Budget & Tax , Health Care

Trent England | December 11, 2017

Medicaid costs continue to rise

Trent England

By refusing to adopt the Obamacare Medicaid expansion, Oklahoma lawmakers stood up for the premise that Medicaid should remain a safety net for the most vulnerable, not an entitlement for able-bodied adults.

And yet Medicaid has been growing in Oklahoma nonetheless, eating up an ever larger portion of state spending.


The Oklahoma Health Care Authority (OHCA) administers the state’s Medicaid program. During last year’s budget debate, OHCA leaders again called for Medicaid expansion and threatened that, without it, most Oklahoma nursing homes would shut down. It was a craven claim, easily disproved, and both appropriations and total spending at OHCA actually went up.

In fact, Medicaid enrollment and costs have been increasing in Oklahoma for years. A higher percentage of Oklahomans are covered by either Medicaid or the related Children’s Health Insurance Program than in Texas, Kansas, Missouri, and a dozen other states. Looking at data from all states between 2000 and 2014, The Pew Charitable Trusts found Oklahoma had the 11th largest increase in state Medicaid spending as a share of the total state budget.

In 2008, the legislature appropriated $771 million to the agency. The agency had 410 staff and spent a total of $3.8 billion. OHCA last year had 556 staff, and (as shown in the chart below) received an appropriation of nearly $1 billion to support total spending of $5.6 billion. (Numbers come from Senate reports; the Governor’s budget book includes similar and additional data.)

OHCA has a critical mission. Medicaid was designed to be the safety net for those who are both poor and also disabled, elderly, or children. Oklahoma is spending more than ever on these programs. Both taxpayers (who foot the bill for every state and federal dollar) and service recipients deserve an honest conversation about these costs and an active consideration of reforms.

Trent England David and Ann Brown Distinguished Fellow

Trent England

David and Ann Brown Distinguished Fellow

Trent England is the David and Ann Brown Distinguished Fellow at the Oklahoma Council of Public Affairs, where he previously served as executive vice president. He is also the founder and executive director of Save Our States, which educates Americans about the importance of the Electoral College. England is a producer of the feature-length documentary “Safeguard: An Electoral College Story.” He has appeared three times on Fox & Friends and is a frequent guest on media programs from coast to coast. He is the author of Why We Must Defend the Electoral College and a contributor to The Heritage Guide to the Constitution and One Nation Under Arrest: How Crazy Laws, Rogue Prosecutors, and Activist Judges Threaten Your Liberty. His writing has also appeared in the Wall Street Journal, USA Today, Washington Times, Hillsdale College's Imprimis speech digest, and other publications. Trent formerly hosted morning drive-time radio in Oklahoma City and has filled for various radio hosts including Ben Shapiro. A former legal policy analyst at The Heritage Foundation, he holds a law degree from The George Mason University School of Law and a bachelor of arts in government from Claremont McKenna College.

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