SB 1059 would allow the Oklahoma Insurance Department to enter into agreements with one or more states to allow the sale of insurance across state lines.  The bill also exempts these out-of-state insurers from the minimum benefits that Oklahomans are entitled to under existing state law.  Oklahoma requires insurance companies to cover a handful of basic benefits. These benefits, or ‘mandates’, ensure that health insurance plans cover essential health services. The state’s mandated benefits cover preventive health services for children (immunizations), women (mammography and bone density screenings, maternity care, and annual pelvic exams and cervical cancer screenings), and those with chronic conditions (diabetes supplies, mental health treatment).

Proponents of the legislation are quick to point out that exempting insurers from minimum coverage requirements is not the intent of the bill; the purpose of exempting in-state insurers from covering basic benefits is to allow them to compete with new out-of-state plans that will flow in after we’ve signed a compact with another state.  For instance, if Texas insurers are allowed to sell so-called ‘skeleton’ coverage in Oklahoma, without including basic benefits like child immunizations or colonoscopies, than Oklahoma insurers should be allowed to offer such plans too.  Regardless of the intent of the bill, if SB 1059 becomes law it effectively suspends minimum benefit requirements for any insurer in the state that wants to mimic a ‘skeleton’ plan sold by an out-of-state competitor.

For households of modest means, paying out-of-pocket for cancer screenings and immunizations represents a significant cost burden, and many families will have to go without some of these critical services.  Not to mention the symbolic indifference of exempting insurers from covering the costs of, for instance, wigs or hairpieces to extend a little basic human dignity to Oklahoman’s undergoing radiation and chemotherapy treatments.  Oklahoma insurers cleared $25 million in after-tax profit in a single year in the individual market alone, which doesn’t even include profits made off the large group market, where most Oklahomans get their health insurance.

This bill has already passed the state House and Senate and will move next to a conference committee.  If changes are made in conference, it must be approved by both the House and Senate again before heading to Governor Fallin for final approval.  To voice your opinion about SB 1059, click here to enter your address and find your state House and Senate members’ contact information.

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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:

• An additional 202,000 Oklahomans will be covered by Medicaid. Of this population, 17 percent, or 36,000 people, are currently eligible but unenrolled for Medicaid, while the remaining 83 percent will be newly eligible as a result of the expansion of Medicaid eligibility to 138 percent of the federal poverty level for adults. These numbers further refute an alarmist study put out last year by the Oklahoma Council of Public Affairs which projected huge new costs for Oklahoma under the ACA based on four times as many currently eligible but unenrolled people signing up for Medicaid.
• An additional 135,000 Oklahomans will be covered through private insurance, either through their employer or in the non-group market. The study projects an increase of 77,000 people covered through their employers and an additional 58,000 people covered in the non-group market.
• Of the 2.0 million Oklahomans who will have private coverage after the law takes effect, some 275,000 are expected to purchase coverage through the new health insurance exchanges that will operate beginning in 2014. Of this population, some 100,000 are expected to be eligible for premium subsidies to assist with the cost of care.

The study also projects that the ACA’s coverage expansion will significantly reduce the amount of uncompensated care provided by Oklahoma hospitals, doctors, and other health care professionals and facilities. Uncompensated care costs are projected to fall by over two-thirds, 69 percent, from $886 million annually to $277 million.  Nationally, uncompensated care costs are projected to fall by 51 percent.

The study notes that Oklahoma, like several of the states that stand to see the greatest benefit from the Affordable Care Act, has made little progress towards implementing the new law. According to the study, Oklahoma is among 15 states that has not yet implemented a health insurance exchange or demonstrated significant interest in doing so, and one of only six states to have taken no legislative action in 2011.  The federal government will run the exchange in states that are not ready to launch a state-based exchange by January 2014, . Whether Oklahoma still can or should develop an exchange is certain to be a hotly contested issue during the 2012 legislative session. Yet unless the entire law is struck down (a question we will address in a forthcoming post), this report provides further grounds for confidence that the state’s long-standing problems associated with high rates of uninsured and uncompensated care should be significantly eased in the years ahead.

Click here to see the study, “State Progress Toward Health Reform Implementation: Slower Moving States Have Much to Gain”

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Growing numbers of Americans have almost no savings or other assets to fall back on if they lose their jobs or face a medical crisis.  Without those savings, few will be able to invest in a more economically secure future, including buying a home, saving for their children’s college educations or building a retirement nest egg.

The 2012 Assets & Opportunity Scorecard offers a comprehensive look at Oklahomans’ ability to build wealth, fend off poverty, and create a more prosperous future. The Scorecard compares states along 52 different measures of how residents fare in five issue areas: Financial Assets & Income, Businesses & Jobs, Housing & Homeownership, Health Care and Education.

Oklahoma ranks 33rd overall and earns a “D” in Financial Assets & Income, with above-average income poverty and an over-reliance on predatory lenders and subprime credit. In Health Care, the state ranks 46th in the overall uninsured rate and 47th in uninsured low-income parents. We rank 43rd in residents with two- or four-year college degrees. The one bright spot among the five issue areas for Oklahoma is in housing and homeownership. The state earned a “B” on the Scorecard and ranks 14th in overall homeownership and housing affordability.

The Scorecard also highlights a dozen policy solutions that can help Oklahoma increase opportunity and promote financial stability.  To address asset and income poverty, Oklahoma should fund a state Individual Development Account program to help its low-income population build wealth. To improve its below-average secondary and post-secondary educational outcomes, Oklahoma should increase funding to schools, especially in high-poverty districts, and match savings for college in 529 accounts. In addition, to protect assets and avoid the pitfalls of predatory high-cost loans, Oklahoma should increase access to safe financial products and limit high interest rates and other harmful practices of payday lenders.

Oklahoma Policy Institute is co-releasing the Assets & Opportunity Scorecard as part of an ongoing commitment to advance anti-poverty policies in Oklahoma that prioritize wealth creation and asset-building for low- and middle-income households.  Oklahoma Policy Institute Director, David Blatt, interprets the scorecard results to mean that, “Too few Oklahomans have a college degree and too many are living in asset poverty, without the savings to weather a financial setback or invest in their future. We need better policies that ensure that all Oklahomans are on a path to prosperity and we must protect existing policies, like tax credits for working families, that help hundreds of thousands of households make ends meet.”

The Scorecard paints a picture of a country where middle class families continue to fall further behind more than two years after the official end of the recession.  For ‘asset poor’ families, making ends meet from day to day is a constant struggle and investing in the future is all but impossible.  Locally, a new organization is committed to promoting those policies that improve the outlook for poor, near poor, and middle class Oklahomans.  The mission of Oklahoma Assets is to advocate policies and programs, like the ones just outlined, that create a more inclusive economy – one in which financial success, economic stability, and opportunity are available for all.

To download a summary of Oklahoma’s Scorecard click here.

To view all Oklahoma data from the 2012 Assets & Opportunity Scorecard click here.

To access the complete Scorecard, including data from all 50 states click here.

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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 explained what federal budget cuts could mean for Oklahoma.  Doug Hall of the Economic Policy Institute underscored the urgency of fixing America’s crumbling infrastructure.  Our director David Blatt spoke at a StateImpact Oklahoma forum about why proposals to reduce or eliminate the income tax would effectively raise taxes for most Oklahomans.

Also this week, we featured remarks by Maryland Governor Martin O’Malley on how health care reform improves business competitiveness.  We posted event information about the first annual Grandparenting Workshop at Oklahoma State University.

Numbers of the Day

• $107 – Average tax increase on sixty percent of Oklahoma households under a legislative proposal to eliminate a slate of broad-based tax credits and exemptions.
• 8,600 – Number of jobs lost in state and local government in Oklahoma over 2010.
• $22,007 – Annual average wage for home health aides in Oklahoma, just below the federal poverty level for a family of four in 2010, $22,050
• 11 percent – Percentage of ex-offenders released in Oklahoma who were re-incarcerated for technical violations of their probation/parole in 2004, up from 3 percent in 1999.
• $34 million – Amount needed to repair sewer lines and make major improvements to two facilities slated for closure that house medically fragile, mentally disabled Oklahoma residents.

In The Know, Policy Notes

• The Center for Economic and Policy Research shares five reasons we should be concerned about the rising share of low-wage work.
• Touchstone examines the austerity curve, or the point at which cutting government spending becomes self-defeating because it lowers growth, depresses tax revenues, and pushes up social security spending by more than the government is cutting.
• The Century Foundation shares a series of graphs that bust the myths about food stamps.
• The Kaiser Family Foundation released their annual survey of employer health benefits, with a detailed look at trends in employer-sponsored health coverage.

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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.

First, we do not have enough doctors, nurses, and health care providers in Oklahoma.  If you live in an urban area, this will be hard to relate to, but it’s true.  We rank 49th in availability of primary care physicians, with only about 82 physicians per 100,000 Oklahomans.  The consequences of this fact should be obvious.  Without access to regular preventative care and treatment when you’re sick, minor health problems can become catastrophic illnesses.  Rural Oklahomans could be making healthy choices, but end up unhealthy because of lack of access to care.  We need government support for efforts that promote access to care, like schools of community medicine, graduate student loans, and incentive programs for doctors who settle in remote areas.  How can we attract modern economic development to a state where many residents haven’t ever had a doctor?

Second, we have hundreds of thousands of households living in poverty.  Poverty affects a person’s health in innumerable ways that are beyond their control.  Not being able to afford medical care, even if you have a doctor nearby, can be an insurmountable hurdle to well-being.   Children living in poverty are especially vulnerable, as their health choices are totally dependent on caregivers who are already struggling to meet other basic needs like food, clothing, and shelter.  The state and federal governments, through the SoonerCare/Medicaid program, currently subsidize medical care for 472,111 Oklahoma children who might otherwise go without.  If you don’t think that government has a role to play in the overall health of our citizens, then you’d better be prepared to count those children out.

Other structural conditions, many perpetuated by living in poverty, also contribute to poor health:

• Lack of medical care, malnutrition, and second-hand smoke as an infant or during early childhood has lifelong effects on health.
• Limited access to healthy groceries coupled with abundant access to fast food in urban areas (‘food deserts’) significantly constrain household diet choices.
• Poor air quality exacerbates chronic conditions like asthma and other respiratory disorders.
• Fewer gyms and public parks in low-income areas make consistent exercise more challenging.
• Insufficient income to purchase nutritious food coupled with lack of knowledge about healthy eating stacks the deck against low-income households.

Government can and should invest in improving the structural conditions that destine impoverished people to a lifetime of poor health outcomes. There is no other alternative.  Oklahoma households cannot continue to work, save, and invest as more and more of their labor and income is taken up caring for ailing parents and grandparents.  The economic development goals of the state cannot be met with an ever-sicker, ever-poorer workforce.  Individual health problems eventually become public health problems that the state must address.  If we don’t come to terms with the grim reality of our health care situation on the ground, we cannot expect the state to enjoy continued, broad-based prosperity.

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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.

Only a very small percentage of those without insurance reported that they did not have insurance because they did not need it. Further, those without insurance reported worrying about their health significantly more than those with insurance. Overwhelmingly, the main barrier for uninsurance status was cost: 85 percent of those survey indicated that cost was a significant barrier for obtaining health insurance. Many young adults also believed that they would not qualify for state insurance programs or were not employed, or employed at jobs without health coverage.

When those young adults without insurance were asked what they considered to be an affordable monthly premium, 97 percent reported that they could only afford a premium under $100.00.

Another assumption about young adults is that they are a fairly healthy group, with fewer and lower medical costs. Results from this study reveal a different picture. Young adults struggle significantly with medical costs; more troubling, 60 percent of uninsured young adults report having medical debt and 57 percent report that they have used pay day lenders to assist with covering medical costs. Debt among Oklahomans is a a major problem, and health care costs are a significant portion of this debt.

Further, young adults without insurance coverage report poorer health and over half report having long term and ongoing medical problems that require regular care as well as health related limitations.

Improving coverage for young adults is an important policy problem for Oklahoma, so what could be done?

• Address the affordability of coverage.
• Expand access to affordable care for Oklahoma’s young workforce. If we promote pathways to higher education and training for young adults, better paying jobs will mean better health insurance coverage.
• Educate young adults about state programs. Many young adults believe they are not eligible or are aware of state programs designed for adults without health insurance (e.g. Insure Oklahoma).
• Consider marketing campaigns aimed at young adults. On the precipice of health reform in Oklahoma and the development of health exchanges, young adults will require information specific to their needs. Social media campaigns that explain health care changes and options will increase knowledge and enhance decision making. Targeting young adults who are particularly at risk for underinsurance is also important (e.g. those without access to Cobra coverage through parents, lower income or minority young adults).

Strategies such as the above could prevent some of the serious health and financial consequences that young Oklahomans experience without health insurance coverage. Secure coverage would afford them both health and future economic stability.

This blog summarizes some findings of a collaborative state-wide survey of young, uninsured Oklahomans by the University of Oklahoma–Anne and Henry Zarrow School of Social Work and the Oklahoma Insurance Department. For the full report, please contact  jmcribbs@ou.edu

The opinions stated above are not necessarily those of OK Policy, its staff, or its board. This blog is a venue to help promote the discussion of ideas from various points of view, and we invite your comments and contributions. To see our guidelines for blog submissions, click here.

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Jeffrey Alderman, M.D., is an associate professor in the Department of Internal Medicine at the University of Oklahoma School of Community Medicine in Tulsa.

With Medicaid cuts looming and the federal government entertaining efforts to shift the costs of Medicare and Medicaid on to states and individuals, the future of health care reform and reimbursement seems murkier now than ever. But gaining little attention is the issue of physician workforce. In other words – with the size and scope of our health care provider pool now shrinking, how will we meet increasing patient demand with our current available workforce?

Despite our best efforts, we simply cannot attract new physicians to the state, and a large percentage of our OU/OSU graduates leave to work outside of Oklahoma. This helps to explain why in 2009 the Commonwealth Fund ranked Oklahoma 50^th in the nation for health status and health system performance. Similarly, a 2007 American Medical Association report found that Oklahoma ranks last in the US in physicians per capita, perhaps revealing why there is a 14-year difference in life expectancy between some north and south Tulsa communities.

Therefore, we depend upon a pool of providers that is ever shrinking – and an even smaller pool of doctors who are willing to practice primary care AND will accept Medicaid insurance. If deeper cuts to providers are made, the urban and rural poor, disabled, pregnant and aged patients will be forced to seek care in the only places where doctors will continue to accept SoonerCare (at higher contracted rates): the universities and the Federally Qualified Health Centers (FQHC’s.)

This is highly problematic, because many Medicaid patients have difficulty securing transportation to such far-flung facilities. Moreover, attracting physicians to work in these settings is challenging – especially when a physician can earn two to five times more income working in the private sector.

We need to graduate and retain doctors in Oklahoma who feel a sense of mission (like the innovative Dr. Jeff Brenner of Camden, NJ – who was recently featured in ‘The New Yorker.’) This line of thinking led OU-Tulsa and the George Kaiser Family Foundation to launch ‘The School of Community Medicine’ – with its emphasis on improving health status through retooling medical education.

The school’s new curriculum is designed to train medical students not just to focus on meeting the health care needs of individual patients, but on whole communities as well. Yet, when medical students are now graduating with over $200K in debt, it’s easy to see why we have a surplus of highly paid specialist physicians, such as urologists and orthopedists, opening practices in wealthy Tulsa and Oklahoma City enclaves. It is also easy to see why we have very few primary physicians throughout Oklahoma that will accept Medicaid.

Of course, the biggest losers in the new paradigm are low-income patients, who will face ever-decreasing access to medical care. In essence, we’re waiting for Superman to open a primary care practice in Oklahoma – but I worry he may have just moved to Texas to become a Neurosurgeon.

The opinions stated above are not necessarily those of OK Policy, its staff, or its board. This blog is a venue to help promote the discussion of ideas from various points of view, and we invite your comments and contributions. To see our guidelines for blog submissions, click here.

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Medicaid  is a primary source of health insurance for seniors, persons with disabilities, and children. Medicaid is especially important for Oklahomans receiving long-term care  in their homes or in nursing home facilities. It is also a cornerstone of the health care system for hospitals, physicians, pharmacies, nursing care facilities, home health care providers, and other professionals and businesses across the state. About one out of every five Oklahomans – close to 700,000 people -  receive health insurance coverage through Medicaid.

The Ryan proposal would turn Medicaid into a block grant.  Instead of covering a fixed share of a state’s Medicaid costs, the federal government would write a check each year. It would dramatically cut the amount of money it gives to a state, and that cut will grow bigger and bigger every year.  In total, states would receive $771 billion less over the next ten years under the Ryan plan; Oklahoma would lose some $8.2 billion, according to projections from Families USA.

Some Republican Governors, including Oklahoma Governor Mary Fallin, argue that a block grant would give them greater flexibility to decide their own rules on eligibility and benefits and operate the program more efficiently. However, states already have a lot of flexibility and the capacity to save money through greater efficiency is limited. The cost of care through Medicaid has grown at a much slower pace than in private insurance and it costs less per person than private insurance.  According to analysis by the Center on Budget and Policy Priorities, Medicaid costs 27 percent less for children and 20 percent less for adults than private insurance for people with similar health status, while providing more comprehensive benefits and lower out-of-pocket costs.

In reality, the Ryan budget would cut federal Medicaid spending so deeply that states would find deep cuts unavoidable, leaving seniors, children and people with disabilities without the health care they need.  As the Congressional Budget Office stated in an analysis of Ryan’s budget:

Because of the magnitude of the reduction in federal Medicaid spending under the proposal, however, states would face significant challenges in achieving sufficient cost savings through efficiencies to mitigate the loss of federal funding.  To maintain current service levels in the Medicaid program, states would probably need to consider additional changes, such as reducing their spending on other programs or raising additional revenues.  Alternatively, states could reduce the size of their Medicaid programs by cutting payment rates for doctors, hospitals or nursing homes; reducing the scope of benefits covered; or limiting eligibility.

In Oklahoma, with no end in sight to the state budget crisis, reduced federal Medicaid funding would mean cutting provider rates, benefits or eligibility.  Cutting provider rates would threaten the livelihood of many health care providers, and would likely lead many to withdraw from the program, endangering access to timely and appropriate care. Reducing benefits would risk depriving people in the poorest health – persons with disabilities and chronic health conditions – of needed services. Limiting eligibility is likely to especially affect children, undoing the progress Oklahoma has made in covering more kids, and persons with long-term care needs who are currently being served in home and community-based waiver programs. All these cuts would have their greatest impact in poor and rural parts of Oklahoma, where Medicaid participation rates are highest and provider networks are most limited.

While there is a definite need for reasonable steps to address rising health care costs and tackle the federal deficit, this is the wrong approach. Capping federal spending through a block grant would be bad for the state budget, bad for Oklahoma’s health care providers, and bad for the low-income seniors, persons with disabilities, children and families who count on Medicaid for the health care they need.

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• 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.

Programs under the new law are providing coverage for previously uninsured adults with pre-existing conditions through a Temporary High Risk Pool, and businesses, schools, non-profits and other entities are receiving assistance to cover the health care costs of early retirees. Oklahoma consumers are poised to benefit from a $415,000 grant for the Health Care Ombudsman Program operated by the Insurance Department and from a $1 million grant to improve the health insurance premium review process. Oklahoma has also received almost $5 million in grants from the Prevention and Public Health fund to prevent illness and promote health, and significant funding to address health professional workforce needs and support capital projects for health centers serving uninsured and low-income individuals.  As we discussed in this blog post, Oklahoma was one of only seven states to receive an Early Innovator Grant, in the amount of $54 million, to develop a high-quality health insurance exchange that will facilitate and coordinate the purchase of insurance by individuals and small businesses beginning in 2014.

More provisions of the Affordable Care Act will take effect in 2011, including several that expand choices for long term care and provide new incentives to promote preventive care and wellness in Medicaid and Medicare. In addition, some of the tax changes that help pay for health care reform, including changes to tax-free health savings accounts, take effect this year. There is no question that the Affordable Care Act will remain controversial and that battles and skirmishes over the law will play out in Congress, statehouses and courthouses over the next several years. For now, however, we believe it is worth celebrating the real, if incremental, progress the law has made in expanding access to quality health care for a large number of Oklahomans.

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Over the past two years, most agencies have lost 15 percent or more of their funding. Even though state appropriations as a share of the economy is at a 30 year low, next year’s shortfall is projected at $500 million. The Governor’s proposed budget for next year would eliminate some agencies and take another 3 to 5 percent from the rest.

Last year we surveyed some of what’s been lost. Here’s an update:

• With personnel costs making up 93 percent of its budget, more cuts to the Public Safety Department will mean furloughs and possibly laying off troopers. The Department already has 110 fewer employees than 2 years ago, and more than half of the drivers’ license testing sites across the state have been closed. A portion of these funds are being replaced by increasing the fee to reinstate a driver’s license.
• Oklahoma prisons are at 99 percent capacity with 8,000 more inmates and fewer staff than in 1995, which creates a dangerous situation where one officer can be supervising as many as 276 offenders. County jails have gone over capacity, with 1,348 state prisoners backed up in county jails at the end of 2010. Community sentencing, sex offender and substance abuse programs, and education and job training programs have all been cut or eliminated. Family visitation was cut to two weekends per month.
• To prevent additional furloughs, the legislature authorized taking $5.3 million from the Oklahoma Correctional Industries operating fund, which will end programs that make a profit and provide job training for inmates, reducing recidivism rates by one half compared to inmates not in the program. Cutting the program also leaves prisoners idle, which compounds problems of overcrowding. Longtime Board of Corrections member David Henneke said he is “very fearful something drastic or bad will happen, and we can end up with injuries and people hurt.”
• A projected shortfall of $7 to $9 million in the court system next year will mean layoffs of special judges, deputy court clerks and secretary-bailiffs. It also means inflated fees for anyone in need of court services as they increase to partially make up for inadequate tax dollars.
• Reductions in mental health services are putting more of the burden of handling the mentally ill on state and local police. From 2009 to 2010, calls for police to help the mentally ill increased by 50 percent. Police spending hours to transport mental health patients across the state to find treatment. In the past 18 months, the Department of Mental Health and Substance Abuse Services has eliminated164 mental health and substance abuse beds. Even before the cuts, Oklahoma was ranked 46th in the nation for mental health services.
• Oklahoma’s county health departments have begun charging $25 for flu shots because they can no longer afford to offer the vaccinations for free.
• The Health Department has been pared back to the point where it is unable to sustain further across the board cuts without imperiling public health and epidemic disease response. Health Commissioner Terry Cline stated if the agency is cut more he would have to eliminate the Office of Child Abuse Prevention, which oversees 21 different provider contracts and is a primary source of services aimed at preventing abuse and neglect in families at risk for such outcomes. Cuts already implemented include $200k cut from Tobacco Use Prevention services, about a thousand people no longer screened for HIV in Oklahoma County Jail, 880 fewer Hepatitis A and B vaccines, $28k taken from five community-based teen pregnancy prevention projects, and more.
• Buildings owned by the state are in need of more than $200 million in repairs. That includes $90 million in repairs at the state Capitol, which has rusted water pipes, some electrical wires insulated by cloth, and water leaking into the building.
• The House voted to suspend the Art in Public Places Act, which dedicates 1.5 percent of the construction budget on nonhighway projects to public art. The suspension will not improve what is available for appropriations since these projects are already largely funded through bonds.
• The Tourism and Recreation Department is closing 7 state parks, including Adair State Park in Stilwell, Beaver Dunes in Beaver, Boggy Depot in Atoka, Brushy Lake in Sallisaw, Heavener Runestone in Heavener, Lake Eucha in Jay, and Wah-Sha-She in Copan.
• Class sizes are going up across the state. At Tulsa Public Schools, elementary and secondary school class sizes rose by more than 8 percent, and other districts in the area saw class size increase of more than 5 percent. Tulsa Public Schools cut 225 teaching positions, while Union, Broken Arrow and Jenks cut 53, 32 and 22 positions, respectively. The 3 percent cuts proposed for next year will mean even more teachers laid off. In Norman, the school board voted to freeze pay and benefits for all district employees. School districts everywhere are cutting back in ways large and small, such as an end to field trips in Washoe County Schools.
• Appropriations for Oklahoma community colleges have decreased almost 9 percent while enrollment is up 34 percent over the last decade. At the same time, cuts in federal aid through Pell Grants threaten to take away hundreds of Oklahoma students’ access to a college education.

These are just a sample of the toll that successive rounds of budget cuts are taking on our state. Obviously some wasteful spending can and has been eliminated, but the examples above show that we have gone far beyond simply eliminating waste. With state leaders ready to cut taxes again and refusing to consider any ways to substantially increase revenue, we are looking at serious and lasting harm to the core public services that promote our health, education and safety. Refusing to pay for a solution to dire public needs today only makes them more difficult and expensive to solve in the future.

For OK Policy’s most recent information and materials on the state budget, click here.

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