All articles by David Blatt

Are Medicaid patients overusing the ER?

by | August 21st, 2014 | Posted in Blog, Healthcare | Comments (0)

ERIn the debate over Medicaid, a frequently heard claim is that Medicaid recipients overuse emergency rooms for non-emergency care, and that we need to address this problem if we are to contain Medicaid spending.

This past session, the Legislature approved HB 2906, which directs the Oklahoma Health Care Authority, the state’s Medicaid agency, to conduct a study of current and potential ways to reduce trips to the emergency department. Earlier in session, legislation passed the House that would have limited Medicaid coverage to six emergency room visits per year.

However, Health Care Authority data seems to dispel the idea that ER overuse by Medicaid members is as pervasive or as serious a problem as many assume. In State Fiscal Year 2013, there were just over 1 million Oklahomans enrolled in SoonerCare. Of this population, nearly three in four (73.8 percent) made no emergency room visits in a 12-month period. Another 21 percent visited the ER once or twice. Only 11,763 individuals, or 1.1 percent of the Medicaid population, had six or more ER visits. This small population accounted for some 107,000 ER visits, or about one in five of all visits.

ERusageFY2013Since 2004, the Health Care Authority has operated the High ER utilization project, which identifies and contacts members who have been to the ER more than once in a quarter and provides information about appropriate usage and referrals to care management. The program has a provider education component as well. Since 2007, emergency room usage has declined from an annual average of 0.58 annual visit per member to 0.53 annual visits per member. Although we should be careful about making direct comparisons because of differences in demographic make-up and data sources, ER utilization for Medicaid recipients appears comparable to the overall population. According to the Kaiser Family Foundation, Oklahomans had 488 ER visits per 1,000 people in 2011; OHCA data suggests that Medicaid recipients made 550 visits per 1,000 people in fiscal year 2011.

It’s also not apparent that ER visits are a major expense in the Medicaid program. In fiscal year 2013, total emergency department costs, including facility and professional claims, were $141.0 million, which represents less than 3 percent of total SoonerCare expenditures of $4.97 billion (with ancillary services, the total cost was $178.3 million, or 3.6 percent of total expenditures). The average cost per emergency room visit was $257.31.

The Health Care Authority’s efforts to monitor and prevent inappropriate emergency room usage should certainly be continued. However, the idea that many Medicaid members make unnecessary trips to the ER seems to reflect myths and anecdotes more than reality.

Tobacco tax revenue declined last year. Here’s why that’s mostly good news.

by | August 13th, 2014 | Posted in Blog, Healthcare, Taxes | Comments (0)

In 2004, Oklahoma voters approved SQ 713, which increased the excise tax on cigarettes and other tobacco products while eliminating the state and local sales tax on these products. The new revenues from the increased taxes were dedicated to a variety of health-related purposes, including the Insure Oklahoma premium assistance program, a comprehensive cancer center, trauma care, tobacco cessation, and others.

Tobacco tax revenues allocated for health care under SQ 713 rose from $107.1 million in FY 2006, when the new taxes took full effect, to $145.6 million in FY 2012. However, these revenues fell slightly in FY 2013 and then dropped dramatically by $18.3 million (13 percent) in the fiscal year that just ended. The two largest recipients of tobacco tax funds – Oklahoma Health Care Authority general operations and the Insure Oklahoma fund – saw their funding decrease by $7.3 million and $6.0 million respectively in FY 2014. The shortfall contributed to the Health Care Authority having to enact larger cuts to provider payments and services.

TobaccoTaxRev06-14What accounts for the drop in tobacco tax collections? The answer is complicated.

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Two great OK Policy opportunities for Oklahoma college students

by | August 12th, 2014 | Posted in Blog, OK Policy | Comments (0)


OK Policy is pleased to announced two exciting opportunities for Oklahoma college students. We are currently accepting applications for our fall internship and for our 2014-2015 research fellowship. Students working with OK Policy have a wide range of opportunities to conduct research, write blog posts, and contribute to OK Policy projects and events. We invite all interested candidates to apply.

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Definition of two small words could have large consequences

by | August 6th, 2014 | Posted in Blog, Taxes | Comments (0)

dictionaryIs a bill that adjusts the tax rates on production of oil and gas a “revenue bill” under the terms of the Oklahoma Constitution? This is the question for the Oklahoma Supreme Court to decide in a challenge filed by Oklahoma City Jerry Fent to HB 2562. Along with a similar challenge to a bill , SB 1246, that cuts the top income tax rate, the Court’s answer could have a dramatic effect on Oklahoma’s fiscal and political landscape.

HB 2562 was the outcome of one of most contentious political battles of the past year. Currently, Oklahoma assesses a standard 7 percent severance tax on oil and gas but offers lower tax rates as a way to support and incentivize various forms of production. The most generous tax break – a 1 percent rate on horizontal wells for the first 48 months of production – is set to expire at the end of June 2015. With an overwhelming share of drilling activity in Oklahoma and elsewhere having shifted to horizontal production in recent years, the question of whether to continue the tax break became one with significant budgetary and economic implications.

continue reading Definition of two small words could have large consequences

Upcoming Event: The Legacy of Gov. Henry Bellmon

BellmonHLOklahoma Policy Institute will honor Governor Henry Bellmon with the 2014 Good Sense/Good Cents Award, followed by a panel discussion on the Bellmon legacy, on Monday August 4th from 1:00 – 3:00 pm at the Lorton Performance Center on the University of Tulsa Campus. The events are free and open to the public.

The Good Sense/Good Cents award will be presented to Gov. Bellmon’s daughters Ann Denney and Pat Hoerth by Tulsa Mayor Dewey F. Bartlett Jr., whose father, Dewey F. Bartlett Sr., succeeded Henry Bellmon as Governor and served concurrently with him in the United States Senate. The  annual award honors political leaders whose political service is distinguished by a commitment to respectful political dialogue, sound fiscal stewardship, and concern for the less fortunate. The inaugural recipients of the award in 2013 were Mayors Robert LaFortune of Tulsa and Melvin Moran of Seminole.

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Did term limits really change how long Oklahoma legislators serve?

by | July 16th, 2014 | Posted in Blog, Capitol Matters | Comments (1)
Gene Stipe, who served 53 years in the Oklahoma Legislature (1948-54, 1956-2003)

Gene Stipe, who served 53 years in the Oklahoma Legislature (1948-54, 1956-2003)

*This post has been updated to correct errors in the original version, noted by *

In September 1990, Oklahoma voters, by an overwhelming margin, approved State Question 632 which limited service in the Oklahoma legislature to no more than twelve years in the House of Representatives and Senate combined. The new term limits took effect in *1992 and did not apply to time already served. The first group of legislators subject to SQ 632 hit their term limits in 2004 (for House members and Senators elected in 1992) and in 2006 (for Senators elected in 1994).

Oklahoma political observers are in near unanimous agreement that term limits have had profound and far-ranging effects on the Oklahoma legislature. In the view of many journalists, legislative and agency staffers, and lobbyists, today’s legislators are significantly less experienced than were their predecessors. Short legislative careers are taken to mean that legislators are less familiar with policy issues, agency operations, public finances, and the legislative process itself.  With less time to rise through the ranks to leadership, term-limited legislators are often seen as more overtly ambitious and more beholden to lobbyists than in pre-term limit days. 

Yet is it really the case that term limits have brought about the sweeping changes that are often attributed to them?

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Invalidated appropriation leads to $6.7 million budget cut

by | July 7th, 2014 | Posted in Blog, Budget | Comments (0)

Attorney General Scott Pruitt

The state’s new fiscal year began on July 1st with most state agencies funded slightly worse than they had originally expected.

Last month, OK Policy broke the story that this year’s General Appropriations (GA) bill diverted $7.9 million out of the trust fund for Oklahoma’s Promise scholarships. In accordance with state statutes, each year the State Board of Equalization certifies an amount to transfer to the trust fund to cover scholarships for the coming year. In December, the Board certified $57 million for Oklahoma’s Promise in FY 2015. However, the Legislature attempted to order the Board to reduce the transfer by $7.9 million so that it could be used to balance the overall FY 2015 budget.

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Tax cut legal challenges could be game-changers

by | June 30th, 2014 | Posted in Blog, Taxes | Comments (0)

Jerry Fent. Photo courtesy of David Glover.

Over the years, Oklahoma City attorney Jerry Fent has proven a big thorn in the side of Oklahoma policymakers, filing and winning a string of constitutional challenges to legislation. Several of his lawsuits have led the Supreme Court to strike down down bills as violations of the state’s single-subject rule, including last year’s ruling overturning a measure that combined funding for repairs to the State Capitol and an income tax cut. Others have overturned various bond issues and budget provisions.

This year, Fent is back with new lawsuits challenging SB 1246,the bill that would reduce Oklahoma’s top income tax rate subject to certain revenue triggers, and HB 2562, the bill that changes taxation of oil and gas production. If successful, these challenges would represent a seismic shift in Oklahoma’s budget and tax landscape.

This post will focus on SB 1246, which has now been argued in front of an Oklahoma Supreme Court referee.  The lawsuit (Fent v. Fallin) contends that SB 1246 is unconstitutional because it violates Article  5, Section 33 of the Oklahoma Constitution, which pertains to revenue bills.  The original constitutional language, which dates to statehood, states:

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They did what?? Funding grabs create shortfalls for many agencies

by | June 19th, 2014 | Posted in Blog, Budget | Comments (1)

pickpocketFaced with a nearly $200 million shortfall in building the FY 2015 budget, legislative leaders and Governor Fallin had three basic choices.

They could have simply cut spending, slashing deeply across all areas of government. This would have left unaddressed critical needs for schools, state employees, the child welfare system, and others, and forced massive cuts on our health care system.

They could have filled the budget hole by curbing tax breaks and closing tax loopholes. This would have strengthened our faltering tax system over the long term but would have antagonized powerful beneficiaries of tax preferences and anti-tax hardliners.

Instead of either of these tough options, they went for the seemingly easier one of balancing the budget by scrounging together whatever money they could find in state funds, even if they were only one-time revenues and even if the money was collected for other purposes than supporting general state operations.

continue reading They did what?? Funding grabs create shortfalls for many agencies

Inappropriate appropriations and a broken promise

by | June 11th, 2014 | Posted in Blog, Budget, Education | Comments (4)

cookie jarIn building next year’s budget, legislative leaders and Governor Mary Fallin faced the challenge of starting with nearly $200 million less revenue than this year. Ultimately, the FY 2015 budget ended up at nearly the same amount as this year. In order to get the numbers to balance, the budget agreement scrounged together nearly $300 million in one-time revenue from nearly 30 different funds, including cash reserves, agency revolving funds and other state funds (see the full list here).

The use of one-time revenues to fund ongoing budgetary obligations has drawn concern from OK Policy, Treasurer Ken Miller, and others, particularly for building automatic holes into future year budgets. There has been less attention paid to whether the use of these one-time revenues for general appropriations was legal or constitutional.

One especially problematic provision of the budget  has gone largely undetected until now — the diversion of nearly $8 million from the Oklahoma Higher Learning Access Program (OHLAP), also known as Oklahoma’s Promise scholarships. This diversion could cause a popular pathway to college to run out of money for low- and moderate income students. It also seems to rest on very shaky legal footing.

continue reading Inappropriate appropriations and a broken promise

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