Among other things, she discussed the future of health care in Oklahoma. I’ve written an attempt of a transcript of what she said.

It’s worth noting that, during her answer to host Dick Pryor, Fallin misstates the percentage of the cost that the federal government would pay if Oklahoma were to expand its Medicaid program.  Fallin says in her answer that the federal government would cover 90 percent of the new costs in the first three years. However, the law says that 100 percent of the expansion will be paid by the federal government from 2014 through 2016. As the Kaiser Family Foundation explains:

Initially, the federal government will finance the full cost of covering most of these “newly-eligible” Medicaid beneficiaries. In later years, the federal matching rate will decline slightly, but still will remain well above the regular Medicaid matching rate at 90 percent. Specifically, for calendar years 2014 through 2016, the federal government will pick up 100 percent of the cost of newly-eligible adults up to 133 percent of the FPL. In 2017, the matching rate will be 95 percent; in 2018, it will be 94 percent; in 2019, it will be 93 percent; and in 2020 and future years, it will be 90 percent.

She also states that as many as 200,000 people might join Oklahoma’s Medicaid system after the health care exchanges are created in 2014 under the Affordable Care Act.

I’m not sure where this number came from. It has been said that, if Oklahoma were to expand Medicaid, then as many as 200,000 people would qualify for Medicaid. But Fallin has said we’re not expanding Medicaid.

There is a group of people who qualify for Medicaid who aren’t currently enrolled. The Oklahoma Health Care Authority, which manages our state’s Medicaid system,  refers to them as “woodwork.” Presently, there are an estimated 60,000 people who qualify for Medicaid in Oklahoma but aren’t enrolled.

In her budget proposal, Fallin quotes this woodwork number in explaining why she has proposed $40 million in funding for the Oklahoma Health Care Authority:

Because of mandates within the Affordable Care Act, over 60,000 Oklahomans who are already eligible to be on Medicaid but are not currently enrolled will likely enroll in the coming years. These individuals are commonly known as “woodwork eligibles.” The state has a legal obligation under federal law to extend Medicaid benefits to “woodwork eligibles” who choose to enroll in the program. That, combined with the rising cost of medical treatment, administrative costs and other fixed costs, means the Oklahoma Health Care Authority will need a significant budget increase to meet its current level of services and legal obligations. Therefore, Governor Fallin’s budget includes $40 million to cover those costs as well as annualizations and maintenance costs associated with Medicaid.

I’ve asked Fallin’s office to explain what numbers she was referencing, and I will update this blog post once I hear back.

Here is my attempt at a transcript, starting at 18:19:

Dick Pryor:  There’s been a lot of interest understandably in your decision to reject the money for the federal funds to set up a health care exchange in Oklahoma.  Do you still think that that is the right decision today?

Gov. Mary Fallin: I do think it’s the right decision. I had the opportunity to be in Congress when we voted on the Affordable Health Care Act, and it was certainly a very challenging time then. You know, we have $16 trillion in debt for our nation right now, which is going to be hard to reduce that number down. Unfortunately under this administration, we keep spending more and more money. We’re not spending less money. It keeps going up.

So my concern is — can the state of Oklahoma afford to expand and add more services for Medicaid? President has come back and said he’ll pay 90 percent for the first three years of the cost, the state would pick up 10 percent of expanding the Medicaid services of our state. We’re naturally going to see more people come into the Medicaid system once the health exchanges go up because they’re going to be required to by federal law come into Medicaid, those who are eligible but have not signed up. So we will have more people coming into the system, could be up to 200,000 more Oklahomans that will just come into it. That’s why I put $44 million new dollars into my budget for the Medicaid budget itself. That excludes expanding the Medicaid system itself.

And my main concern is, Congress told us they were going to give us more money for the Indian cultural center many years ago. They told Tulsa they were going to help them finish some damming of the river many years ago in Tulsa. They’ve never once given us the money they told us they were going to give us. And so from my friends in Congress that are still there saying ‘We’re broke in Washington. Don’t anticipate we’re going to keep our word.’

In fact, I can give you lots of examples, like No Child Left Behind, where Congress passes laws and tells you  they’re going to send you a certain percentage of funding, and they don’t do it. And so, that’s my concern is — it’s been estimated it could cost Oklahoma, by the Kaiser Foundation, over the next 10 years, $689 million new dollars to expand Medicaid in our state. So my concern is being fiscally responsible, yes, implementing an Oklahoma plan to take care of those who don’t have coverage to health insurance. Improving the health is a huge goal of mine. That’ll help us reduce health care costs, too.

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From here, Pryor asks Fallin where the Oklahoma Plan stands. She explains that the state has hired Leavitt Partners to study how Oklahoma can move forward to develop a health care plan that is affordable for the state. That report should be ready by June.

“There is a federal law that we have to comply with,” Fallin responds. “We understand that, rules and regulations we have to comply with. So how can we do it in a way that we can afford it and in a way that we can do it Oklahoma’s way?”

Hospitals across Oklahoma City have invested in a da Vinci surgical robot, a highly marketed robot that can be used to perform a variety of surgeries. I’ve interviewed several doctors who use the robot to perform surgeries, and many of them rave about it.

They say patients recover faster, have fewer complications and leave the hospital faster than patients who don’t have the same kinds of surgeries using the robot.

But there’s a catch to some of their claims — comprehensive data to back it up.

As this article points out, recently published medical research has found that robotic surgery might not always prove to be more beneficial.

In the dozen years since the Da Vinci robot has been approved for surgeries in the United States, it’s been embraced by health care providers and patients alike. Surgeons routinely use the multi-armed metal assistant to remove cancerous prostate glands and uteruses, repair heart valves and perform gastric bypass operations, among many other procedures.

Lately a key study and reports of problems have raised questions about robotic surgery’s safety and cost-effectiveness, leading to a review of the Da Vinci system by the Food and Drug Administration and causing some experts to wonder whether the benefits of undergoing robot-assisted surgery may have been overstated.

To make any claim in medicine that one approach works better than the other, you need a study published in a medical journal that says “Yes, this is very, very true.” Actually, you probably need several studies by different academic institutes that agree and say, “Yes, that study is very, very true, and here’s what we found that says it’s still very, very true.”

Surgeons I’ve talked to with say the da Vinci robot allows them to operate inside a patient and affect the least amount of tissue while inside. And so far, the debate continues, with the U.S. Food and Drug Administration currently reviewing the system.

Complications can occur with any type of surgery, and so far it’s unclear if they are more common in robotic operations. That’s part of what the FDA is trying to find out.

Intuitive Surgical disputes there’s been a true increase in problems and says the rise reflects a change it made last year in the way it reports incidents.

The da Vinci system “has an excellent safety record with over 1.5 million surgeries performed globally, and total adverse event rates have remained low and in line with historical trends,” said company spokeswoman Angela Wonson.

But an upcoming research paper suggests that problems linked with robotic surgery are underreported. They include cases with “catastrophic complications,” said Dr. Martin Makary, a Johns Hopkins surgeon who co-authored the paper.

West Nile virus season ended a few months ago in Oklahoma, but many Oklahomans are still working to recover from the virus.

For the past few months, I’ve been writing about Bob Matthews, an Oklahoma City resident who contracted West Nile virus and was paralyzed because of it.

Bob Matthews is comforted by his wife, BJ Matthews, as he continues to recover from the effects of West Nile Virus in Oklahoma City, Friday, August 10, 2012. Photo by Bryan Terry, The Oklahoman

Recovering from West Nile virus is not easy. It can be a slow and painful process.

Bob told me in December:

“Therapy is painful, but it has to be because they’re stretching those muscles,” he said. “It’s nothing that’s intentional. It’s just something that comes with the territory.”

The Matthews family is one of many that has been affected by West Nile virus this past year.

Over the past several months, 15 people in Oklahoma have been reported dead because of West Nile virus. A total of 180 residents have contracted the virus since last summer.

These numbers are much higher than Oklahoma’s previous record — in 2007, the state saw 107 cases of West Nile virus and nine deaths.

Health officials think West Nile virus first entered North America in 1999.  The virus is spread through contact with an infected mosquito and can cause serious symptoms, especially in adults older than 50.

The 15 Oklahoma residents who died ranged in age from 47 to 87 years old. As you can see from this map, they were from across the state.

They include Bill Brady, a 77-year-old grandfather from Healdton; Jon Gumerson, a former Guthrie mayor; and Doug Brecht, a former OU women’s golf coach.

And because of that, I can get bored quickly when you start spouting out tons of numbers.

So, here’s a visual aid of what Medicaid expansion would look like in Oklahoma.The Oklahoma Health Care Authority estimates that expanding Medicaid to 138 percent of the federal poverty line would make 180,000 Oklahomans eligible for SoonerCare, the state’s Medicaid program.

What does that look like?

Gaylord Family – Oklahoma Memorial Stadium, filled up about 2.2 times.

Boone Pickens Stadium, about three times full.

Photo by Zach Gray, for The Oklahoman

Chesapeake Energy Arena during an OKC Thunder game, about 10 times full.

Photo by Bryan Terry, The Oklahoman

The BOK Center in Tulsa, about 9 times full.

Because if it weren’t for Mississippi — and generally, West Virginia and Louisiana — Oklahoma would come in last in a variety of health rankings.

But, really — Are we doing that much better? Let’s take a look.

Each year, the United Health Foundation comes out with its annual report, known as America’s Health Rankings. Although the rankings aren’t the end-all be-all of health rankings, our state leaders pay a fair amount of attention to them. That’s because the rankings provide an overall idea of how Oklahoma is doing in a range of categories.

The good news is, Oklahoma improved its ranking this past year. The bad news? We’re still in the bottom 10.

Oklahoma ranked No. 43 in overall health in the national report, the highest ranking the state has received in eight years.

Meanwhile, the top five worst states were  South Carolina (No. 46), West Virginia (No. 47), Arkansas (No. 48), Louisiana (tied No. 49) and Mississippi (No. 49). Meanwhile, Vermont ranked best for overall health.

As you can see from the comparisons below, in some instances, we’re not that far off from sinking back toward the bottom.

Gov. Mary Fallin has said, rather than expanding Oklahoma’s Medicaid program, Oklahoma will instead create its own health plan that will focus on the future health of residents.

I’m curious about what that plan will be. Oklahoma has some of the highest rates in the nation in obesity, diabetes, heart disease, cancer and stroke, and we have a major shortage of primary care doctors. We also eat the fewest fruits and vegetables of any state. And, to top all of that off, poverty in Oklahoma is at a 10-year high.

The solutions for our state won’t be simple, and it will be interesting to see how receptive our lawmakers will be to Fallin’s plan. In her State of the State address, Gov. Fallin came out in support of a bill before the Oklahoma Legislature that would have allowed cities to make their own smoking laws, an idea that multiple lawmakers have shot down in committee.

Medicaid expansion is one of the key elements of the Affordable Care Act, or “Obamacare.” (Want to know more about the health care debate? Here’s a graphic novel we created that explains the basics)

Most leaders have been quoted as saying expanding Medicaid would be too expensive for their states and that they didn’t trust the federal government to hold its end of the bargain.

So what’s the alternative plan?

Gov. Fallin hasn’t yet announced what Oklahoma’s alternative plan might be, but a few state leaders have made a proposals on how to help the uninsured in their states.

Wisconsin

In Wisconsin, Republican Gov. Scott Walker announced in mid-February that he is rejecting Medicaid expansion and instead pushing forward with his own plan.

Walker said he would instead work to increase health coverage for Wisconsinites with an alternate plan that involves lifting an enrollment cap on Medicaid programs for childless adults, tightening income eligibility for state residents able to use Medicaid programs, and bumping thousands of people from such programs to federal government-run health care exchanges where they can buy private insurance.

Avik Roy, a contributor at Forbes, wrote a detailed piece on Walker’s approach, noting:

Prominent Republican governors, like John Kasich in Ohio, have said yes to Medicaid, reasoning that if Ohio doesn’t grab the federal money, other states will. But, as Wisconsin governor Scott Walker now shows, there is a far better path forward, one that reduces the footprint of Medicaid while providing coverage to the uninsured.

Alabama

In Alabama, lawmakers are looking at Oregon’s model and discussing whether they could duplicate something similar:

Over the decades, Oregon has built a relatively generous Medicaid program and has been a bellwether for health policy experimentation. Alabama, like most other southern states, has run a barebones program with few optional benefits.

Launched last year, Oregon’s current Medicaid plan relies on local health care organizations to coordinate all forms of health care, from acute medical services to mental health and dental care, all in an effort to lower costs and improve health. Basically, the local entities, which may be headed by a hospital, physician group, community service provider or a managed care organization, are given a budget and challenged to beat it. If costs exceed the budget, the organization takes the loss.

Alabama lawmakers will soon consider a proposal from Bentley for a Medicaid overhaul based in part on Oregon’s groundbreaking “community care organizations.” Although Bentley has said he would not support an expansion of Medicaid “under its current structure,” the expected reforms are seen as paving the way for a possible expansion as early as 2015.

South Carolina

Lawmakers in South Carolina have proposed their alternative to expanding Medicaid, which includes paying hospitals to send uninsured patients to community health centers.

Instead, House Republicans this week put forward an alternative plan that would pay hospitals up to $35 million to steer uninsured patients to community health centers, free health clinics and rural health clinics. Lawmakers also pledged to give those health centers and clinics an extra $10 million in state money to care for those uninsured patients.

Those clinics, which the state gave $1.8 million this year, hailed the plan Thursday.

“The new plan is a positive alternative if the state does not decide to participate in the Medicaid expansion,” said Lathran Woodard, chief executive of the S.C. Primary Health Care Association.

They argue cigarette companies target young people and minority populations. For example, Project SCUM was recently brought up in an interview I did about high smoking rates among people with mental illness. As a side note, here’s Philip Morris explaining its marketing strategy.

I wanted to look back at cigarette ads throughout the past several decades.

Here are some ads that were published in the Oklahoman. I’ve included the date that each advertisement was published. As you click through the ads, you’ll start to notice a warning from the Surgeon General in the mid-1960s. (And I’ve included one ad from the Oklahoman that compared the smoking habit to the newspaper habit. Probably not our best idea ever.)

And this song is now stuck in my head.

Health advocates, including Gov. Mary Fallin, argue that passing this law would have a major impact on the state’s health. They also argue that only Oklahoma and Tennessee have this type of restrictive law on the books regarding cities and smoking ordinances.

Opponents say that cities passing their own smoking laws would be confusing to business owners and also would trample on individual rights. Others voice concerns that a smoking ban could have a negative impact on business.

I’m not here to argue who’s right. I’ll leave that to, well, non-journalists. However, I was curious about other states that have made similar efforts. So, here’s a list of five states that have recently gone “smoke-free” in some regard.

1. North Dakota

North Dakota is the 28th smokefree state in the U.S. through approval of a ballot initiative in November. North Dakota went smoke free through the same type of effort Gov. Fallin proposed yesterday. Fallin proposed the ballot initiative after lawmakers refused to hear Senate Bill 36, which would have allowed cities to pass their own smoking ordinances.

In North Dakota, you cannot smoke in all public buildings, including restaurants, bars, places of business, hotels, health care facilities, tobacco stores, workplace vehicles and taxis.

In one news story, a few bar owners discussed the potential impact of the ban:

Anderson said business might slow down initially but then pick up once nonsmokers start coming more often. When Bismarck passed a citywide smoking ban, Anderson didn’t see an increased number of patrons.

Now that the ban has passed, Anderson will have the carpet replaced and minor remodeling done.

“We were going to do it last summer and then we said, ‘Let’s wait and see what happens with this smoking ban,’” she said.

2. Wisconsin

Before the law passed, bar owners worried the law would hurt business. Two years later, there’s a mixed review on what impact the law has had on bar business.

A study through the University of Wisconsin researched bartenders and found that “this policy will help reduce the future risk of disease related to secondhand smoke among employees and patrons of bars and restaurants throughout the state.”

3. Indiana

Indiana’s smoking law went into effect in July. Unlike Wisconsin and North Dakota, Indiana’s smoking law does not ban smoking in bars.

Rather, in Indiana, you can smoke in a “horse-racing facility, a riverboat, a facilitywith a gambling game license, a satellite-gaming facility, cigar bars, hookah bars, certain fraternal clubs, a retail-tobacco store, a bar or tavern meeting certain requirements, a cigar-manufacturing facility, a cigar-specialty store, a business in a private residence…”

There’s a current discussion in Indiana to extend the ban to bars, but that doesn’t look likely to happen.

4. Michigan

Starting in May 2010, smoking was banned in Michigan in most public places.

The law will cover any workplace and any food service establishment. A workplace is a site employing at least one person. A food service establishment is any place with a license to serve food or beverages. This law covers public places, including, but not limited to, restaurants, bars, shopping malls, bowling alleys, concert halls, arenas, museums, mechanic shops, health facilities, nursing homes, education facilities, and child carecenters.

After the law passed, a bar owner challenged the constitutionality of the smoking ban on the grounds that it unfairly provides advantages to casinos and has illegally cut into his profits.

Meanwhile, a study through the University of Michigan found that, after two years, the smoking ban had “no significant negative impact on bars and restaurants.” The study was commissioned by the state of Michigan.

5. Kansas

Under the Kansas smoking ban, which became effective July 1, 2010, you cannot smoke in the following places:

• Public places
• Places of employment
• Restaurants
• Bars
• Taxicabs and limousines
• Lobbies, hallways and other common areas in apartment buildings and other multiple-residential facilities
• Restrooms, lobbies and other common areas in hotels and motels
• Within 10 feet of any doorway, open window or air intake where smoking is prohibited

In January, the Kansas Health Institute argued that “there is no apparent evidence that smoking bans in Kansas have been associated with a decrease in statewide restaurant and bar sales, or with a decrease in the number of establishments serving liquor.”

Meanwhile, there has been some movement to exempt bars from the ban.

The campaign, launched in November, focuses of on issues that “undermine the well being of children.”

For example, in the U.S., “black and brown kids” are three times more likely to be impoverished, according to the organization. That means their educational attainment is likely to be lower, and health outcomes are likely to be worse.

“You think, ‘Well, that’s too bad for them,’” Van Jones, president of Rebuild the Dream, said in the video posted below. “No, too bad for all of us, because we’re on our way to being a country by 2050 where the majority of Americans are black and brown. If we let all these kids slip through the cracks, we’re letting the country slip through the cracks.”

Too Small campaign leaders argue that health impacts education, and family income affects both a child’s education and health. But, according to this infographic from the campaign, money and race alone do not account for many challenges that children face:

This past weekend, Carla Hinton and I finished our project about the anniversary.

In one of Carla’s stories, she wrote about a large group of young people who will participate in the March for Life on Friday. A total of 220 high school and college-age Oklahomans will participate in the march.

These young people are apparently in the minority of people younger than 30 who even know what Roe v. Wade is about.

The Pew Research Center recently found that there seems to be an age gap in who knows what the case was about:

Decades after the Supreme Court rendered its decision, on Jan. 22, 1973, most Americans (62%) know that Roe v. Wade dealt with abortion rather than school desegregation or some other issue. But the rest either guess incorrectly (17%) or do not know what the case was about (20%). And there are substantial age differences in awareness: Among those ages 50 to 64, 74% know that Roe v. Wade dealt with abortion, the highest percentage of any age group. Among those younger than 30, just 44% know this.

I’m not sure how surprising those numbers are. The poll also revealed that:

Most Americans remain opposed to overturning the controversial U.S. Supreme Court decision in Roe v. Wade, which 40 years ago legalized abortion at least in the first three months of pregnancy, according to a poll released Wednesday.

For the anniversary, The Daily Beast created a map of the 724 remaining abortion clinics and the closest clinic in every part of the country. The map also provides information about state laws regarding wait times, medication restrictions, ultrasound provisions and insurance restrictions.

There’s a white stripe through the middle of the U.S. where no clinic is within between 200 and 300 miles. The map becomes even more interesting when you choose “Show female population, ages 15-44″ on the map and see where most women in that age group live.

The Oklahoma Legislature regularly sees bills regarding abortion, and this session will be no different. For example, this session, another “personhood” bill has been filed:

One of the most divisive issues of the 2012 legislative session apparently will be revisited this spring, with at least one “personhood” bill already filed.

State Rep. Mike Reynolds, R-Oklahoma City, is author of House Bill 1029, the Personhood Act of 2013. As written, the bill appears to be virtually identical to one that led to a bitter fight in the House before failing to get a vote on the floor.

The Oklahoma Supreme Court struck down a similar bill last year.