On World AIDS Day, a Q&A about HIV and AIDS in Oklahoma

by | December 1st, 2014 | Posted in Blog, Healthcare | Comments (0)
AIDS/HIV memorial. Photo by byronv2.

AIDS/HIV memorial. Photo by byronv2.

Since 1988, health advocates around the world have recognized World AIDS Day as an opportunity to unify in the fight against AIDS. To learn more about HIV/AIDS in Oklahoma, we spoke with Kathy Williams, executive director of Health Outreach Prevention Education, Inc. (H.O.P.E.), a Tulsa-based HIV/AIDS testing and educational organization. Her answers are summarized below.

continue reading On World AIDS Day, a Q&A about HIV and AIDS in Oklahoma

Legislature’s wandering budget hands get slapped again

by | November 25th, 2014 | Posted in Blog, Budget, Healthcare | Comments (0)

pickpocketFor the second time, Oklahoma Attorney General Scott Pruitt has struck down a provision of this year’s state budget, ruling that the legislature acted unconstitutionally when it pulled $5 million out of the State Health Department’s Trauma Care Assistance Fund to fund other government services.

In June, the A.G. ruled that the legislature had acted improperly when it diverted $7.9 million intended for the Oklahoma Higher Access Learning Program (OHLAP), also known as Oklahoma’s Promise, for other purposes. The college scholarship money was part of $191 million that the legislature redirected from nearly 30 different agency revolving funds and other state funds in an effort to balance the FY 2015 budget and avert even deeper cuts to services.  With the OHLAP money no longer available, officials decided to apply an across-the-board cut to all agencies in proportion to their funding from the FY 2015 General Revenue fund.

Back in June, we called attention to several other funding grabs by the Legislature to balance their budget. In the case of the Health Department’s Trauma Care Assistance Fund, we noted that this would result in a $3 million shortfall in payments to hospitals and other trauma care providers in FY 2015, and had also led the agency to further slash critical funding for community health centers and cut support for the cord blood bank.

continue reading Legislature’s wandering budget hands get slapped again

Oklahoma has options to insure our people. Here’s how.

by | November 24th, 2014 | Posted in Blog, Healthcare | Comments (1)
Image from University of Salford used under a Creative Commons license

Image from University of Salford used under a Creative Commons license

When justifying their opposition to the Affordable Care Act’s provisions to extend health coverage to the uninsured, Oklahoma leaders often cite a preference for a state-specific solution. For example, Governor Mary Fallin promised an “Oklahoma plan” to address the large number of uninsured citizens in the coverage crater. And State Insurance Commissioner John Doak called for “state-based regulation that gives consumers options and the freedom to make the choices that best suit their families’ needs.”

Despite this rhetoric, state leaders have gone all out to obstruct the Affordable Care Act’s efforts to expand coverage. Simultaneously, they’ve refused to take advantage of the flexibility that the federal government has granted to other states.

 Of the 28 states that have accepted federal funds to expand health coverage, four have negotiated with the federal government for a waiver to use the funds in innovative, creative ways that are specific to their own state’s needs. A few more, like New Hampshire and Indiana, are negotiating such plans for their states. They have done exactly what Governor Fallin and Commissioner Doak claim is needed.

Here’s what they did:

continue reading Oklahoma has options to insure our people. Here’s how.

Go get your flu shot. Yes, you. Now.

by | November 5th, 2014 | Posted in Blog, Healthcare | Comments (0)
Photo by David Reber used under a Creative Commons license

Photo by David Reber used under a Creative Commons license

What’s highly contagious, put over 1,000 people in the hospital and killed nearly 60 people in Oklahoma last year alone?

It’s certainly not Ebola. It is, in fact, the flu – and flu season is upon us. The state recently announced its first confirmed cases this year. That means it’s time for your reminder that the flu is easily transmitted, miserably uncomfortable at best, and deadly at worst.

Fortunately, keeping the flu away requires neither travel bans nor hazmat suits. All it takes is a flu shot, which lessens the likelihood that you’ll get the flu and pass it on. While it’s recommended that everyone get vaccinated, it’s strongly recommended for particular groups: children age 6 months to 4 years; adults age 50 and older; people with chronic disorders or who are immunodepressed; pregnant women; and nursing home residents and health care personnel. But seriously, everyone should get one. And that includes you*.

continue reading Go get your flu shot. Yes, you. Now.

Covering the uninsured is not a hard problem (Steve Lewis Capitol Updates)

by | October 31st, 2014 | Posted in Blog, Capitol Updates, Healthcare | Comments (1)

Steve Lewis served as Speaker of the Oklahoma House of Representatives from 1989-1991. He currently practices law in Tulsa and represents clients at the Capitol. You can sign up on his website to receive the Capitol Updates newsletter by email.

Steve Lewis

Steve Lewis

The House Appropriations and Budget Subcommittee on Public Health and Social Services, chaired by Rep. Doug Cox (R-Grove), an emergency room physician, took up three interim studies this week on the topic of trying to find a way to provide healthcare for Oklahoma’s 665,000 uninsured.  Over 17% of our population is uninsured which means over 1 in 6 people.  The three studies were requested by Rep. Emily Virgin, Rep. David Perryman, Rep. Joe Dorman and Rep. Chuck Hoskin, all Democrats.  It’s encouraging that Speaker Jeff Hickman, our Republican Speaker, approved the studies, something he didn’t have to do.

continue reading Covering the uninsured is not a hard problem (Steve Lewis Capitol Updates)

Medicaid Expansion’s Track Record Shows It’s a Good Deal for Oklahoma

In 2012, Gov. Fallin announced that Oklahoma would reject a central feature of the Affordable Care Act, refusing to expand health insurance coverage for low-income adults the infusion of federal funds that would have accompanied expansion. Two years after the Governor’s announcement, the experience in the state shows it was the wrong decision.

Expanding the state’s Medicaid program would have extended insurance coverage to roughly 150,000 people – approximately 1 in 5 of the state’s uninsured. Now, those 150,000 Oklahomans are caught in the “coverage crater.” They earn too much for traditional Medicaid, but don’t qualify for subsidies to purchase health insurance on the online marketplace.

Comparing Oklahoma to similar states that did accept expansion clearly shows that the Governor made the wrong choice. Arkansas, Kentucky and New Jersey are just three of the 28 states that have expanded their Medicaid programs, and are using the accompanying funding to in innovative ways to improve not only their states’ health outcomes, but also their local economies and state budgets.

continue reading Medicaid Expansion’s Track Record Shows It’s a Good Deal for Oklahoma

Misguided ruling could rob health care from 55,000 Oklahomans

by | October 8th, 2014 | Posted in Blog, Healthcare | Comments (0)

ACA_SupremeCourtThe ruling by Oklahoma federal District Court Judge Ronald A. White that Oklahomans buying health insurance on healthcare.gov are ineligible for tax credits may have been a victory for Attorney General Scott Pruitt. But if upheld by higher courts, it would be a huge defeat for tens of thousands of previously-uninsured Oklahomans who are using these credits to purchase affordable health coverage. The good news is that the ruling rests on a misguided interpretation of the Affordable Care Act that may still be overturned.

Premium tax credits are a central mechanism of the Affordable Care Act’s goal of extending health insurance coverage to tens of millions of  uninsured Americans. Individuals and families with incomes between 100 percent and 400 percent of the poverty level are eligible for the tax credits on a sliding-scale basis. The credits can only be used to buy certain health plans on the new health insurance marketplaces, known also as Exchanges. Under the ACA, states were given the opportunity to operate their own exchange; where they chose not to do so, as in Oklahoma and a majority of states, the exchange is operated by the federal government at HealthCare.gov.

continue reading Misguided ruling could rob health care from 55,000 Oklahomans

Upcoming Event: The 2014 Elections and the Future of Health Reform

by | October 2nd, 2014 | Posted in Blog, Healthcare, Upcoming Events | Comments (0)

poli-sci department u of mnOn Monday November 10th, Dr. Lawrence R. Jacobs, one of America’s foremost experts on health care policy, will give a lunchtime talk titled, “The 2014 Elections and the Future of Health Reform.” The talk, co-hosted by Oklahoma Policy Institute and the Oklahoma Scholars Strategy Network, will be will be held at the Jim Thorpe Association and Oklahoma Sports Hall of Fame, 4040 N. Lincoln Blvd., Oklahoma City, beginning at 11:45 am. Tickets for this public event, which includes lunch (vegetarian options provided), are $15 and can be reserved online by clicking here.

continue reading Upcoming Event: The 2014 Elections and the Future of Health Reform

Flatline: Funding cuts threaten Oklahoma’s community health centers

by | September 24th, 2014 | Posted in Blog, Healthcare | Comments (0)
flatline

Photo by Sean Dreilinger.

Last winter, Oklahoma’s community health centers (CHCs) received some unwelcome news. A state fund for cover uncompensated care had run dry seven months early. Community health centers, which are among the very few places that low-income Oklahomans can get care regardless of ability to pay, struggled to cut costs without cutting essential services until the state fiscal year ended in July. 

This year, CHCs calculated that they would need $9 million to cover fiscal year 2015 uncompensated costs.  But by the time the budgetary dust settled, CHCs were allocated just $2.55 million – less than one-third of what they’d asked for, and even less than the $3.12 million FY 2014 funding that ran out before half the year was over.

continue reading Flatline: Funding cuts threaten Oklahoma’s community health centers

Are Medicaid patients overusing the ER?

by | August 21st, 2014 | Posted in Blog, Healthcare | Comments (0)

ERIn the debate over Medicaid, a frequently heard claim is that Medicaid recipients overuse emergency rooms for non-emergency care, and that we need to address this problem if we are to contain Medicaid spending.

This past session, the Legislature approved HB 2906, which directs the Oklahoma Health Care Authority, the state’s Medicaid agency, to conduct a study of current and potential ways to reduce trips to the emergency department. Earlier in session, legislation passed the House that would have limited Medicaid coverage to six emergency room visits per year.

However, Health Care Authority data seems to dispel the idea that ER overuse by Medicaid members is as pervasive or as serious a problem as many assume. In State Fiscal Year 2013, there were just over 1 million Oklahomans enrolled in SoonerCare. Of this population, nearly three in four (73.8 percent) made no emergency room visits in a 12-month period. Another 21 percent visited the ER once or twice. Only 11,763 individuals, or 1.1 percent of the Medicaid population, had six or more ER visits. This small population accounted for some 107,000 ER visits, or about one in five of all visits.

ERusageFY2013Since 2004, the Health Care Authority has operated the High ER utilization project, which identifies and contacts members who have been to the ER more than once in a quarter and provides information about appropriate usage and referrals to care management. The program has a provider education component as well. Since 2007, emergency room usage has declined from an annual average of 0.58 annual visit per member to 0.53 annual visits per member. Although we should be careful about making direct comparisons because of differences in demographic make-up and data sources, ER utilization for Medicaid recipients appears comparable to the overall population. According to the Kaiser Family Foundation, Oklahomans had 488 ER visits per 1,000 people in 2011; OHCA data suggests that Medicaid recipients made 550 visits per 1,000 people in fiscal year 2011.

It’s also not apparent that ER visits are a major expense in the Medicaid program. In fiscal year 2013, total emergency department costs, including facility and professional claims, were $141.0 million, which represents less than 3 percent of total SoonerCare expenditures of $4.97 billion (with ancillary services, the total cost was $178.3 million, or 3.6 percent of total expenditures). The average cost per emergency room visit was $257.31.

The Health Care Authority’s efforts to monitor and prevent inappropriate emergency room usage should certainly be continued. However, the idea that many Medicaid members make unnecessary trips to the ER seems to reflect myths and anecdotes more than reality.

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