The Affordable Care Act, the federal health care law that takes full effect in 2014, is expected to provide health insurance coverage to over 335,000 uninsured Oklahomans and reduce the state’s uncompensated health care costs by more than two-thirds , according to a new report from the Robert Wood Johnson Foundation (RWJF).

Currently, some 597,000 Oklahomans, or 19 percent of the non-elderly population, lack health insurance. Under the Affordable Care Act (ACA), the number of uninsured is projected to fall by 57 percent to 259,000, or 10 percent of the non-elderly population. Oklahoma’s 57 percent drop exceeds the national average of 48 percent and is the tenth highest drop among the states.

The researchers, who are health care policy experts at the Urban Institute, use the Health Insurance Policy Simulation Model to build projections of how coverage will be affected by the new law. For Oklahoma and for the nation, they find that the ACA will lead to more people with both public and private health insurance. Specifically, they project that: Read the rest of this entry »

The question of whether to require a prescription for the purchase of pseudoephedrine (the main ingredient in medications such as Sudafed) as a means to help combat the production of methamphetamine,  promises to be one of the  hotly contested issues of the 2012 legislative session. We invited a supporter and an opponent of the proposal to present their sides of the debate.

Jessica Hawkins: Time to say ‘enough is enough’

Jessica Hawkins is the Director of Prevention Services for the Oklahoma Department of Mental Health and Substance Abuse Services, which funds a network of Regional Prevention Coordinators providing community-based prevention services to all 77 Oklahoma counties. 

Substance abuse and untreated addiction must be a priority for Oklahoma.  It is the underlying cause for many of the negative consequences we are faced with in this state such as crime, incarceration, rising health care costs and broken families…issues that will not go away unless we start investing in the things that impact the root problem.

Want a great example? Methamphetamine.  Everybody knows about meth.  It is in the headlines every day.  If there is a picture that illustrates how drug use impacts us all, then this is it. Read the rest of this entry »

These comments were excerpted from a speech by Maryland Governor Martin O’Malley to a plenary session of an annual healthcare conference hosted by FamiliesUSA.

Our country is now poised through the Affordable Care Act to help millions of American families and small businesses and their employees access high quality, affordable health care coverage.  This isn’t going to happen by itself.  This is not simple.  If it were simple, someone would have accomplished it years ago.  This is complicated, but it is not beyond our grasp [..]

We are ready in Maryland to turn the corner on the healthcare costs that have been sapping our productivity as a people and as a nation.  Sapping the productivity of our businesses.  Taking from them the ability to reinvest in their own plants and their own opportunities and their own markets. Costs that force moms and dads to choose between health care and paying for groceries, or tuition, or school supplies, heat, rent, mortgage payments.  These are the big decisions that happen in the most important place – the kitchen table of every family home.

In Maryland we believe we are gaining a competitive advantage by being an early implementer [of health care reform].  Last year we had the best year of new job creation that we’ve had since the recession hit [..] Why is it that at the same time we’ve cut 7.5 billion from our state budget, we’re increasing the ranks of those who are covered by healthcare so very, very dramatically?  It’s because there is an historic truth – not a Democratic truth or a Republican truth – but an American truth and an economic truth.  In order to create jobs, a modern economy requires modern investments. Read the rest of this entry »

Our health care system is experiencing an unprecedented period of upheaval. Decades of rising costs, an ever-increasing share of citizens without insurance, and an aging baby boom generation are putting immense pressure on payers, providers, and patients alike.  A new policy brief from Oklahoma Policy Institute underscores the importance of SoonerCare/Medicaid as the primary safety net health care program for low-income Oklahomans who would otherwise go uninsured, primarily children, the elderly, and persons with disabilities.  The five-page brief, Medicaid 101: The SoonerCare Safety Net, outlines the program and its eligibility requirements, breaks down its funding sources, and debunks common Medicaid myths.

One popular myth is that Medicaid costs are rising exponentially and the program is riddled with waste.  In fact, scholarly research has demonstrated that Medicaid costs about 20 percent less on average per person than private insurance, so the program is quite lean.  While it is true that health care costs are rising, it’s important to remember that they are rising across the board, not just for the Medicaid program.  The state can also take advantage of a favorable federal matching rate to leverage their health care investment.  For every $1.00 the state government invests in SoonerCare in FY 2012, the federal government will contribute $1.77. Read the rest of this entry »

As the Affordable Care Act is implemented across the nation, states have taken varying approaches to making sure coverage is available for all children.  While most states have done a good job maintaining and ensuring the availability of health insurance for kids, Oklahoma has taken an enormous step backwards by changing state law to restrict coverage for newborns and babies.  This post explains the series of events leading up to a recent move by the Insurance Commissioner to pass an unprecedented and short-sighted emergency rule that makes it impossible for some babies to get health insurance in the state.

Beginning in September 2010, the Affordable Care Act prohibited new health plans from denying coverage to children based on pre-existing conditions.  In some instances, insurers withdrew from the child-only market rather than comply with the guaranteed issue rule.  It’s very important to note that this did not include policies that are sold to adults with children as dependents – just child-only policies sold on the individual market.  Such policies are often sold to parents whose employers don’t have coverage or to grandparents on Medicare who are the primary caregivers to their grandchildren.  In thirty-three states, caregivers are still able to access child-only plans.  In fact, some states had guaranteed-issue for children even before the federal health care law. Read the rest of this entry »

Is it the role of government to put policy in place to impact the overall health of our citizens?  As the Oklahoma legislature’s interim study committee prepares its final report on the state’s obligations under the new federal health care law, the co-chairs have posed a series of questions to committee members to elicit thoughts, opinions, and lessons learned.  This post responds to a central theme of those questions, a theme we think has implications for the state’s future prosperity well beyond the new health care reform law.

Let’s assume that you stand on principle that it’s not the government’s role to engage the health care system.  Then we have a gravely serious problem.  We are very nearly the unhealthiest state in the country and we’re getting worse.  Individual behaviors – smoking, diet, fitness - certainly affect health, but it’s by no means certain that they’re the most important factors.  What we’re facing in Oklahoma is bigger than the sum of each individual resident’s health choices.  Acute structural defects in the state’s health care system demand solutions that are bigger than each of us and addressing them will benefit all of us. Read the rest of this entry »

The Oklahoma Insurance Department (OID) has asked the federal government to waive a key provision of the new federal health care law set to go into effect in 2012.  OID wants to exempt insurers in the state from adhering to a ‘medical loss ratio’ (MLR) requirement that they spend at least 80-85 percent of premiums directly on medical care, or else rebate consumers.  Oklahoma Policy Institute has recommended to HHS that they deny this request and allow full enforcement of an important and reasonable consumer protection that will put millions of dollars back in the pockets of Oklahoma consumers.  This post explains the simple rationale behind our recommendation: Why should profitable insurers get a free pass to cost-shift their administrative expenses onto already strained household budgets? Read the rest of this entry »

This is part of an ongoing series of posts examining the Affordable Care Act, including previous posts on health insurance exchanges,  rate review and temporary high risk pools. For links to previous posts and additional resources, please visit the health care reform page on our website. 

Employer-based health insurance coverage is the single largest pillar of the American health insurance system. Unemployment and rising costs continue to erode employer-based coverage, but more than half of all Americans – 169 million -  are still insured through employers.  The federal tax code has long encouraged employers to provide coverage by making employer health care expenditures tax-deductible.

The new federal health care law, the Affordable Care Act (ACA), aims to expand health insurance coverage in the United States in part by strengthening employer-based coverage. The law provides sizable tax credits to small businesses (≤25 employees) that offer insurance. Beginning in 2014, large employers (≥50 employees) will have new responsibilities to provide coverage.  Known as the ‘play or pay’ provision, the law outlines that:

• If a large employer does not offer coverage and any of its employees receives a premium subsidy through a health insurance exchange, it will be subject to a fee of $2,000 per full-time employee (in excess of 30 employees);
• Large employers that offer only unaffordable coverage to workers will also be subject to a fee if employees receive subsidized coverage through an exchange;
• Large employers must automatically enroll employees into their lowest-cost plan if the employee does not sign-up for or opt-out of the employer’s coverage. Read the rest of this entry »

The Joint Committee on the Federal Health Care Law has hosted regular meetings this fall to take stock of Oklahoma’s options and responsibilities as new provisions of the Affordable Care Act (ACA) take effect.  The first meeting explored the impact of health reform on public programs; the second heard testimony about the new law from private business and industry representatives.  The third meeting, held last week in Oklahoma City, got down to brass tacks by beginning to address a major policy piece for states:  planning and implementing health insurance exchanges. OK Policy staff was invited to offer our assessment and we concluded that the window for Oklahoma to operate its own exchange – versus having the federal government do so – may have already closed. Read the rest of this entry »

Under the new national health care law, the Patient Protection and Affordable Care Act (ACA), one major strategy for providing health insurance coverage to the 50 million Americans who are currently uninsured is an expansion of eligibility in the Medicaid program. Even though the federal government will assume the lion’s share of the costs of insurance for those who gain Medicaid coverage, this expansion has created concern and uncertainty about the impact the law will have on state budgets.

We do not yet have a comprehensive study of the projected costs and savings of the Affordable Care Act for Oklahoma’s state budget. However, as a new OK Policy issue brief shows, most studies of the impact of the Affordable Care Act have concluded that increases to state Medicaid budgets will be modest. National studies from the Urban Institute and projections developed by the Oklahoma Health Care Authority have estimated that state spending on Medicaid may grow by $200 to $800 million between 2014 and 2019 or 2020, depending on various assumptions, while increasing state Medicaid spending by under 10 percent.  The federal government will assume over 90 percent of total costs of expanded Medicaid coverage. To cite the conclusion of the study by John Holahan and Irene Headen, the Urban Institute’s experienced and widely-respected health policy analysts: Read the rest of this entry »

This is the eleventh in an ongoing series of posts examining the Affordable Care Act, including previous posts on state insurance exchange flexibility and rate review. For links to all previous posts and additional resources, please visit the health care reform page on our website.  If you have thoughts on health care reform, we encourage you to comment below or contribute a guest blog.

Over the last decade, many American businesses have radically transformed their operations with networked, computer-based processes,  yet health care is one of the few industries that still relies primarily on paper records.  To address the technology gap in the health care professions, the new federal health care law contains several provisions aimed at modernizing the American health care system.  The Patient Protection and Affordable Care Act makes substantial investments in health information technology and introduces new regulatory standards for their adoption.  This post explores how these new requirements and closely affiliated initiatives like the HITECH Act, part of the American Recovery and Reinvestment Act in 2009, are being used to improve the quality of health care in Oklahoma. Read the rest of this entry »

This article is co-authored by Dr. Kristen Marie Burkholder, Dr. James Cane-Carrasco, Dr. Douglas Catterall, Elizabeth Powers, Rev. Scott Scrivner, and Dr. Tony Wohlers. For the authors’ longer study of the American health care system, click here.

On March 23^rd, 2010 President Obama signed into law a sweeping reform of the U.S. health care system.  Since that time some have taken action to repeal these reforms, others have indicated support for extending them.  Much of the talk opposing or supporting reform has been remarkably free of the perspective of those who would benefit most from it: the uninsured, the underinsured, and those who may soon enter their ranks. We are writing to address an injustice that the citizens of the United States, the country of our birth or adoption, are inflicting upon themselves.

Let’s first show the health care system working at its best.  Recently, a colleague of ours became ill and physicians suspected the worst: a brain tumor that might be near or actually embedded in her speech center.  Our colleague received incredible support from family and friends and our employer offers first-rate health insurance, giving her a choice of clinics, hospitals, and specialists.  She chose MD Anderson in Houston whose physicians and staff provided her with the excellent care. Happily, the neurosurgeon who operated on her found no tumor and she has returned to work.  However, this best-case scenario could have turned out differently. Our current health insurance provider, Blue Cross/Blue, Shield., covered the roughly $58,000 cost of our colleague’s treatment. But, with our previous health provider, MD Anderson would have been an out-of-network, leaving our colleague with more of the costs. Read the rest of this entry »