These comments were excerpted from a speech by Maryland Governor Martin O’Malley to a plenary session of an annual healthcare conference hosted by FamiliesUSA.

Our country is now poised through the Affordable Care Act to help millions of American families and small businesses and their employees access high quality, affordable health care coverage.  This isn’t going to happen by itself.  This is not simple.  If it were simple, someone would have accomplished it years ago.  This is complicated, but it is not beyond our grasp [..]

We are ready in Maryland to turn the corner on the healthcare costs that have been sapping our productivity as a people and as a nation.  Sapping the productivity of our businesses.  Taking from them the ability to reinvest in their own plants and their own opportunities and their own markets. Costs that force moms and dads to choose between health care and paying for groceries, or tuition, or school supplies, heat, rent, mortgage payments.  These are the big decisions that happen in the most important place – the kitchen table of every family home.

In Maryland we believe we are gaining a competitive advantage by being an early implementer [of health care reform].  Last year we had the best year of new job creation that we’ve had since the recession hit [..] Why is it that at the same time we’ve cut 7.5 billion from our state budget, we’re increasing the ranks of those who are covered by healthcare so very, very dramatically?  It’s because there is an historic truth – not a Democratic truth or a Republican truth – but an American truth and an economic truth.  In order to create jobs, a modern economy requires modern investments. Read the rest of this entry »

Our health care system is experiencing an unprecedented period of upheaval. Decades of rising costs, an ever-increasing share of citizens without insurance, and an aging baby boom generation are putting immense pressure on payers, providers, and patients alike.  A new policy brief from Oklahoma Policy Institute underscores the importance of SoonerCare/Medicaid as the primary safety net health care program for low-income Oklahomans who would otherwise go uninsured, primarily children, the elderly, and persons with disabilities.  The five-page brief, Medicaid 101: The SoonerCare Safety Net, outlines the program and its eligibility requirements, breaks down its funding sources, and debunks common Medicaid myths.

One popular myth is that Medicaid costs are rising exponentially and the program is riddled with waste.  In fact, scholarly research has demonstrated that Medicaid costs about 20 percent less on average per person than private insurance, so the program is quite lean.  While it is true that health care costs are rising, it’s important to remember that they are rising across the board, not just for the Medicaid program.  The state can also take advantage of a favorable federal matching rate to leverage their health care investment.  For every $1.00 the state government invests in SoonerCare in FY 2012, the federal government will contribute $1.77. Read the rest of this entry »

Is it the role of government to put policy in place to impact the overall health of our citizens?  As the Oklahoma legislature’s interim study committee prepares its final report on the state’s obligations under the new federal health care law, the co-chairs have posed a series of questions to committee members to elicit thoughts, opinions, and lessons learned.  This post responds to a central theme of those questions, a theme we think has implications for the state’s future prosperity well beyond the new health care reform law.

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. 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.

This week OK Policy released a paper showing that state costs under the new federal health care law are likely to be modest and could even yield net savings.  Click here to access a 1-page summary of our issue brief: Health Care Reform and the State Budget: Savings Likely to Partly or Fully Offset Modest New Costs.

OK Policy testified this week before the Joint Committee on the Federal Health Care Law.  Click here for our presentation exploring Oklahoma’s options for implementing state health insurance exchanges, a major requirement of the new law.  Read the Tulsa World’s coverage of our paper along with a summary of the committee meeting. 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 »

Though revenue collections continue to show steady growth, state budgets remain under great stress. After three successive years of funding cuts, most state agencies are operating this year with appropriations that are at least 10 percent less than prior to the economic downturn. Even if the economy does not slip back into recession, the prospects are dim that revenues will grow sufficiently to restore funding to pre-downturn levels and begin to tackle our long-term obligations.

Budget-cutting efforts in Washington are adding to the perils confronting the state budget. Federal spending has a major impact on both the state economy and the state budget. The federal government spent $38.5 billion in Oklahoma last year, which works out to $10,256 for each resident.  The largest component of federal spending is for direct payments to individuals for Social Security and Medicare, along with salaries and wages to military personnel and other federal employees based in Oklahoma. Read the rest of this entry »

As states and Washington grapple with ongoing budget shortfalls, the Medicaid program is often in the crosshairs of those calling for major reductions in government spending. But while the costs of funding Medicaid are readily apparent, we should not forget the program’s crucial role in providing health care for those who may be too poor or too unhealthy to buy coverage in the commercial insurance market. Recently, a path-breaking new study reported that when those without health insurance are enrolled in Medicaid, they see wide-ranging benefits in terms of access to health care services, better physical and mental health, and financial stability. These findings should assume great importance in ongoing state and federal debates on Medicaid and health care reform.

Medicaid is the primary source of health insurance for low-income children, pregnant women, seniors, and individuals with disabilities. The federal-state program covers 47 million Americans, or just under one in five of all those with health insurance coverage (2009). In Oklahoma, 728,594 persons are covered by Medicaid as of May 2011; the majority (63 percent) are low-income children. Medicaid is administered by the states with the federal government assuming a majority share of the costs. Read the rest of this entry »

Every year during state budget discussions, state leaders speak about prioritizing spending to protect core services. That’s especially true when times are bad and the overall budget pie is shrinking. However, the distribution of that pie among agencies over the past decade has remained relatively unchanged (with a couple notable exceptions).

A series of visualizations created with the online tool Many Eyes illustrates this fact well. The graphs are derived from data compiled by OK Policy on the percentage of total state appropriations received by the ten largest agencies, plus another category for all other agencies, from FY ’00 to FY’12.

Click on any of the images below to see a larger, interactive version.

Read the rest of this entry »

In the new national health care law (the Affordable Care Act, or ACA), exchanges are state-level competitive marketplaces for individuals and small businesses to purchase insurance. After winning a $54 million Early Innovator grant earlier this year, Oklahoma was poised to become a national leader with a high-quality, consumer-oriented health insurance exchange. In a state that ranks 46th in overall citizen health and where almost one in  six residents are without health insurance, the decisions our leaders make regarding the exchange are critical to our efforts to expand coverage and improve our state’s health care infrastructure.

Governor Mary Fallin and legislative leaders’ recent decision to reverse course by rejecting the federal grant and relying instead on state and private money to build an “Oklahoma Health Insurance Private Enterprise Network” is a symbolic victory for the most vocal opponents of  health reform.  Unfortunately, this puts unnecessary strains on the state budget and sends Oklahoma on a collision course with federal law. More importantly, it is likely to deprive Oklahomans of access to a strong, well-regulated, consumer-friendly marketplace to purchase private insurance coverage and will do nothing to actually make health insurance more affordable for Oklahomans. Read the rest of this entry »

When we elect someone to public office, should we expect them to use their best judgment in making decisions about the public interest? Or should they adhere to the dictates of outside groups that always take the most simplistic and extreme stance on their particular issue, regardless of the context for Oklahomans? And when politicians sign a pledge sponsored by a special interest, should that give the interest veto power over the legislators’ judgment?

A couple of recent events have put these questions into dramatic relief. The first concerns a hospital provider fee, which would be assessed on participating hospitals and matched with federal dollars to pay for treating Medicaid recipients. Hospitals support the fee, since the match would generate another $223 million beyond the $153 million they pay into it, and the combined funds would then return to the hospitals as reimbursements for patient care. Read the rest of this entry »

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. Read the rest of this entry »

The U.S. House or Representatives is expected to vote tomorrow on a federal budget proposal for the coming year that would —  among other things —  force drastic cuts to Medicaid that would harm Oklahoma seniors, people with disabilities, and children.  The budget plan, introduced by Republican Congressman Paul Ryan of Wisconsin, would also shift costs and risks onto our state and likely would force the state to cut payments to hospitals, nursing homes, physicians, and pharmacies.

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. Read the rest of this entry »