corbyn Van Brunt Dr. Jonah Vandiver Dr. Nathan Villines Dr. Robert Webb III Dr. Daniel Wilguess Dr. Rieger Wood III Dr. Paul Wood
OKCapitol Club is for that “ABC” group of DENPAC members; or those who want to be “ABOVE AND BEYOND CONTRIBUTORS.” OKCapitol Club members truly understand the importance of the ODA’s participation in the political process and want to support candidates who are committed to the state’s oral health and the issues that affect your practice. OKCapitol Club members support those efforts even more by contributing an additional $300 to DENPAC ($470 total) per year. For more information about Capitol Club, contact Lynn Means at 800-876-8890 or lmeans@okda.org.
DENPAC Grand Level
DENPAC funds our voice. Without our input, legislators are merely making decisions based on what sounds good, what makes the fewest people angry, or what is easiest for them. Whether you like it or not, the campaign contributions we make to dentistry-friendly candidates are what opens those lines of communication. It’s what reminds legislators once they’re in office to go directly to the ODA for information, and not somewhere else.
For more information about DENPAC, contact Lynn Means at 800-876-8890 or lmeans@okda.org.
THANK YOU TO THESE 2021 DENPAC
