Medicaid Expansion

Angels in the Outfield

Angels in the Out Fields - February 3, 2019

State Representative David Perryman

The 1994 film, Angels in the Outfield featured Danny Glover, Tony Danza and Chistopher Lloyd in a family sports fantasy that provided the answer to a young boy’s prayer and along the way engaged the services of a group of angels who helped the California Angels win a pennant and gave him the family that he had so desperately longed for.

I was reminded of that storyline this weekend during a Super Bowl commercial. The ad was for a wireless phone company but it was centered around Major League Football coach Anthony Lynn who had been asked to give a motivational talk to a group of First Responders. As he spoke to the Police Officers, Paramedics and Firefighters who had been gathered, he confessed to them that fourteen years earlier he had nearly died when he was hit by a speeding car as he walked across a street.

Unknown to Coach Lynn, several of the men and women who had responded to his 2005 accident had been assembled in the group to which he was speaking. For the first time since he was injured, he and those who had rendered aid to him were reunited. The emotional coach told the First Responders that he had been told that angels had helped him survive. He surmised through tears that these men and women were indeed those angels.

Across Oklahoma’s 77 counties there are a lot of “out fields.” We call them rural communities and long stretches of highways that at a moment’s notice may need first responders, paramedics and other emergency personnel. The people who need those “angels” are not just the citizens of rural Oklahoma. Visitors to rural Oklahoma hail from all corners of the state and nation as they engage in recreational activities, enjoy nature and attend hundreds of festivals, fairs and other events that represent the true history and heritage of our great state.

While there has been much news coverage about hospitals and emergency rooms closing across the state, the rate of insolvency and closure of Oklahoma’s ambulance services exceeds that of Oklahoma hospitals. More than 50 rural Oklahoma ambulance services shut down between 2003 and 2015 and the rate of closure has not slowed. When an ambulance service closes, that simply means that the territory becomes absorbed in the next closest service. Consequently, distances between ambulance services increase. When Oklahoma ambulance services suffer, so do the people who need them. It is no wonder that life expectancies in some rural communities are as much as 20 years shorter than life expectancies in more urban areas.

A May 11, 2018 Policy Brief by the National Rural Health Association provided the most concise illustration on the challenges facing EMS Services in rural America. 1) The cost per transport is higher in rural areas because the base costs of “maintaining readiness” are sunk costs. 2) With lower volumes there is less of a funding stream to offset costs. 3) Reimbursement rates by Medicare, Medicaid and private insurance are often based on call volume and therefore, in a vicious cycle, studies have shown that over 60% of rural EMS providers rely on volunteers for EMT-Intermediate or EMT-Paramedic staffing and over 70% report having difficulty in recruiting volunteers.

The statistic that is most injurious to rural emergency medical services is the demographic of rural Oklahoma. Oklahoma’s rural population is older, poorer and less healthy than urban Oklahoma. Therefore, when an ambulance call is made in rural Oklahoma, it is less likely that the patient is privately insured or can afford to pay for the services rendered. That “uncompensated care” is often the straw that breaks the back of a rural ambulance service.

There is a solution. If Governor Stitt, in some form or fashion, would accept federal Medicaid funds, $2.3 Million PER DAY would go to Oklahoma hospitals and ambulance services, thus preventing hundreds of Oklahoma EMTs, nurses and medical personnel from losing their jobs. It would not only sustain medical care in rural areas but also roll those dollars many times over through Oklahoma’s economy.

Rural Oklahoma is important to our state and residents and visitors there need “angels” just as urgently as do urban areas.

            Questions or comments, contact or 405-557-7401.

Economic Development and Health Outcomes

Economic Development and Health Outcomes - October 21, 2018

State Representative David Perryman

According to the Cecil G. Sheps Center for Health Services Research, since 2010, 89 rural hospitals across the country have closed leaving communities without healthcare. The study shows that five of those facilities are in Oklahoma communities like Frederick, Pawnee and Eufaula and mean that in rural Oklahoma there are 204 fewer hospital beds to treat patients who may not have the means to travel to the state’s urban centers for medical care.

That list is only the tip of the iceberg. Most every rural hospital in our state is operating on a shoestring budget. Many are teetering on bankruptcy and several like those in Sayre, Atoka, Antlers, Drumright, Ceiling, Fairfax, Prague and Stigler have either been declared insolvent, been placed in receivership or are currently operating under the supervision of a bankruptcy trustee.

The most recent closure occurred last week in Pauls Valley where 64 more beds were lost and area residents have to be transported to Purcell to the north, Sulphur to the south, Ada to the east or Chickasha to the west, assuming there is a functioning ambulance service available to make the trip.

There are a number of reasons for the current hospital and ambulance financial crisis. Insurance companies intercede with greater frequency and classify many more medical procedures to be outpatient procedures or otherwise substantially shorten hospital stays.

Decreases in the rates paid to hospitals by Medicaid and Medicare also impacts the facility’s bottom line.

Perhaps the most damaging issue faced by hospitals (and ambulance providers) arise out of what is called “Uncompensated Care.” In short, uncompensated care represents those services that are provided to a patient and for which the provider is not paid.

The primary reason that hospitals face the expense of uncompensated care is because a Reagan-era federal law requires that persons who are in need of treatment must be cared for without regard to whether they have insurance and without regard to their ability to pay.

Since the law applies equally across the entire country, one would think that hospital closures would be located consistently from coast to coast. The fact is that according to a study published in the January 2018 edition of the journal, Health Affairs, hospitals located in states that accepted federal dollars to pay Medicaid expenses for low income workers were six times LESS likely to close than in states like Oklahoma where federal funds were refused. Put another way, 90% of the nation’s hospitals that have closed since 2010 were located in states that had refused to expand Medicaid at the time that hospital closed.

The fact is that Mary Fallin is one of only 18 governors who have refused to allow Oklahoma to accept those federal funds. The other 17, like Oklahoma, are primarily in the southern U.S. The 32 states that did accept federal funds for Medicaid expansion have seen the uninsured rate drop by as much as 50%. Cutting the number of patients who cannot afford to pay for medical services by half is big in any state.

Other benefits include financially healthy ambulance services and medical related businesses that can only operate in the presence of a functioning hospital. Likewise, when more citizens are insured, the community enjoys healthier outcomes. But the most exciting part of Medicaid expansion occurs when a community’s economic development director can showcase the community to a potential business prospect and point with pride to a vibrant medical facility that can provide quality health care services to the CEO, his employees and to their families.

Questions or comments, contact David Perryman at 405-557-7401 or

Reliable Sources of Recurring Revenue

Reliable Sources of Recurring Revenue - March 27, 2016

State Representative David Perryman

According to an article on March 24 in the Oklahoman, Preston Doerflinger, Governor Fallin’s Secretary of Finance and chief budget planner said that the State of Oklahoma needs a new, permanent source of money to be a reliable source of “recurring revenue.” He was talking about taxes.

For you and me, a reliable source of recurring revenue is a job, preferably with benefits.

For Oklahoma’s rural hospitals that can’t turn anyone away and are required by law to treat anyone who shows up regardless of ability to pay, a reliable source of recurring revenue would be patients who could either pay cash or have some form of insurance to pay for care and treatment.

Some say that rural hospitals are businesses just like any other business; however, no business could survive if it was continuously required to provide services in excess of revenue.

So how bad is it? According to information released this week by the Oklahoma Hospital Association, 42 of Oklahoma’s 76 rural hospitals are at risk of closing as did hospitals recently in Sayre and Frederick. A number of other Oklahoma hospitals have filed bankruptcy.

The health care industry provides nearly 10% of Oklahoma’s jobs statewide. In rural communities the percentage of the total workforce is often greater because the hospital is an economic engine that allows clinics and a myriad of other health care product and service providers to locate in close proximity and work hand in hand.

The crisis does not end there. How likely is it that a rural community that has no hospital can recruit industry when competing with a community that does?

For nearly four years, Oklahoma has turned its back on accepting federal funding to provide Medicaid to working Oklahomans who earn between $9,500 and 138% of the federal poverty level. Remember, these are working Oklahomans whose employers do not provide insurance and who have no access to insurance coverage. Consequently they use the nearest hospital emergency room as their physician, leaving the hospital with more red ink in the form of uncompensated care.

In a March 26 editorial in the Tulsa World, Fred Morgan, President and CEO of the Oklahoma State Chamber suggested that Oklahoma “seek new sources of funding so that hospitals can continue to treat all of Oklahoma’s residents.” Mr. Morgan was not suggesting that rural hospitals open tire and lube shops in their vacant wings.

All but a dozen or so states are already accepting federal dollars. Oklahoma has a chance to do that. Accepting such funding will create more than 24,000 jobs across Oklahoma and will literally save tens of thousands more. Not only do those federal funds provide payments to hospitals and other medical providers, they also include coverage for mental health issues.

Making the situation even more critical is the fact that a bill in the State Senate will remove 111,000 Oklahomans who earn less than $9,500 per year and care for dependent family members from the Medicaid rolls, and as of last Friday, the Oklahoma Department of Mental Health and Substance Abuse announced that the care and treatment of more than 72,000 mentally ill Oklahomans would be cut back or terminated because of budget cuts.

With rural health care on life support, these dollars are essential. This reliable source of recurring revenue may be too late for the many hospitals that are closed, but the hospital they save may someday be the hospital that saves your loved one’s life.

Questions and comments are welcome. or 405-557-7401.