Health care companies competing for one of the contracts to handle Oklahoma’s Medicaid program spent tens of thousands of dollars on lobbyists and campaign donations last year, while many of the health associations fighting against the effort increased their own campaign contributions to state lawmakers. 

Not every dollar or lobbyist meal can be directly attributed to the controversial program referred to as managed care. But money and influence flowed heavily from the companies and organizations at the center of a debate that is likely to continue in the months to come.

“It’s the most divisive issue in the state Capitol, has been for the last couple of years,” Senate Pro Tem Greg Treat said Thursday, speaking about the split within the state Legislature over managed care. 

Last month, state officials announced four private health insurance companies would be awarded shares of nearly $2.1 billion in health care contracts to operate Oklahoma’s Medicaid program.

“Partnering with these organizations today will represent one of the largest procured contracts in the state’s history, yet the amounts associated with it are staying right here in our state,” said Secretary of Health Kevin Corbett, speaking at a news conference to announce the contract winners.

Secretary of Health and Mental Health Kevin Corbett. BEN FELDER/The Frontier

The four companies awarded contracts have a business presence in Oklahoma but also represent some of the nation’s largest health organizations: Blue Cross Blue Shield of Oklahoma; Humana Healthy Horizons; Oklahoma Complete Health, which is a subsidiary of Centene; and United Healthcare.

Lobbyists hired by Health Care Service Corporation, which is affiliated with Blue Cross Blue Shield of Oklahoma, spent more than $6,100 on meals and events over the past two years, although each lobbyist also represented other clients, according to lobbying expense reports filed with the state.

Affiliated political action committees with Blue Cross Blue Shield also gave more than $63,000 in recent years, according to contribution reports.

Centene hired one of the state’s most active lobbyists and its political action committees gave $32,000 in campaign donations to Oklahoma lawmakers in just the last four months.

United Health’s political action committee increased its campaign contributions in 2020 with $16,000 handed out to several lawmakers. The healthcare company also has three lobbyists registered in the state.

The state Capitol dome in Oklahoma City. BEN FELDER/The Frontier

At least two other companies were competing for the contracts, including one that hired one of Gov. Kevin Stitt’s top policy advisers as its lobbyist.

In September, with the bidding window for Oklahoma’s managed care contracts weeks from opening, CareSource Oklahoma hired Samantha Davidson, Stitt’s policy director. Over the next several weeks, Davidson spent more than $3,200 on meals for lawmakers, the governor, and his staff.

WellCare, another company not awarded one of the contracts, donated $5,000 to Stitt and another $5,000 to his transition fund.

WellCare’s lobbyist spent more than $1,400 over the past two years on meals with lawmakers and the governor’s staff.

While the Oklahoma Health Care Authority has named the four contract winners, some members of the state Legislature continue to fight against the move to managed care.

Some lawmakers believe the Legislature can withhold funds for the program and legislation has been filed that would prevent Oklahoma from engaging in managed care without consent from the Legislature.

Sen. Kim David, R-Porter, who has been a vocal supporter of managed care and stood by the governor last month to announce the winning contracts, said she doesn’t believe there is much the Legislature can do to stop the program from taking place.

At last month’s news conference, David said her colleagues opposed to the plan don’t understand it, “and then I have several who stand to gain keeping the system the way it is.”

Sen. Kim David, R-Porter. BEN FELDER/The Frontier

David did not mention any lawmakers by name, and she was later censured for the remarks, but some of those opposed have business interests in the medical field. 

Sen. Rob Standridge, R-Norman, a pharmacy owner who in 2013 said managed care was an idea worth exploring, now opposes the idea.

The Oklahoma Pharmacists Association opposes managed care and its political action committee spent more than $57,000 last election cycle, an increase of $10,000 from the previous cycle. 

The Oklahoma Hospital Association, which is also opposed to managed care, doled out $47,000 through its political action committee last year, a more than $10,000 increase from the previous election year, according to campaign finance reports. 

The Oklahoma Dental Association’s political action committee gave more than $37,000 to candidates during the 2020 election cycle. 

“Managed care, farming out the health care decisions of our most vulnerable citizens, to an out-of-state, for-profit insurance company is absolutely not the answer,” said Lynn Means, executive director of the Oklahoma Dental Association.

The Oklahoma State Medical Association, which has donated more than $107,000 to candidates over the past four years, announced this month it plans to ask the Oklahoma Supreme Court to issue an injunction against Medicaid managed care contracts moving forward.

“The fact remains that Oklahoma’s Legislature has not passed the appropriate legislation or funding to move managed care forward,” said Dr. Pete Aran, chair of the OSMA board of directors. “We believe it is premature to move ahead with these contracts until the legislative process is completed.”

Supporters of managed care and the bid winners themselves plan to continue pushing for the move, including through the creation of a new advocacy organization.

BlueCross BlueShield of Oklahoma and UnitedHealth Group, along with several other organizations, have launched Oklahomans for Better Medicaid.

Health care executives attend a Jan. 29, 2021, news conference to announce the winners of the state’s managed care contracts. BEN FELDER/The Frontier

“We want to help get the word out to the public because most of your average Oklahomans are not necessarily all that familiar with what managed care is,” said Karma, Robinson, a spokesperson for the organization.

Robinson said OFBM is not set up to lobby at the Capitol but will participate in future town halls the Health Authority is planning.

Carly Putnam, a policy director for the Oklahoma Policy Institute, said it should be expected that the managed care contract winners will continue to lobby heavily at the state Capitol because the system intentionally ties profitability to health outcomes.

“The profit motive and then the substantial lack of transparency that comes with it means that companies often prioritize saving money,” Putnam said.

“Managed care companies will say what is good for their business is good for the patients but I’m not sure we can draw that line that clearly.”

Further reading about Oklahoma’s move towards managed care:

State officials announced the winners of up to $2.1 billion in health care contracts last month, a major milestone in implementing Oklahoma’s hotly debated privatized Medicaid program