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 »

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 »

At last week’s Fall Legislative Forum organized by the Oklahoma Institute for Child Advocacy, a panel of state agency directors discussed some of the accomplishments and continuing challenges facing Oklahoma government. Taking part in the panel were leaders from the Department of Mental Health and Substance Abuse Services, Department of Human Services, the Office of Juvenile Affairs, the Health Department, and the Health Care Authority. The panelists discussed several ways we have made progress in Oklahoma despite tough budget times.

Commissioner Terri White, Department of Mental Health and Substance Abuse Services

White said that preventing addiction is the biggest public health problem facing Oklahoma. She expressed concern that the current discussion on allowing sale of strong beer and wine in grocery stores has concentrated on economic development issues without taking into account increased risk of underage access to alcohol.

“The younger someone uses alcohol, the more likely it is they’ll use as adults,” White said.

Over the course of the budget crisis, she said $30 million had been cut from the mental health budget, 90 percent of which goes directly to care providers. On the positive side, she praised new investments of $3 million for a Smart on Crime initiative and $2 milion to Systems of Care, which coordinates services between agencies for children with the highest needs.

“If we don’t make sure the brain health of our children is our highest priority, we’re going to be paying for those problems over and over with more tax dollars than we can afford to come up with,” White said. 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 »

The Tulsa Association of Health Underwriters hosted Governor Mary Fallin and Insurance Commissioner John Doak at a forum on how health care reform would affect the insurance industry.  Addressing a packed house at the Tulsa Country Club, Governor Fallin repeated her opposition to the law and support of Oklahoma’s pending legal action challenging the ‘individual mandate’.  She didn’t mince words about what that meant in the short term for implementation:

The fact of the matter is until a court, and the Supreme Court, rules on the health care bill itself, it’s still the law of the land, unfortunately.  I don’t like it, but it’s still the law of the land.

However, the biggest point of contention for this group didn’t seem to be the individual mandate.  Underwriters, agents, and brokers sell insurance, so if everyone is suddenly required to buy insurance, it stands to reason that they will benefit.  Luncheon attendees were instead most concerned about insurance exchanges. 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 »

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 »

OK Policy has argued repeatedly  that next year’s budget outlook, with shortfalls equal to cuts of 12 percent across all agencies of state government above those already enacted this year, threatens to have catastrophic consequences for the state’s economy, businesses, and families (see our budget page for an op-ed, issue brief and fact sheet, or this blog post). Here we examine the especially grim options for dealing with budget shortfalls faced by the Oklahoma Health Care Authority (OHCA), the state agency responsible for administering the state Medicaid program that serves nearly 700,000 low-income Oklahomans, primarily low-income children, seniors, pregnant women, and persons with disabilities.

At recent legislative hearings, the agency outlined next year’s budget situation. This year, the agency’s state funding – after budget cuts and including $33 million in additional funds that were authorized as part of the mid-year “supplemental” approved by the Legislature – is $980 million. As a result of increased enrollment and utilization, OHCA estimates that it will need $1.098 billion in state appropriations to maintain the Medicaid program in FY ’11 at its current levels. If, as is possible, the Legislature were to remove the supplemental from OHCA’s base and cut funding by an additional 10 percent, its appropriation for FY ’11 would be some $850 million. Thus, OHCA anticipates that it could be facing a shortfall for the coming year of some $250 million in state funds. With the corresponding loss of federal matching funds, the program would face the challenge of enacting total cuts of at least $1 billion. Read the rest of this entry »

According to an e-mail that went out late last Friday afternoon from Nico Gomez, the Deputy CEO for External Relations and Communications of the Oklahoma Health Care Authority (OHCA), the agency will recommend to its Board this week that it make up for shortfalls in its FY ’10 budget by adopting a cut of 2.5 to 3 percent in the rates it pays all its providers. Read the rest of this entry »

With Oklahoma in the midst of what is certain to be a severe and extended fiscal crisis, protecting core public services in every area of state government from deep and painful budget cuts poses a great challenge. However, protecting the budget of Medicaid, the main health insurance program for low-income children, seniors, pregnant women, and persons with disabilities, will present policymakers with special difficulties.

As noted in a recent fact sheet from the Kaiser Commission on Medicaid and the Uninsured, state Medicaid budgets face two distinct dilemmas: “the crunch” and “the cliff”. The crunch refers to the surge in Medicaid enrollment and spending associated with the economic downturn, as those losing jobs and access to employer-based coverage turn to Medicaid for coverage. Nationally, the Kaiser Commission found that total Medicaid spending growth averaged 7.9 percent across all states in FY 2009, the highest rate of growth in six years. As we reported in our last Numbers You Need bulletin, Oklahoma’s SoonerCare (Medicaid) enrollment climbed 8.9 percent between August 2008 and August 2009 and shows no signs of letting up. Read the rest of this entry »