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

by | October 31st, 2014 | Posted in Blog, Capitol Updates, Healthcare | Comments (0)

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.

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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.

Tobacco tax revenue declined last year. Here’s why that’s mostly good news.

by | August 13th, 2014 | Posted in Blog, Healthcare, Taxes | Comments (0)

In 2004, Oklahoma voters approved SQ 713, which increased the excise tax on cigarettes and other tobacco products while eliminating the state and local sales tax on these products. The new revenues from the increased taxes were dedicated to a variety of health-related purposes, including the Insure Oklahoma premium assistance program, a comprehensive cancer center, trauma care, tobacco cessation, and others.

Tobacco tax revenues allocated for health care under SQ 713 rose from $107.1 million in FY 2006, when the new taxes took full effect, to $145.6 million in FY 2012. However, these revenues fell slightly in FY 2013 and then dropped dramatically by $18.3 million (13 percent) in the fiscal year that just ended. The two largest recipients of tobacco tax funds – Oklahoma Health Care Authority general operations and the Insure Oklahoma fund – saw their funding decrease by $7.3 million and $6.0 million respectively in FY 2014. The shortfall contributed to the Health Care Authority having to enact larger cuts to provider payments and services.

TobaccoTaxRev06-14What accounts for the drop in tobacco tax collections? The answer is complicated.

continue reading Tobacco tax revenue declined last year. Here’s why that’s mostly good news.

Results on the first year of Obamacare are in. What’s it look like for Oklahoma?

by | August 4th, 2014 | Posted in Blog, Healthcare | Comments (0)
obamacare awesome

Image by Will O’Neill used under a Creative Commons license

The Affordable Care Act’s first open enrollment period, when eligible Americans could compare and purchase health insurance on the online marketplaces, was a bit of a roller coaster. But despite considerable hiccups with the launch of Healthcare.gov in October, eight million people had signed up nationwide when enrollment closed on March 31st, a number that exceeded earlier estimates. The nationwide uninsured rate has dropped precipitously thanks to the marketplaces and to expansions of Medicaid coverage in states that accepted federal funds. And those with new health insurance coverage report being pleased with it.

However, much of the ACA’s positive benefits in Oklahoma have been muted by the state government’s obstruction of the law, especially by its refusal to accept federal funds and expand coverage. Here’s what’s happening.

continue reading Results on the first year of Obamacare are in. What’s it look like for Oklahoma?

Gov. Fallin blames Obama for Oklahoma’s Medicaid cuts. The real reason is closer to home.

by | July 14th, 2014 | Posted in Blog, Healthcare | Comments (16)
President Barack Obama greets Governor Mary Fallin at Tinker Air Force Base.

President Barack Obama greets Governor Mary Fallin at Tinker Air Force Base.

Earlier this year, we warned that Oklahoma risked deep cuts to our state’s health care safety net if we didn’t increase state funding for Medicaid and mental health services. The Oklahoma Health Care Authority, which administers Medicaid, needed $90 million and the Department of the Mental Health and Substance Abuse Services needed $20.9 million in new funding just to maintain existing services.

Instead, lawmakers budgeted flat funding for the Health Care Authority and just $2.2 million in new funding for mental health. As a result, Oklahoma has slashed Medicaid doctor reimbursements, hiked copayments for Medicaid patients, and reduced eligibility for services. Families who stand to lose behavioral health rehabilitation services have spoken out about the cuts. In response, Governor Fallin responded with a statement blaming President Obama. Governor Fallin’s spokesman Alex Weintz said:

continue reading Gov. Fallin blames Obama for Oklahoma’s Medicaid cuts. The real reason is closer to home.

Insure Oklahoma extended – but we could do so much more

by | July 9th, 2014 | Posted in Blog, Healthcare | Comments (0)

InsureOklahoma_logoA rare bright spot in health care-related news came early last week with the announcement that Insure Oklahoma, a public-private partnership providing health insurance for some 18,500 low-income Oklahomans and their families, has been given permission by the federal government to continue operating for another year. 

The program had been expected to be discontinued at the end of 2013, with the understanding that the state would accept federal funds to extend health insurance coverage to all eligible low-income Oklahomans, thus negating the need for Insure Oklahoma.  But Oklahoma refused to accept the funds, and for the past two years, the state has negotiated extensions with the federal government. While heartening for those who would lose their insurance were Insure Oklahoma to expire, the current system of negotiated extensions isn’t sustainable. Here’s what’s going on:

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