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 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 »

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 »

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 »

It was a busy session.  Last Friday marked the deadline for Governor Fallin to take final action on bills that landed on her desk. Now that sine die has passed, we thought it would be useful for OK Policy to do inventory and update you on the status of the bills we wrote about this session on our blog.

There were over two dozen immigration bills introduced this session.  Neither of the ‘English only’ bills, HB 2083 and SB 905, intended as implementing legislation for State Question 751, were approved by the legislature.  On our blog, we advised against passage and pointed out that the bills would have imposed new and draconian restrictions on speech and potentially entangled state officials in a legal double bind.  We also blogged about two bills, SB 683 and HB 1446, that sought to rescind resident tuition eligibility for undocumented high school students enrolling in public colleges and universities.  The stand alone bill, SB 683, died in House committee and the sections pertaining to resident tuition eligibility were removed from HB 1446 in conference committee.  We have blogged extensively about other sections of HB 1446, the omnibus immigration legislation which went through several incarnations and was eventually defeated on the House floor by a vote of 62 (N) to 31 (Y). Read the rest of this entry »

Julie is an Associate Professor and Assistant Director of the Anne and Henry Zarrow School of Social Work.

The number of uninsured individuals in Oklahoma has reached approximately 600,000 individuals. Almost half of Oklahoma’s uninsured are between the ages of 19-34. Despite this high number, little is known about why these young adults are underinsured or what strategies might encourage them to obtain coverage.

A state-wide survey and focus groups were designed to capture the opinions of young Oklahomans ages 19-34 regarding access to and the use of Oklahoma’s health care system in the absence of health insurance. Although it has been suggested that the young adults believe that they do not need health care coverage, results of the survey suggest otherwise. Read the rest of this entry »

Today is the one-year anniversary of President Barack Obama signing into law the landmark Affordable Care Act (ACA).  Many of the most far-reaching provisions of the health care reform law – including the launch of new health insurance exchanges for individuals and small groups, subsidies for the purchase of individual coverage, expansion of Medicaid eligibility, and the individual coverage requirement- do not take effect until January 1, 2014. However, some provisions of the law are already improving health insurance, expanding coverage to new populations, and making insurance more affordable. According to a fact sheet from Families USA, Oklahomans have already benefited from health care reform in a number of ways:

• Over 50,000 uninsured Oklahomans under the age of 26 are now eligible to remain on their parents’ health insurance plans;
• Some 50,000 Oklahoma Medicare recipients received a $250  rebate check in 2010 to help plug the “doughnut hole” in prescription drug coverage. In 2011, those who reach the doughnut hole will receive a 50 percent discount on brand-name drugs and will be eligible for reduced-price generic drugs;
• Nearly 600,000 Oklahoma seniors and persons with disabilities on Medicare now enjoy access to free preventive services, such as mammograms, colonoscopies and flu shots, along with a free annual wellness visit;
• Over 65,000 Oklahoma children with pre-existing health conditions can no longer be denied coverage by their insurance company;
• Some 50,000 Oklahoma small businesses with 25 or fewer employees and an average wage of less than $50,000 are now eligible for tax credits to help cover up to 35 percent of the cost of health insurance premiums for their employees. 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.

Our series on marriage promotion continued Monday with two perspectives from new staff, Kate Richey and Gene Perry.  The OK Policy Roundtable, Should Oklahoma be promoting marriage? continues the conversation started this month by Scott Stanley, guest blogger and research professor at the University of Denver, who reported on the success of Oklahoma’s Family Expectations program.  Are there any topics you would like to see covered in an OK Policy Roundtable? Read the rest of this entry »

This is the sixth in an ongoing series of posts examining the Affordable Care Act, including previous posts on the Temporary High Risk Pool and tax credits for small businesses.  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.

One of the most important provisions of the federal health care reform law, officially known as the Affordable Care Act (ACA), is the requirement that states establish private insurance marketplaces, or ‘Exchanges’, to sell plans to individuals and small groups in their state.  Health insurance exchanges were written into the law to ensure that these particularly vulnerable segments of the market – individuals and small groups – could obtain affordable coverage.  What is unique about these segments?  Well, consider how insurance works for a large group employer:  every employee is covered regardless of medical history and all employees pay roughly the same premiums.  This is possible, and perhaps more importantly profitable, because the risk of covering the sicker/costlier employees is offset by the ease of covering healthier/cheaper employees. Read the rest of this entry »

Donna Rhodes is the CEO of the Long Term Care Authority, a public trust authority of the city and county of Tulsa leading the Tulsa community and the state in addressing long term care reform.

While the voice of long term care has been mostly silent in the health care reform discussion, it is unlikely to remain that way for much longer.  This sleeping giant has been extensively studied and analyzed, producing a multitude of recommendations both nationally and locally.  Yet without serious effort to strategically plan and implement the necessary infrastructure changes, states will be caught unprepared for the impact of long term care’s growing cost and will miss out on the expected federal incentives for supporting long term care systems change.

Shifting more financing for long term care from institutional care to home and community based services (HCBS) has been a policy goal across the nation since the 1970s.  Oklahoma’s initial investment in “balancing” the state’s long term care financing and service delivery systems changes began in earnest with the creation of a local public trust authority focused exclusively on long term supports and services and, subsequently, the establishment of a statewide comprehensive HCBS system.  The ADvantage HCBS Program, operated and managed by private business located across the state, was intended to become the foundation on which to build a Medicaid managed long term care system for the predicted “tsunami” of long term care needs of an aging population with chronic illnesses and disabilities. Read the rest of this entry »