This week marks two years since landmark health care reform legislation, the Affordable Care Act (ACA), was signed into law.  While some of the law’s major provisions have yet to take effect, many of the rule-changes and programs that have been rolled out over the last two years are beginning to have an impact in Oklahoma.  Individuals buying insurance in the private market, families obtaining coverage through their employer, and seniors who rely on Medicare have all seen their costs go down and the quality of their benefits improve.  This post catalogs some of the ways Oklahomans have benefited under the Affordable Care Act: Read the rest of this entry »

The United States Supreme Court is gearing up for oral argument in what is sure to be a landmark case in American history – the multi-state challenge to the Affordable Care Act, the federal health reform law passed by Congress in 2009.  The court has scheduled an unprecedented six hours for oral argument over three days, the most time allocated to a single case since the 1960s.  Oral argument is the only interactive portion of the Court’s decision-making process, where attorneys from both sides state their case and take questions from the justices.  This post breaks down the issues scheduled for debate and summarizes each side’s position.

Day 1: Monday March 26th, 2012

The first day of argument will focus on a procedural question: are the states even allowed to bring suit over a portion of the law that hasn’t yet been enacted?  An existing federal law, the Anti-Injunction Act, prohibits challenging a tax prior to that tax being imposed.  Proponents of the Affordable Care Act argue that since the ‘individual mandate’ amounts to a tax that doesn’t take effect until 2014, this little-known law might actually pose a significant threat to the health law’s challengers.  As Stuart Taylor of the Brookings Institution wryly observes:

If the justices agree that the Anti-Injunction Act applies, this year’s case will be perhaps the greatest anticlimax in Supreme Court history. And, the justices’ assignment of a full hour of oral argument to this question suggests that some take this issue very seriously. Read the rest of this entry »

Following a year of open defiance and several months of interim study, the Oklahoma Legislature now appears poised to take action on a major requirement of the new federal health care law, the Affordable Care Act.  States are required by the law to have web-based health insurance marketplaces, known as exchanges, up and running by 2014.  If Oklahoma does not act to establish an exchange during this legislative session, the federal government will take over the process and establish and maintain an exchange on the state’s behalf.

Last week, legislation to establish an exchange authored by Senate President Pro Tem Brian Bingman was introduced and passed in the Senate Health and Human Services Committee.  SB 1629 creates the ‘Health Insurance Private Marketplace Network Trust’ and broadly outlines the rudimentary functions of a new ‘marketplace network’ – or, insurance exchange.  If this bill is intended to establish an exchange that will satisfy the requirements of the health law and preempt federal intervention, it seems they’ve missed the mark.

Exchanges are meant to serve as a one-stop shop for health insurance.  State-based exchanges should feature a web portal that enables simple and standardized plan comparisons, navigators to provide expert consumer assistance, and a 24-hour hotline.  Residents should be able to purchase insurance and apply their premium tax credits to the cost of a health plan with just a few clicks of the mouse.  If a household is eligible for Medicaid, the exchange should reroute them to apply for the program.  The ‘marketplace’ outlined in SB 1629 shirks almost all of these essential exchange functions. Read the rest of this entry »

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 »

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 »

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 »

What’s up this week at Oklahoma Policy Institute? The Weekly Wonk is dedicated to this week’s events, publications, and blog posts.

This week OK Policy released a paper showing that state costs under the new federal health care law are likely to be modest and could even yield net savings.  Click here to access a 1-page summary of our issue brief: Health Care Reform and the State Budget: Savings Likely to Partly or Fully Offset Modest New Costs.

OK Policy testified this week before the Joint Committee on the Federal Health Care Law.  Click here for our presentation exploring Oklahoma’s options for implementing state health insurance exchanges, a major requirement of the new law.  Read the Tulsa World’s coverage of our paper along with a summary of the committee meeting. Read the rest of this entry »