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 »

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 »

The ‘Oklahoma Health Insurance Exchange’ will begin serving as an online marketplace for individual and small group consumers to buy private insurance in 2014.  Online insurance exchanges – which we discussed in this recent blog post -  are one of the primary requirements of the Affordable Care Act passed by Congress last year. News from the governor’s office that the state has accepted a $54 million dollar ‘early innovator’ grant from the federal government means that Oklahoma is now poised to build the most advanced insurance exchange in the country.

Why was Oklahoma one of only six states selected for this grant?  There are two programs that uniquely position Oklahoma as an innovator of health care information technology:  Insure Oklahoma (IO) and SoonerCare online enrollment (OE).  Online enrollment for SoonerCare, the state’s Medicaid program, went live in September 2010 and has already dramatically improved the efficiency of the application process.  Applicants input required information on family members, income, etc. into a web-based interface, and their eligibility is determined in real-time (subject to verification). Three months after online enrollment launched, only 7 percent of SoonerCare applications were paper.  OK Policy blogged about the launch of online enrollment and the resulting national accolades this past December. Read the rest of this entry »

This is the seventh in an ongoing series of posts examining the Affordable Care Act, including previous posts on the Temporary High Risk Pool, health insurance exchanges 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.

It’s been almost a year since President Obama signed major health care reform legislation into law.  On the opening day of Oklahoma’s 53rd legislature, Governor Fallin made it clear that her administration would join other state’s in challenging one of the most controversial parts of the Affordable Care Act (ACA):

Many Oklahomans, including myself, feel that the federal mandate is unconstitutional and wrong. That’s why Attorney General Scott Pruitt and I have acted to add Oklahoma to the list of states that are now challenging the president’s health care law in court.

How does the governor’s – and by extensions the state’s – stance on the individual mandate affect the myriad other ACA changes?  For now, their position has no effect on the millions of dollars allocated to the states under the new law to address acute health care needs.  Beyond the individual mandate, which goes into effect in 2014, the ACA asks the states to make fundamental improvements in health care infrastructure and expand insurance coverage to the 671,663 Oklahomans who are currently uninsured. 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 »

“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 »

Every year or two, I get an e-mail from my former housemate in France asking me to help make sense of some raging American political issue – impeachment, the electoral college, superdelegates – that is getting regular coverage abroad but which is largely unfathomable if you’re not fully immersed in our political system. On Christmas Eve, after the Senate’s passage of the health care bill, the latest e-mail came from Maxime.  If I had a few minutes (ha!), could I help him understand the stakes in the health care reform debate, especially the public option?  My response oversimplified and only touched on a small portion of the legislation, but tried to explain the crux of what the House and Senate bills would do in ways a non-expert can follow. Assuming this may be of some value to a few Americans as well, here is a slightly modified version of what I wrote him:

In the US, there are three main ways that people get health insurance. According to the US Census Bureau:

* about three in five (59 percent) are covered through private insurance provided through their employer or the employer of a family member;
* about one in three (29 percent) are covered through the government – primarily through Medicare, a program for the elderly, or Medicaid, a program for the poor;
* about one in ten (9 percent) buy insurance for themselves on the individual market. Read the rest of this entry »