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 »

Michael Fogarty, Chief Executive Office of the Oklahoma Health Care Authority, will be speaking on “The Economics of Health Care Reform” at noon on Thursday, January 20, 2011 at the Oklahoma History Center. The talk is the first spring lecture of the Practice and Policy Lecture Series co-sponsored by the Oklahoma Department of Human Services and the University of Oklahoma Center for Public Management. The event is free and open to the public, with lunch available for purchase.

Fogarty has been CEO of the Oklahoma Health Care Authority since 1999. The agency administers the Oklahoma SoonerCare (Medicaid) programs with a staff of more than 430 employees. As CEO of the Health Care Authority, his statutory duties include service on several agency boards including the University Hospitals Authority and Trust, the Oklahoma Commission on Children and Youth and the O.S.U. Medical Authority.

Fogarty previously served as the Health Care Authority’s State Medicaid Director and Chief Operating Officer. His career includes stints at the Oklahoma Department of Human Services as the Deputy Director and Assistant Director for Medical Services. He was a member of the Washington D.C. legislative staff of former U.S. Senator David Boren. Fogarty’s career also included private law practice and private health-related business.

In 2005, Fogarty was named Administrator of the Year by the Oklahoma Chapter of the American Society for Public Administration. The award is given annually to a public servant in Oklahoma whose career exhibits “the highest standards of excellence, dedication, and accomplishment.”

For additional information and for the full list of lectures in the series, click here.

“Is there anyone here from Oklahoma?”

I was at a national conference of health care policy experts and advocates last month when the morning’s plenary speaker, Cindy Mann, Medicaid Director for the Centers for Medicare and Medicaid Services, posed that ominous question. “Uh-oh. What have we done this time?”, I wondered, as I tentatively lifted my hand.  But this time, Oklahoma was being singled out for major praise, not ridicule. What Oklahoma had done that had Mann and several others at the conference gushing was launch a new streamlined enrollment system for the Medicaid program that may be the most user-friendly in the nation – and that positions Oklahoma at the front of the pack as states face the challenges and opportunities of implementing health care reform in the coming years.

Until the launch of the new enrollment system, applicants for SoonerCare health insurance coverage, the state’s Medicaid program, submitted a paper application to the Oklahoma Department of Human Services (DHS) during regular office working hours. In most cases an eligibility determination would be made 20 to 30 days later after information was entered into the agency’s legacy mainframe computer and verified. Policies and procedures were handled at least slightly differently in each county office and by each caseworker, and the client numbering and tracking system was prone to errors. Read the rest of this entry »

This blog was authored by Tricia Brooks, a Senior Fellow at the  Center for Children and Families at Georgetown University. It originally appeared on November 4th on Say Ahhh! A Children’s Health Policy Blog and is cross-posted here with permission. For prior blog posts on health care reform and additional resources, click here

I’m not big on rules. When I ran New Hampshire’s Children’s Health Insurance Program  and had to talk with a family who was unhappy about some bureaucratic rule, I often diffused the conversation by saying “I don’t make the rules, if I did there wouldn’t be any.” I know, that was a cop-out but it worked. Now I take those words back. This is one rule I might love!

The Centers for Medicaid & Medicare Services (CMS) has published a proposed rule in the federal register that would broaden the definition of “claims” to include “claims of eligibility” in regard to Medicaid management information systems. What does this really mean? It means that eligibility systems may qualify (assuming the rule is adopted) for a 90 percent federal financial participation to support the design, development, testing and implementation of new or enhanced eligibility systems capacity through 2015. Systems could also qualify for an ongoing 75 percent federal match once they are operational.

Is this a big deal? Indeed it is. States have been severely encumbered by a lack of resources to make system innovations or replace decades old legacy systems that, quite frankly, have outlived their usefulness due to a lack of major overhauls. Moving forward on streamlining efficiencies and the use of data matching to verify eligibility helps both states and real people but requires the latest in systems architecture and performance to achieve the innovations that we know are possible. These kinds of system transformations, along with seamless integration with Exchange IT systems, require major investments and the enhanced federal funding will be welcome news to cash-strapped states. Read the rest of this entry »

This is the fifth in an ongoing series of posts examining the new federal health care reform law. Our previous posts have explored the “cliff effect”; the  impact on state budgets; the Temporary High Risk Pool; and tax credits for small businesses. For full information on health care reform, the Henry J. Kaiser Family Foundation website is excellent. If you have thoughts on health care reform, we encourage you to contribute a comment or a guest blog.

While most of the attention and passion in the health care reform debate  has focused on insurance coverage for acute medical care, the Affordable Care Act includes several provisions that could provide important new choices and opportunities for the large and growing segment of the population that is in need of long-term care services and supports.

Over 10 million Americans – or almost one out of twenty adults – need long-term services and supports to assist with daily living activities, such as dressing, eating and toileting, preparing food, and medication management. While 58 percent of those with long-term care needs are age 65 and over, the population includes people of all ages, including, for example, children with intellectual disabilities, young adults with serious mental illness, and disabled veterans. The aging of the baby boom generation ensures that the population with long term care needs will grow rapidly over the coming decades.

The cost of long-term care is one of the great challenges facing governments and families alike. According to the Kaiser Family Foundation, nearly $176 billion was spent on long-term care services in 2006. Medicaid is the single-largest payer of long-term care services, covering 40 percent of the costs, followed by Medicare (23 percent), out-of-pocket spending (22 percent), and private insurance (9 percent). Medicaid expenditures on long-term care services totaled $109 billion in 2006, having more than doubled since 1995.  Since states are responsible for a significant share of Medicaid expenditures, policy choices regarding the provision of long-term care services matter greatly for state budgets. Read the rest of this entry »

Oklahoma voters have the great good fortune this November to decide the fate of no less than 11 proposed constitutional amendments on matters ranging from education funding and health care reform to judicial nominations and (we kid you not) Sharia law. For the confused voter – which means you, me and everyone else – here are some resources on the ballot measures that may be helpful in understanding these issues and making informed decisions. We will keep the State Ballot Question page of our website updated as additional information and resources become available.

OVERVIEWS

The State Election Board has compiled all eleven state questions into a single PDF document.

These websites provide helpful overviews of all the measures on November’s ballot:

• The Secretary of State lists each proposed state question, along with the short title that will appear on the ballot. You may also view the full text of the document by selecting the corresponding Adobe PDF icon.
• Ballotpedia provides a list of the questions and links to additional information on each one.

INDIVIDUAL QUESTIONS

For each question, we link to the Ballotpedia article and full text of the measure from the Secretary of State’s website. Where available, we’ve identified selected additional information and analysis, including pieces we have published and analysis by two journalists – Wayne Greene, an editor of the Tulsa World, and Patrick McGuigan, editor of CapitolBeatOK.com – who have published columns on several ballot measures.

State Question 744: Amount of money the State provide common schools

• Full text
• Yes on SQ 744 website
• One Oklahoma Coalition (anti-744) website
• Oklahoma Policy Institute’s issue brief and fact sheet opposing SQ 744
• Kurt Hochenauer op-ed supporting SQ 744 Read the rest of this entry »

Ryan Kiesel, the author of this guest blog, has served as State Representative from District 28 since 2004 and is not seeking reelection.  Ryan is the leader of the Oklahoma Lawyer Chapter of the American Constitution Society.

This November, Oklahoma voters will decide State Question 756, determining whether Oklahoma will participate in what is likely to be a futile attempt to block the recently approved federal health care reform.  In 2014, as part of the health care reforms contained in the Affordable Care Act, “most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans“.  Individuals and families that fall below certain income levels would be exempt from the mandate and tax penalty.  Opponents of the Affordable Care Act argue the federal government does not have the authority to mandate coverage.  However, this argument runs counter to over a century of Constitutional precedent, and a challenge to the law would only precipitate lengthy, frivolous, and costly litigation that Oklahoma would ultimately lose.

The author of the measure that placed SQ 756 on the ballot said “this measure will hopefully bring about a court case that we need to have.”  Perhaps if the legal questions at issue were unsettled, litigation would be necessary to establish a clear interpretation of Congress’ authority to act and the ability of states to nullify or opt out of federal law.  But that is not the case.  While the politics of health care reform are still evolving, the legal issues raised by health care reform have long been settled, and barring a sweeping dismissal of precedent by an activist court, we already know the outcome of state-based challenges. Read the rest of this entry »

This is the fourth in an ongoing series of posts looking at the impact of the new federal health care reform law on Oklahoma and Oklahomans. Our previous posts have explored the “cliff effect” , the  impact on state budgets and the Temporary High Risk Pool. For full information on health care reform, the Henry J. Kaiser Family Foundation website is excellent. If you have thoughts on health care reform, we encourage you to contribute a comment or a guest blog.

Most people who have been following the Affordable Care Act, the new health care law passed earlier this year, know that the law will strengthen the individual market for health insurance coverage, by offering subsidized coverage on the new health insurance exchanges, and expand access to public coverage for low-income families through Medicaid. What is less well known and understand is that the Affordable Care Act also includes several important mechanisms for strengthening the beleagured employer-based system of health insurance coverage, especially for small businesses that currently face the greatest challenges in offering coverage to their workers and where the rates of the uninsured are currently the highest.

A recent report from Families USA looks at one of the most important provisions of the new law, tax credits for small businesses that will provide significant help with the cost of coverage. Beginning this year, businesses with fewer than 25 workers and average wages of less than $50,000 will be eligible to receive a tax credit for the health insurance premiums they provide to their employees.  The smallest firms with the lowest wages will be eligible for the maximum credit, which is 35 percent of the cost of coverage, or 25 percent for non-profits. The credit will phase down for businesses with more employees and higher average wages. Businesses that are already offering coverage, as well as those opting to cover the workers for the first time, will be eligible for the credits. After 2014, when the new health insurance exchanges will be operating, credits will increase to 50 percent of the cost of coverage, or 35 percent for non-profits. Read the rest of this entry »

A key provision of the health care reform law passed in March creates new insurance options for individuals with pre-existing health conditions. The new program, known as the Oklahoma Temporary High Risk Pool, began accepting applications this week. Click here for further information about eligibility and how to apply. Here is our blog post on the subject from May.

It’s a widely known and much lamented fact that our current health insurance system can place the greatest obstacles in the path of precisely those most in need of affordable and adequate coverage. Individuals with pre-existing medical conditions who are unable to obtain coverage through their employer or government programs tend to be left uninsured or paying exorbitant premiums for insurance that may exclude their chronic conditions or disabilities.

A central goal of the new health care reform law passed in February is to solve this problem by prohibiting insurance companies from denying coverage based on pre-existing medical conditions. This prohibition will apply both to employer-based coverage and to products offered through the new health insurance exchanges, where those not covered by employer or public insurance will be able to purchase coverage, with sliding scale subsidies available for those with income up to 400 percent of the federal poverty level. Read the rest of this entry »

From time to time, we use the OK Policy blog to post contributions from guests on important policy issues for the state. Brad Byers is a retired Tulsan whose professional experience includes having been public affairs officer for the National Academy of Sciences/National Research Council and the U.S. Department of Energy, as well as executive editor of Southern Living Magazine.

People are quick to believe anything that fits their view of the world, their ideology. Even when presented with facts that prove their belief is false, they stick to their belief.

And this is the problem of health care reform in Oklahoma.

At a June 18 forum in Tulsa, three visiting experts explained the benefits of the new national health care law, known officially as the Patient Protection and Affordable Care Act. “For the first time in America, health care is for everyone,” said Tricia Brooks of the Center for Children and Families at Georgetown University. The net effect should be a huge improvement in the availability of health care to a large percentage of Oklahomans. Immediate benefits include a high-risk pool for persons who previously could not get insurance because of  pre-existing conditions, coverage for children with pre-existing conditions, coverage for young adults up to age 26 on their parents’ policies, tax credits to small businesses to help pay health premiums, and a gradual closing of the prescription drug “doughnut hole” for Medicare recipients. Read the rest of this entry »

OK Policy is pleased to be partnering with the Community Service Council, Oklahoma Institute for Child Advocacy, and other community organizations to host a one-day forum titled, “Health Care Reform: Transitioning Health Care for Oklahoma’s Children and Families.” The event will be held in Tulsa on Friday, June 18th from 10:00 to 3:00 at the University of Oklahoma Tulsa Schusterman Center.

The forum will unfold in three sessions. The first will feature an overview of the new national health care law by Tricia Brooks, a leading national health care policy expert and advocate with the Center for Children and Families at Georgetown University. Tricia’s talk will focus especially on how the new law expands coverage for low-income families and children.  She will then be joined by state officials for a lunchtime panel addressing some of the choices, challenges, and opportunities Oklahoma will confront between now and 2014 in implementing health care reform. Finally, participants will have a choice of three break-out sessions that will explore enrollment issues, public education and advocacy, and the budgetary challenges facing state health coverage.

The workshop should be a highly informative day for advocates for low-income children and families, policymakers, and health care professionals. Admission is free and lunch will be provided; however, registration in required. Click here to register.