This week I had the pleasure of attending a gathering of policy analysts and advocates from 15 states on “Transforming Health Care Coverage for Children and Families,” convened by Georgetown University’s Center for Children and Families. The conference, which focused on the opportunities and challenges of providing coverage to the uninsured while the new health care reform law is being implemented, featured a keynote address by Cindy Mann, Director of the Center for Medicaid and State Operation within CMS, the Centers for Medicare and Medicaid Services. This post shares some of her key points. It has been cross-posted to CCF’s “Say Ahhh!” blog.

Mann started out by reminding the attendees that Medicaid is already a key source of health insurance, providing coverage to nearly 63 million Americans over the course of the year in 2008. Currently, Medicaid is of particular importance for covering children in low-income families, and has been primarily responsible for the substantial progress made in reducing the rates of uninsured children to below 10 percent nationally in 2008.  Enrollment in Medicaid and CHIP, the program that covers children from moderate income families in some states, grew by 2.6 million children in 2008-09, picking up the slack for declining employer-based coverage during the initial phase of the economic downturn. Read the rest of this entry »

According to the latest U.S. Census figures, 565,000 Oklahomans, or 15.8 percent of the total population, were without health insurance in 2007-2008. The uninsured rate is just under 10 percent for children but over 20 percent for adults ages 18-64.

The Oklahoma Legislature has made several efforts in recent years to chip away at the number of uninsured by expanding eligibility for Insure Oklahoma, a program that provides public subsidies towards the purchase of employer-sponsored coverage for employees of small businesses or a public product for those without access to employer coverage. Eligibility for Insure Oklahoma goes up to 200 percent of the federal poverty level ($44,000 for a family of four) and is available to employees of businesses with up to 250 employees. 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 »

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 »

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 »

Health care reform is in the news. We have the world’s most expensive health care system, but our health care outcomes are not that good and we still leave one-sixth of Americans under age 65 without insurance coverage. President Obama and the Democratic-controlled Congress are making this one of their many top priorities this year.

The possibility of reform raises many troubling questions. Will there be new taxes? Will current employer-provided benefits be taxed? Will government control health care decisions? Will private insurers be run out of the business? Will the federal deficit get even worse?

Whenever we consider significant public policy changes, it is reasonable to ask “What happens if we do nothing?” The Council of Economic Advisers, a White House agency charged with offering objective economic advice to the President, suggests that may be the worst alternative of all. Their new report forecasts the economic effects of health care reform and gives us some insight into the “do nothing” alternative. The Council finds that:

• Letting costs grow at the present rate stunts economic growth. By 2030, gross domestic product would be eight percent below levels we could expect if we achieve minor–1.5 percent per year–cost controls.
• Translated into personal terms, a family of four would see about $10,000 less income in 2030 under the current health care system than under one that controls cost growth.
• Uncontrolled health care costs reduce employment by about 500,000 per year.
• The current system is inefficient. There is no relationship between cost and health outcomes, and it costs society more to leave people uninsured than it would to insure them. Employer-provided insurance keeps people in jobs when they might have better opportunities elsewhere, and makes it difficult for small businesses to compete with larger ones.

The Council concludes:

The CEA report makes clear that the total benefits of health care reform could be very large if the reform includes a substantial reduction in the growth rate of health care costs. This level of reduction will require hard choices and the cooperation of policymakers, providers, insurers, and the public. While there is no guarantee that the policy process will generate this degree of change, the benefits of achieving successful reform would be substantial to American households, businesses, and the economy as a whole.

Keep in mind that the Council works for a pro-reform president. The report, however, is well-documented and does not advocate any particular reform.

As we learn more about specific reform proposals, most of us will see something we don’t like. Many will vocally and arduously oppose most of the proposals that are offered. As we weigh new options, however, we should never lose track of the risks of leaving the current system alone.

Last week,  I attended a meeting of the State Coverage Initiative (SCI), an effort that has taken shape over the past two years under the leadership of Insurance Commissioner Kim Holland to develop a plan to extend health insurance coverage to a sizable segment of the 640,000 Oklahomans who are currently uninsured. The meeting reached a consensus on adoption of the SCI strategic plan, which lays out a blueprint for expanding coverage.

The cornerstone of the plan would be a gradual expansion of Insure Oklahoma, the public-private partnership which provides subsidized employer-based coverage for working adults, along with a public product for eligible adults without access to employer coverage. The program, which is funded by a portion of tobacco tax revenues approved by voters in 2004,  has now grown to cover just under 20,000 Oklahomans, which is about half of the capacity under existing revenues. The principal SCI recommendation is to generate new revenues by assessing a dedicated fee on all health insurance claims paid by health insurers in Oklahoma. It is estimated than an initial 1 percent fee would generate $78 million that, along with matching federal funds, could insure an additional 80,000 Oklahomans.  If and when 75 percent of the target population is reached, the assessment would increase.

The main argument advanced by the SCI leadership in favor of the new health care assessment is the need to confront the enormous cost-shifting that currently takes place in paying for health care for the uninsured. As Commissioner Holland stated in a recent op-ed:

One billion dollars each and every year. That’s how much it costs to provide health care to the citizens of Oklahoma who do not or cannot pay for the care they need and receive. That’s $1 billion that is added to the medical bills and insurance premiums of those who do pay. Imagine what would happen if this $1 billion hidden tax were eliminated — health care costs would be reduced, and health insurance premiums would be reduced.

Read the rest of this entry »

Over the past two years,  Insurance Commissioner Kim Holland has been spearheading an extensive effort known as the State Coverage Initiative (SCI) to develop a plan to extend health insurance coverage to a sizable segment of the 640,000 Oklahomans who are currently uninsured. SCI has recently released a blueprint report setting out its main recommendations.

The SCI report calls on the state to maximize existing opportunities for covering the uninsured through the Insure Oklahoma premium assistance program and to create new publicly-subsidized commercial health plans, which would attempt to control costs either by capping annual benefit limits or by waiving current state mandate requirements. The report proposes funding expanded coverage through a broad-based provider fee that would begin at a modest 0.5 percent of revenues.
Read the rest of this entry »