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 »

Last week, the Department of Human Services announced new co-payment and eligibility rules for the child care subsidy program, which we discussed in this post. By lowering the eligibility threshold for subsidies, the new rules will worsen the “cliff effect” whereby workers with the opportunity to move up the income ladder are penalized by losing work support benefits. Here we rerun a blog post on this subject that first appeared in June 2009; we have also discussed how health care reform promises to significantly improve the situation.

In recent years, whenever I’ve participated in forums on poverty and barriers to self-sufficiency, the single barrier raised most often and most fervently by those who work with low-income individuals and by low-income individuals themselves is the “cliff effect”. A 2007 report prepared for the Women’s Foundation of Colorado and the Women and Family action Network Coalition defined the cliff effect as follows:

Eligibility for work support benefits is typically based on income, so as their earnings increase, families lose eligibility for supports. A benefit cliff occurs when just a small increase in income leads to the complete termination of a benefit. The result is that parents can work and earn more, while their families end up worse off than they were before. 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 »

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 »

The U.S. Census Bureau today released its annual report on income, poverty, and health insurance coverage for 2009 based on its March Current Population Survey.  The data reflected the severity of the recession throughout 2009: the national poverty rate rose from 13.2 percent to 14.3 percent, as an additional 3.7 million Americans in 2009 lived in households with income below the federal poverty level (just over $22,000 for a family of four).  While acknowledging the extent of the hardships facing millions of Americans families, the White House emphasized the important role that increases in unemployment insurance benefits and Social Security payments that were part of the 2009 Recovery Act played in keeping millions of Americans out of poverty – indeed, the poverty rate for seniors actually declined this past year.  Meanwhile, the Center on Budget and Policy Priorities noted that if low-income tax credits and non-cash benefit programs, such as food stamps, had been included, the rise in the poverty rate would have been considerably smaller.  (A new Supplemental Poverty Measure, which we discussed in this recent post, will include these benefits).

The national health insurance data showed a continuation and acceleration of long-term trends: an overall decline in the percentage of Americans with health insurance, with progress in increasing the ranks of insured children through expanded access to public insurance (Medicaid and CHIP) being more than offset by the erosion of employer-sponsored insurance, leading to growing numbers of uninsured adults. Overall, the number of Americans without health insurance increased by 4.3 million to 50.7 million, bringing the rate of uninsured to 16.7 percent. 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 »

As the national health care reform debate has unfolded this past year, we have occasionally tried to point our readers towards good sources for making sense of these complicated issues. This post from  the summer suggested some especially useful magazine articles, blogs, and books on health care reform, while this famous  flow chart (now updated) from Donkeylicious.com tried to summarize the major health care proposals in three easy steps.  We’ve also looked specifically at the debate over comparative effectiveness research and the potential expansion of Medicaid coverage for uninsured low-income adults.

Earlier this month, the radio documentary program This American Life aired two full one-hour programs devoted entirely to health care reform. As usual, the programs were insightful, entertaining, and thought-provoking. The first program focused primarily on trying to understand the exorbitant cost of the American health care system, with segments that looked at the role that doctors, consumers, and insurance companies play in keeping costs rising, even while more, and more expensive, care does not ensure better health outcomes.  The second episode focused on health insurance, and included segments tracing the history of the American employer-based health insurance system and looking at why more competition between insurers may not lower health insurance costs. Read the rest of this entry »

As we noted right after the numbers were  released, last week’s Census Bureau report on health insurance coverage provided some unexpectedly good news for Oklahoma. While the nation as a whole saw an increase in the number of uninsured, which has now reached 46.3 million, Oklahoma saw a substantial drop in both its number and rate of uninsured. Using the 2-year averages recommended by the Bureau when reporting state-level data, Oklahoma’s  uninsured rate for  persons of all ages fell from 18.3 percent in 2006-07 to 15.9 percent in 2007-08. The reported number of uninsured Oklahomans declined from 646,000 in 2006-07 to 565,000 in 2007-08. Oklahoma’s  2-year average uninsured rate now exceeds the national average by less than one percentage point (15.3 percent national to 15.9 percent Oklahoma). Read the rest of this entry »

Yesterday, the U.S. Census Bureau released its annual report on income, poverty and health insurance coverage for 2008  from its Current Population Survey. You can or click here for fact sheets and links to all the data or click here to read the 72-page PDF report. Read the rest of this entry »

The News on 6 in Tulsa reported last week on Oklahomans who lack health insurance. OK Policy’s David Blatt was featured in the story, available here in both print and video, describing who is likely to be uninsured and explaining how care for the uninsured drives up premium costs for everybody. Read the rest of this entry »