BETTER PROGNOSIS?

William C. Wertz

The Oklahoman

USA TODAY NETWORK

When Oklahoma voters approved a constitutional amendment in 2020 to expand the state’s Medicaid program (SoonerCare), hundreds of thousands of residents got a boost in their ability to pay for medical care.

The expansion was particularly important in Oklahoma, a state ranked as one of the poorest in the nation (eighth) and one of the unhealthiest (fifth). Many Oklahomans couldn’t afford health care insurance or trips to the doctor or hospital on their own. A ripple effect was that hospitals throughout the state got a shot in the arm.

'Prior to Medicaid expansion, hospitals in Oklahoma were really struggling,' says Rich Rasmussen, CEO of the Oklahoma Hospital Association. 'The state had lost 10 hospitals over the last decade, but when Medicaid expansion was approved by the voters, it created a pathway for a much more stable future.'

But the future is looking less stable.

As this story went to print and the web, the state Legislature was on its way to approving House Joint Resolution 1067 and House Bill 4440. If approved by voters, the two overlapping measures would move Medicaid expansion from the Oklahoma Constitution to state statute, allowing lawmakers to adjust eligibility without another vote of the people. The state would then be able to add restrictions, like work requirements (currently not allowed), and even end the expanded program altogether if federal funding drops below 90%.

There is no doubt in Rasmussen’s mind that the Medicaid expansion demanded by the people was a good thing.

'It was good in every sense,' he says. 'It meant that a lot of people had access to care and that we could intervene earlier in their care. It meant that a big segment of our population who are low income and often service sector employees would have the ability to continue to be productive. There are so many small businesses in the state who don’t offer their employees health care, and so this was a way they could afford treatment. And for hospitals it ensured that we were able to cut our uncompensated care numbers by 5%, which was huge.'

Rasmussen has had extensive experience with health care issues involving hospitals.

Q: You started out in Florida?

A: I grew up in central Florida and went to college there, and my every intention was to be a journalist. But when I graduated, I had an offer to come to Washington, DC, and work on the Senate Budget Committee staff. I worked on media communications for the staff for three years and then had an opportunity to work for Orlando Health (a nonprofit regional health system). That led me to the Florida Hospital Association, and I was there for 28 years. I lobbied, I oversaw the foundation, did business development, virtually everything I’m doing here and loved every minute of it. In 2018 I had the chance to become CEO of the Montana Hospital Association, and I came here in 2023 when Patti Davis retired. My wife is from Norman. Her dad was varsity swim coach at OU (the University of Oklahoma).

Q: You arrived in Oklahoma not long after the constitutional amendment was approved to expand Medicaid, which you’ve said was a very positive development for hospitals. What continuing challenges do they face, especially rural hospitals?

A: The demographic shift we’ve seen, with people moving from rural to metro areas, is going to accelerate if we can’t offer essential health services in rural towns. Let’s say you’ve been ranching your property for a long time, and you want your children or grandchildren to take it over. But they have a choice. Do they stay, knowing that they’re going to have to drive two hours to get the health care that they need? So, sadly, I think we’re going to see this shift accelerate, not just in Oklahoma, but across our breadbasket from border to border. Health care helps people remain secure in their communities, and I believe our state is really leaning into this. There is a workforce commission created by the Legislature, and Tim Pehrson, the CEO of Integris, chairs it. There is a lot of sensitivity to the need for health care.

Q: Is recruitment of doctors and nurses more difficult in Oklahoma?

A: The challenge is that we’re competing with 49 other states for a limited talent pool. But I believe we’re moving in the right direction. We have a nurse and anesthetist program at OU, which will launch next year, which will allow us to have CRNA’s (Certified Registered Nurse Anesthetists). For our rural hospitals, it is very difficult to recruit an anesthesiologist to a rural town. It’s easier to recruit a nurse anesthetist. But even with new programs, we aren’t really graduating enough doctors and nurses to treat the aging Boomer generation. We have long leaned in on bringing in talent from outside the country, and the immigration controversy has complicated how we can utilize some special visas for bringing in outside health care workers. Also HR 1, passed last year, has put limitations on the borrowing for students, and the (U.S.) Department of Education has unfortunately deemed that nurses are not considered professionals, so they have a lower cap. A young person who graduates from medical school with a high amount of debt, they may skip all of the rural opportunities and go to Dallas or some other metro area and one of the health systems there (which often offer debt forgiveness).

Q: Is technology giving hospitals and medical providers a boost in their ability to improve health care in Oklahoma?

A: Technology today is really becoming a backbone to health care. Whether you call it virtual care, telehealth, or whatever, there have been significant innovations. The ability of artificial intelligence to help in imaging, to help in removing some of the load off of a clinician is having a real impact.

This interview has been edited for length and clarity.

William C. Wertz is The Oklahoman’s opinion editor. If you have a suggestion for someone it would be good for readers to 'get to know,' send him a note at: wwertz@oklahoman.com.

Rich Rasmussen, CEO of the Oklahoma Hospital Association, is pictured April 15 in Oklahoma City.

SARAH PHIPPS/THE OKLAHOMAN