Just before Thanksgiving, Governor Mary Fallin announced a pair of important decisions related to the Affordable Care Act. She said that Oklahoma would not participate in the expansion of Medicaid for low-income adults and would not create its own state-based health insurance exchange. Where do these decisions leave Oklahomans?

The Affordable Care Act provides two primary mechanisms to extend health insurance coverage to most of the 48 million Americans, and 694,000 Oklahomans, who are currently uninsured. The first is to extend Medicaid coverage to working-age adults with incomes below 133 percent of the federal poverty level, roughly $30,000 per year for a family of four. Medicaid is a joint federal-state program; to encourage state participation in the expansion of coverage, the federal government committed to paying 100 percent of the cost of newly eligible Medicaid participants for three years (2014-16) and ultimately to pay 90 percent of the cost from 2020 forward.

Unfortunately, refusing to expand Medicaid slams the door on roughly 130,000 uninsured Oklahomans with incomes below the poverty level. This population will be stuck in a huge ‘coverage crater‘, without access to private coverage or public support. This decision is also a major blow to Oklahoma’s health care providers,  who will remain stuck with absorbing and trying to pass along the crippling costs of uncompensated care, which total $600 million annually for hospitals alone, according to the Oklahoma Hospital Association.

continue reading What Governor Fallin’s healthcare decisions mean for Oklahomans

Oklahoma Policy Institute is seeking to hire a high quality health care policy analyst. The primary responsibilities of the job are to conduct research and analysis on state health care policy issues, and to prepare, write and disseminate issue briefs, fact sheets, opinion articles, blog posts, e-mail alerts and other materials. Qualified candidates will have a graduate or professional degree in a relevant field, 3-5 years work or academic experience on health care policy issues, outstanding writing, research and oral communications skills, and strong familiarity with the Oklahoma policy environment.

Click here for the full job description and instructions on how to apply, and please share this announcement widely with those who may be interested. The deadline for applications is Monday, October 15, 2012.

The Affordable Care Act, the federal health care law that takes full effect in 2014, is expected to provide health insurance coverage to over 335,000 uninsured Oklahomans and reduce the state’s uncompensated health care costs by more than two-thirds , according to a new report from the Robert Wood Johnson Foundation (RWJF).

Currently, some 597,000 Oklahomans, or 19 percent of the non-elderly population, lack health insurance. Under the Affordable Care Act (ACA), the number of uninsured is projected to fall by 57 percent to 259,000, or 10 percent of the non-elderly population. Oklahoma’s 57 percent drop exceeds the national average of 48 percent and is the tenth highest drop among the states.

The researchers, who are health care policy experts at the Urban Institute, use the Health Insurance Policy Simulation Model to build projections of how coverage will be affected by the new law. For Oklahoma and for the nation, they find that the ACA will lead to more people with both public and private health insurance. Specifically, they project that:

continue reading Report: Affordable Care Act to substantially expand coverage, reduce uncompensated care in Oklahoma

In Oklahoma, more than one in four households are “asset poor,” meaning they have little or no financial cushion to rely on if unemployment or another emergency leads to a loss of income, according to a report released today by the Corporation for Enterprise Development (CFED).  Asset poverty is distinct from and broader than income poverty, which measures the amount of money a household receives during the year.  According to the U.S. Census, about one in six Oklahomans were income poor in 2010.  Andrea Levere, president of CFED, highlights asset poverty as a significant barrier to long-term financial stability:

Growing numbers of Americans have almost no savings or other assets to fall back on if they lose their jobs or face a medical crisis.  Without those savings, few will be able to invest in a more economically secure future, including buying a home, saving for their children’s college educations or building a retirement nest egg.

The 2012 Assets & Opportunity Scorecard offers a comprehensive look at Oklahomans’ ability to build wealth, fend off poverty, and create a more prosperous future. The Scorecard compares states along 52 different measures of how residents fare in five issue areas: Financial Assets & Income, Businesses & Jobs, Housing & Homeownership, Health Care and Education.

continue reading Up a Creek: Scorecard shows over a quarter of Oklahomans unprepared to weather financial crisis

What’s up this week at Oklahoma Policy Institute? The Weekly Wonk is dedicated to this week’s events, publications, and blog posts.

This week OK Policy explained what federal budget cuts could mean for Oklahoma.  Doug Hall of the Economic Policy Institute underscored the urgency of fixing America’s crumbling infrastructure.  Our director David Blatt spoke at a StateImpact Oklahoma forum about why proposals to reduce or eliminate the income tax would effectively raise taxes for most Oklahomans.

Also this week, we featured remarks by Maryland Governor Martin O’Malley on how health care reform improves business competitiveness.  We posted event information about the first annual Grandparenting Workshop at Oklahoma State University.

Numbers of the Day

• $107 – Average tax increase on sixty percent of Oklahoma households under a legislative proposal to eliminate a slate of broad-based tax credits and exemptions.
• 8,600 – Number of jobs lost in state and local government in Oklahoma over 2010.
• $22,007 – Annual average wage for home health aides in Oklahoma, just below the federal poverty level for a family of four in 2010, $22,050
• 11 percent – Percentage of ex-offenders released in Oklahoma who were re-incarcerated for technical violations of their probation/parole in 2004, up from 3 percent in 1999.
• $34 million – Amount needed to repair sewer lines and make major improvements to two facilities slated for closure that house medically fragile, mentally disabled Oklahoma residents.

In The Know, Policy Notes

• The Center for Economic and Policy Research shares five reasons we should be concerned about the rising share of low-wage work.
• Touchstone examines the austerity curve, or the point at which cutting government spending becomes self-defeating because it lowers growth, depresses tax revenues, and pushes up social security spending by more than the government is cutting.
• The Century Foundation shares a series of graphs that bust the myths about food stamps.
• The Kaiser Family Foundation released their annual survey of employer health benefits, with a detailed look at trends in employer-sponsored health coverage.

Is it the role of government to put policy in place to impact the overall health of our citizens?  As the Oklahoma legislature’s interim study committee prepares its final report on the state’s obligations under the new federal health care law, the co-chairs have posed a series of questions to committee members to elicit thoughts, opinions, and lessons learned.  This post responds to a central theme of those questions, a theme we think has implications for the state’s future prosperity well beyond the new health care reform law.

Let’s assume that you stand on principle that it’s not the government’s role to engage the health care system.  Then we have a gravely serious problem.  We are very nearly the unhealthiest state in the country and we’re getting worse.  Individual behaviors – smoking, diet, fitness - certainly affect health, but it’s by no means certain that they’re the most important factors.  What we’re facing in Oklahoma is bigger than the sum of each individual resident’s health choices.  Acute structural defects in the state’s health care system demand solutions that are bigger than each of us and addressing them will benefit all of us.

continue reading At a Crossroads: Which path for Oklahoma's troubled health?

Julie is an Associate Professor and Assistant Director of the Anne and Henry Zarrow School of Social Work.

The number of uninsured individuals in Oklahoma has reached approximately 600,000 individuals. Almost half of Oklahoma’s uninsured are between the ages of 19-34. Despite this high number, little is known about why these young adults are underinsured or what strategies might encourage them to obtain coverage.

A state-wide survey and focus groups were designed to capture the opinions of young Oklahomans ages 19-34 regarding access to and the use of Oklahoma’s health care system in the absence of health insurance. Although it has been suggested that the young adults believe that they do not need health care coverage, results of the survey suggest otherwise.

continue reading Guest Blog (Julie Miller-Cribbs, MSW, PhD): Young and Uninsured in Oklahoma

Jeffrey Alderman, M.D., is an associate professor in the Department of Internal Medicine at the University of Oklahoma School of Community Medicine in Tulsa.

With Medicaid cuts looming and the federal government entertaining efforts to shift the costs of Medicare and Medicaid on to states and individuals, the future of health care reform and reimbursement seems murkier now than ever. But gaining little attention is the issue of physician workforce. In other words – with the size and scope of our health care provider pool now shrinking, how will we meet increasing patient demand with our current available workforce?

Despite our best efforts, we simply cannot attract new physicians to the state, and a large percentage of our OU/OSU graduates leave to work outside of Oklahoma. This helps to explain why in 2009 the Commonwealth Fund ranked Oklahoma 50^th in the nation for health status and health system performance. Similarly, a 2007 American Medical Association report found that Oklahoma ranks last in the US in physicians per capita, perhaps revealing why there is a 14-year difference in life expectancy between some north and south Tulsa communities.

continue reading Guest Blog (Jeffrey Alderman, M.D.): The silent problem in Oklahoma health care

The U.S. House or Representatives is expected to vote tomorrow on a federal budget proposal for the coming year that would —  among other things —  force drastic cuts to Medicaid that would harm Oklahoma seniors, people with disabilities, and children.  The budget plan, introduced by Republican Congressman Paul Ryan of Wisconsin, would also shift costs and risks onto our state and likely would force the state to cut payments to hospitals, nursing homes, physicians, and pharmacies.

Medicaid  is a primary source of health insurance for seniors, persons with disabilities, and children. Medicaid is especially important for Oklahomans receiving long-term care  in their homes or in nursing home facilities. It is also a cornerstone of the health care system for hospitals, physicians, pharmacies, nursing care facilities, home health care providers, and other professionals and businesses across the state. About one out of every five Oklahomans – close to 700,000 people -  receive health insurance coverage through Medicaid.

The Ryan proposal would turn Medicaid into a block grant.  Instead of covering a fixed share of a state’s Medicaid costs, the federal government would write a check each year. It would dramatically cut the amount of money it gives to a state, and that cut will grow bigger and bigger every year.  In total, states would receive $771 billion less over the next ten years under the Ryan plan; Oklahoma would lose some $8.2 billion, according to projections from Families USA.

continue reading Medicaid block grant proposal would hurt states, consumers and providers

Today is the one-year anniversary of President Barack Obama signing into law the landmark Affordable Care Act (ACA).  Many of the most far-reaching provisions of the health care reform law – including the launch of new health insurance exchanges for individuals and small groups, subsidies for the purchase of individual coverage, expansion of Medicaid eligibility, and the individual coverage requirement- do not take effect until January 1, 2014. However, some provisions of the law are already improving health insurance, expanding coverage to new populations, and making insurance more affordable. According to a fact sheet from Families USA, Oklahomans have already benefited from health care reform in a number of ways:

• Over 50,000 uninsured Oklahomans under the age of 26 are now eligible to remain on their parents’ health insurance plans;
• Some 50,000 Oklahoma Medicare recipients received a $250  rebate check in 2010 to help plug the “doughnut hole” in prescription drug coverage. In 2011, those who reach the doughnut hole will receive a 50 percent discount on brand-name drugs and will be eligible for reduced-price generic drugs;
• Nearly 600,000 Oklahoma seniors and persons with disabilities on Medicare now enjoy access to free preventive services, such as mammograms, colonoscopies and flu shots, along with a free annual wellness visit;
• Over 65,000 Oklahoma children with pre-existing health conditions can no longer be denied coverage by their insurance company;
• Some 50,000 Oklahoma small businesses with 25 or fewer employees and an average wage of less than $50,000 are now eligible for tax credits to help cover up to 35 percent of the cost of health insurance premiums for their employees.

  continue reading Happy Anniversary, ACA