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 »

Please visit the health care reform page on our website for links to previous posts and additional resources, including our ongoing series examining the Affordable Care Act.

The deadline for Oklahoma to begin operating an online health insurance exchange is just over two years away.  Insurance exchanges, a major component of the federal health care law, are state-operated online marketplaces where private insurance will be bought and sold with robust consumer protections.  Only two states currently operate functioning insurance exchanges – Massachusetts and Utah.  While progress has stalled in developing an Oklahoma exchange, legislative leadership are clearly fans of the Utah model, expressing admiration last session for their “free-market” approach.

Oklahoma legislators should proceed with caution before designing an exchange based on the needs of another state’s consumers. While Utah has been held up as a model for states looking for guidance in developing their exchange, their experiment has not been an unqualified success.  Problems with low enrollment and premiums that offer no cost advantage over the traditional market continue to challenge exchange administrators.  Rather than opting for a copycat exchange, Oklahoma will be better served by a health insurance exchange that accounts for the unique needs and characteristics of Oklahomans. Read the rest of this entry »

This is the tenth in an ongoing series of posts examining the Affordable Care Act, including previous posts on rate review and temporary high risk pools. 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.

Earlier this year, we blogged about health insurance exchanges, a major provision of the federal health care reform law, the Affordable Care Act (ACA).  In a nutshell, states have been tasked with setting-up online insurance marketplaces, or “exchanges,” for selling private coverage and determining eligibility for premium subsidies or public health insurance programs.  The online exchanges envisioned by the Affordable Care Act institute robust consumer protections, simplify plan and premium comparisons, and facilitate competition.  The deadline for states to gain approval for their exchange plans from the federal government is January 2013, and the deadline for having their online insurance marketplace up and running is January 2014. Read the rest of this entry »

Monica Barczak is Director of Innovation Lab at Community Acton Project.

Oklahoma has the sixth highest infant mortality rate in the nation, with 8.5 infant deaths for every 1,000 live births; the rate of infant deaths for African Americans is more than twice the overall average.  Oklahoma’s infant mortality rate could be reduced if women had better access to basic health services, more knowledge about healthy behaviors and habits, and more opportunities to put that knowledge into action.  Healthy Women, Healthy Futures (HWHF) is a pilot program that has demonstrated tremendous success among the women fortunate enough to be able to participate over the past two years.  Operated by the College of Nursing at OU-Tulsa for women with children enrolled at several of Community Action Project’s (CAP) early childhood education centers and at Educare I, HWHF seeks to improve the health of at-risk women living in poverty before they become pregnant again, thereby minimizing their risk of premature birth or infant death. Read the rest of this entry »

As states and Washington grapple with ongoing budget shortfalls, the Medicaid program is often in the crosshairs of those calling for major reductions in government spending. But while the costs of funding Medicaid are readily apparent, we should not forget the program’s crucial role in providing health care for those who may be too poor or too unhealthy to buy coverage in the commercial insurance market. Recently, a path-breaking new study reported that when those without health insurance are enrolled in Medicaid, they see wide-ranging benefits in terms of access to health care services, better physical and mental health, and financial stability. These findings should assume great importance in ongoing state and federal debates on Medicaid and health care reform.

Medicaid is the primary source of health insurance for low-income children, pregnant women, seniors, and individuals with disabilities. The federal-state program covers 47 million Americans, or just under one in five of all those with health insurance coverage (2009). In Oklahoma, 728,594 persons are covered by Medicaid as of May 2011; the majority (63 percent) are low-income children. Medicaid is administered by the states with the federal government assuming a majority share of the costs. Read the rest of this entry »

Legal challenges to national health care reform have proliferated since the Affordable Care Act (ACA) became law in March 2010.  There have been 26 federal lawsuits filed seeking to overturn the legislation, most of them challenging the constitutionality of the ‘individual mandate’ – the requirement that all Americans carry health insurance by 2014 or pay a tax penalty.  Proponents of the ‘individual mandate’ contend that the health care sector takes up a rapidly growing share of interstate commercial activity and the Constitution grants Congress the power to regulate that commerce.  Opponents argue that the Constitution’s commerce clause applies only to economic activity; because the decision not to buy insurance is economic inactivity, there is no constitutional basis for Congressional regulation.

Twenty-six states have banded together and jointly filed Florida vs HHS. This is the most watched of all the legal challenges to the new health care law because of its size and the likelihood that it will be granted an expedited hearing before the U.S. Supreme Court. Oklahoma and Virginia have each filed separate legal challenges. In addition to the states, lawsuits have been filed by plaintiffs from all walks of life, including individual citizens and small groups, businesses and business-owners, physicians, associations, hospitals, universities, and lawyers.

With so many different cases working their way through our complicated judicial system, it’s easy to lose track of the big picture.  This post breaks it down, beginning with the Federal District Courts, the first stop for any case on its way to a Supreme Court hearing.  This chart shows the outcome of district court challenges to date:

Read the rest of this entry »

This is the ninth in an ongoing series of posts examining the Affordable Care Act, including previous posts on health insurance exchanges and temporary high risk pools.  You can also visit the health care reform page on our website for more resources and information.  If you have thoughts on health care reform, we encourage you to comment below or contribute a guest blog.

Addressing the rising costs of care was a driving force behind the passage of national health care reform.   During the long and contentious debates leading up to reform, members of Congress, the media, and the public could all agree on one fact:  health care costs are rising and they are rising fast.  Family premiums for employer-sponsored health coverage increased by 131 percent between 1999 and 2009.  Many factors contribute to the growth of health care spending over time, for example, the enormous expense of supporting an aging population with a longer life span and a greater prevalence of chronic disease.  In addition to a long list of well-documented and legitimate cost drivers, some insurers engage in accounting practices that overestimate expenses and underestimate revenue, artificially inflating consumer premiums.  I recently attended a conference on how to protect consumers from excessive premiums and make health insurers justify rate hikes, hosted by Consumers Union, the nonprofit publisher of Consumer Reports. Read the rest of this entry »