With just one week left until the legislature’s scheduled adjournment, Governor Mary Fallin has called on legislators to approve last-minute changes to the Insure Oklahoma program. These questions and answers explain what is being proposed and the vital issues that are at stake:

Question #1: What is Governor Fallin’s proposal?

The Governor proposes to provide health insurance coverage to some 9,000 people with state-only dollars by redirecting close to $50 million that are currently being spent to match federal Medicaid dollars for the Insure Oklahoma program.

Question #2: What is Insure Oklahoma?

Insure Oklahoma is a public-private health insurance program created in 2005 under a Medicaid 1115 waiver to provide coverage for low-income adults. The state’s share of funding for Insure Oklahoma comes from a portion of the tobacco tax revenues approved by Oklahoma voters in 2004, and is matched with federal Medicaid funds. In FY 2011, the program received $46.0 million in state funds. Insure Oklahoma has two components:

continue reading Key questions and answers on last-minute Insure Oklahoma proposal

Oklahoma Policy Institute released the following statement in response to Governor Fallin’s call to continue Insure Oklahoma with state-only dollars:

It should be of grave concern to Oklahomans that Governor Fallin is proposing to use $50 million in state-only dollars to cover fewer than 10,000 people when we have the opportunity to access federal funds to cover some 150,000 people at little or no state expense. Oklahoma taxpayers and uninsured Oklahomans would be left to suffer to make a political point that the Governor is unwilling to cooperate with the Affordable Care Act.

While the federal government has indicated that Oklahoma must make changes to the Insure Oklahoma program to continue past 2013, it has also emphasized its willingness to work with the state to explore various options, including using the Insure Oklahoma model to purchase private insurance with federal dollars. The Governor’s proposal flies in the face of a preliminary report by the Leavitt Partners, which she requested and contracted with $500,000 taxpayer dollars, that recommends using federal funds to expand health insurance coverage while working to extend Insure Oklahoma beyond this year.

The Legislature should protect Oklahoma’s financial and health care interests by insisting that we provide quality health insurance to the greatest number of people at the least expense to the state.

Last week saw important developments in the  debate over expanding  health coverage for uninsured low-income Oklahomans. While it now seems certain that Oklahoma will not expand coverage at the start of 2014, the state finally appears to be moving along a path to accept federal dollars for expanding coverage in future years.

In November, Governor Mary Fallin announced that Oklahoma would reject federal funds under the Affordable Care Act (ACA) to expand Medicaid coverage for uninsured low-income adults, even though the federal government would assume 100 percent of the cost of this population for three years and 90 percent from 2020 onwards. This decision risks leaving well over 100,000 of the poorest and unhealthiest Oklahomans without health insurance options, stuck in a ‘coverage crater’, because they earn too little to qualify for federal tax credits to purchase coverage on new health insurance marketplaces, or exchanges. Oklahoma would be leaving over $8 billion in federal Medicaid dollars on the table over the next decade, while saddling hospitals and other health care providers with mounting uncompensated care costs.

continue reading Leavitt or Leave It: Consultant’s report suggests path for expanding health insurance coverage

Judy Solomon is Vice President for Health Policy at the Center on Budget and Policy Priorities, where she focuses on Medicaid and the Children’s Health Insurance Program and issues related to the implementation of health reform, particularly policies to make coverage available and affordable for low-income people. A previous version of this post appeared on the CBPP’s Off the Charts blog.

Judy Solomon

The New England Journal of Medicine reported encouraging new findings last week from the Oregon Health Study, a landmark, ongoing study of the state’s Medicaid program.  Medicaid beneficiaries were more likely than the uninsured to access preventive care, such as mammograms for women, and they had far less financial hardship caused by health care spending.  In fact, Medicaid coverage “almost completely eliminated catastrophic out-of-pocket medical expenditures.”  The researchers also report significant improvements in diagnosing depression and diabetes among the Medicaid recipients they tracked.  This report confirms earlier results from this study, which is often described as the “gold standard” for research.

continue reading Oregon Medicaid study strengthens case to expand Medicaid (Guest Blog: Judy Solomon)

Barriers still remain in achieving the real goal of the Affordable Care Act (ACA), to get uninsured Americans affordable healthcare coverage. The Supreme Court created one of these barriers when it ruled that the federal government could not force states to expand Medicaid coverage to all individuals with incomes less than 138 percent of the Federal Poverty Level (FPL). As a result, 14 states, including Oklahoma, have decided or are leaning towards not expanding Medicaid.

The latest barrier is the unwillingness of some states to enforce the consumer protection provisions of the ACA. In states unwilling or unable to enforce these provisions, the Centers for Medicare and Medicaid (CMS) has empowered the Center for Consumer Information and Insurance Oversight (CCIIO) to directly enforce the provisions.

These provisions, which take effect January 1, 2014, reform current health insurance market practices. They are designed to protect health insurance consumers by guaranteeing accessible, affordable, and adequate health insurance plans:

• Accessibility – The consumer protection provisions of the ACA will make health insurance more accessible by requiring that insurers guarantee healthcare coverage to all who apply and prohibiting waiting periods of longer than 90 days.
• Affordability – To ensure affordability of health insurance plans, insurers can only vary rates based on four factors: family composition, geographic area, age and tobacco use. The ACA further limits the variation for age and tobacco use. An insurance company cannot charge an adult more than 3 times the rate of a younger person, and can only charge a tobacco user 1.5 times more than a non-tobacco user.  Consumer out-of-pocket cost will also be limited under the ACA and insurers will be required to cover at least 60 percent of the plan’s total cost.
• Adequacy -  As a result of the market reforms, insurance companies will no longer be able to exclude preexisting conditions from coverage. The law also outlines ten categories of essential health benefits that must be covered by insurance plans being offered through the insurance marketplace.

Health insurance regulation is primarily a state action. In partnership with the federal government, states are expected to enforce the consumer protections provisions of the ACA. States will be responsible for enforcing the provisions for insurance plans offered inside and outside of the health insurance marketplaces. However, CMS will step in and enforce the law if states notify the agency of their lack of authority or unwillingness to enforce the law, or if CMS finds that a state is not substantially enforcing the provisions.

A report by the Commonwealth Fund found that only 11 states so far have taken legislative action to enforce the ACA insurance market reforms. To be fair, some states already have the necessary legislation in place to enforce these provisions, so no more action is required on their part. However, four states, including Oklahoma, have notified federal officials that they will not be taking action to enforce the consumer protection provisions.

In a press release, Commissioner John Doak explained that the Oklahoma Insurance Department would not be participating in a collaborative effort with CCIIO to enforce the ACA. He also released a letter sent to the CCIIO director explaining his department’s lack of authority to enforce the ACA and his disapproval of subjecting health insurers to a “system of dual regulation.” In the letter, Commissioner Doak expressed his concern regarding the impact these dual regulations would have on Oklahoma consumers. 

This system of dual regulation is actually nothing more than requiring insurers to take an extra administrative step to ensure compliance with the ACA. Since Commissioner Doak refuses to enforce the ACA, Oklahoma health insurers will now have to submit policy information and other health insurance plan documentation directly to the federal government. CCIIO will confirm that insurers comply with ACA market reforms and will work with those found to be non-compliant.

For health insurance consumers in Oklahoma, there should be little concern with the federal government regulating health insurance plans. Even some on the right, in our state, have expressed a welcoming attitude in having the federal government enforce the ACA market reforms. Within Wyoming, another state where the federal government will be enforcing the ACA, the outlook for federal enforcement of the ACA is relatively positive.

The Oklahoma legislature could authorize Commissioner Doak to enforce the ACA in the future, but until that time the federal government will ensure that Oklahoma health insurance consumers are receiving the benefits and protections provided by the ACA.

 Click here for our other resources and analysis on Medicaid and the Affordable Care Act

Fred Benjamin serves as the Chief Operating Officer of Medicalodges, Inc., an employee-owned company that owns and operates over 30 facilities in Kansas, Missouri and Oklahoma, employing over 2,200. This post is adapted from his testimony before the US House of Representatives Committee on Education and the Workforce, subcommittee on workforce Protections on March 14, 2013.

Skilled nursing care providers have critical staffing needs. If you are in the business of caring for our nations’ elderly, it is a daily struggle to find enough dedicated caregivers. We are different from other employers in many ways, responsible for the lives of 1.5 million frail and elderly citizens nationwide. And this is the fastest-growing segment of our population.

The general causes of the staffing shortage include chronic underfunding of Medicare and Medicaid, a regulatory system that focuses on fines and penalties, dramatically increased competition for caregivers, annualized turnover rates of nearly 100 percent, and an aging workforce.

continue reading Critical nursing care staffing shortages must be addressed (Guest Post: Fred Benjamin)

A key component of the Affordable Care Act’s efforts to expand access to health insurance is providing federal funds to extend Medicaid to all adults making less than 138 percent of the federal poverty limit. With the Supreme Court’s ruling last June, the decision of whether to extend Medicaid was left in the hands of each state. The ACA gives states a huge financial incentive to extend Medicaid by committing the federal government to paying 100 percent of the cost of newly-insured individuals for three years and 90 percent from 2020 onwards.

If states do not extend coverage, the result could be a large ‘coverage crater’, where the poorest adults are left uninsured. Failing to extend Medicaid also leaves health care providers on the hook for large amounts of uncompensated care, and adds costly new obligations to employers. Still, the Governors of many states, including Oklahoma, have come out against accepting federal funds to extend Medicaid or have expressed strong concerns.

Now the federal administration is making clear that it is willing to show tremendous flexibility in working with states to find  ways to extend health care coverage to low-income adults. Most notably, the Obama administration has given Arkansas Governor Mike Beebe support in principle for a proposal to use Medicaid dollars to purchase private health insurance.

continue reading Many Sizes Fit All: Feds show flexibility in extending coverage

Last summer, the United States Supreme Court in National Federation of Independent Business vs. Sebelius (NFIB) found the Patient Protection and Affordable Care Act (ACA) to be constitutional. The re-election of President Obama confirmed that the law would continue to move forward. Yet while most other states are working hard to implement the new law so as to best serve their state’s residents, Oklahoma has instead decided to devote its energy and resources to waging a stubborn, counter-productive, and hopeless last stand.

continue reading A lose-lose situation: Oklahoma still wears health law blinders

Last week, the House passed HB 1552 by Rep. Mark McCullough, R-Sapulpa. Inspired by Florida’s Medicaid managed care program, the bill would move the entire statewide Medicaid population, including seniors and persons with disabilities who are receiving long-term care, into managed care plans. If implemented, Oklahoma would be among a small handful of states attempting to serve its entire population through managed care plans.

The result of this bill would be a complete overhaul of SoonerCare. Yet we already tried this idea in Oklahoma on a much smaller scale, and it didn’t work. Before we dramatically change the health care system for the one in four Oklahomans enrolled in SoonerCare, it may be helpful to review the state’s earlier experiment with managed care plans.

continue reading Lessons unlearned?

In June 2012, the United States Supreme Court found the Affordable Care Act (ACA) constitutional. However, the ruling allowed the states to decide whether they would accept federal funds to expand Medicaid benefits. Gov. Mary Fallin announced on November 19, 2012 that Oklahoma would not be expanding Medicaid.

If this decision is not reversed, it will have an adverse impact on many working Oklahomans including some Oklahoma veterans. Nationally 12.5 million non-elderly veterans are uninsured. Nearly half of uninsured veterans have incomes below 138 percent of the federal poverty line, which would make them eligible for Medicaid as defined by the ACA. By failing to return Oklahoma federal tax dollars to the state for Medicaid expansion, Gov. Fallin and the legislature are ignoring the healthcare needs of some Oklahoma heroes. 

continue reading Extending Medicaid would help Oklahoma veterans