Archive for 2013

Guest Blog (Camille Landry): Stayin’ alive

by | February 6th, 2013 | Posted in Blog, Healthcare, Neglected Oklahoma, Poverty | Comments (3)

camille_landryCamille Landry is a writer, activist, and advocate for social justice who lives in Oklahoma City. This is the first in a series, “Neglected Oklahoma”, focused on Oklahomans who find themselves in a position where the basic necessities of life are hard to come by. The people whose stories we tell are real people and their stories are true. Names have been changed to protect their privacy.

If you live in Oklahoma and do not have medical insurance, your life is at risk. Lack of health insurance coverage and the inability to access both primary and higher-level medical care result in Oklahomans having a life expectancy that’s ten years shorter than the national average  — on par with countries like Bangladesh and Iraq.  

Oklahoma’s Medicaid insurance program, SoonerCare, provides coverage for low-income people who don’t have insurance, but adults have to be very ill in order to get coverage. The preventive medical care that helps people avoid serious illness and the diagnostic and screening services that identify problems early so that they can be treated before they become fatal, are out of the reach for 690,000 uninsured Oklahomans.

Karen O’Connor (not her real name) has been living without medical insurance for years. A serious illness while she was a student cost far more than her student health policy covered. She was left with a huge amount of debt and a pre-existing condition that would deny her the ability to purchase medical insurance.

continue reading Guest Blog (Camille Landry): Stayin’ alive

Wither Insure Oklahoma?

by | January 16th, 2013 | Posted in Blog, Healthcare | Comments (6)

Insure Oklahoma2In announcing that Oklahoma would not take advantage of the opportunities provided by the Affordable Care Act (ACA) to expand Medicaid to cover low-income adults, Governor Mary Fallin stated she was committed to developing an “Oklahoma Plan to reduce the number of uninsured and the costs of healthcare”. According to several news reports, the options under consideration include expansion of Insure Oklahoma.

Insure Oklahoma involves a mix of public and private funding, and includes a modified benefit package compared to traditional Medicaid, along with greater cost-sharing responsibilities for participants. These features of the program have made Insure Oklahoma popular with some elected officials who are typically less than fully supportive of traditional Medicaid, and have led some to hold out Insure Oklahoma as an alternative to expanding Medicaid under the ACA.

However, with the full implementation of the Affordable Care Act in 2014, the future of programs like Insure Oklahoma becomes highly uncertain. The federal government is unlikely to extend Insure Oklahoma in its present form and may not extend it at all. Even if the program could be continued in some form, its financial terms are far less favorable to the state than the Medicaid expansion proposed by the Affordable Care Act. Rather than trying to preserve Insure Oklahoma, the state would be much better off by expanding Medicaid in a way that takes advantage of federal willingness to provide flexibility regarding benefit packages and cost-sharing for the newly-eligible Medicaid population, and by pursuing premium assistance options within the Medicaid program.

Insure Oklahoma is a 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 that generates over $40 million annually for the program. There are two components of Insure Oklahoma:

  • Employer-Sponsored Insurance (ESI) provides premium assistance to employees and their spouses with income up to 200 percent of the poverty level to purchase employer coverage. Businesses with fewer than 100 employees are eligible to participate in Insure Oklahoma. Employers and employees pay a portion of the cost of coverage, and Medicaid covers the rest;
  • The Individual Plan (IO) allows qualified adults and their dependents with incomes below 200 percent of the poverty level to buy into Medicaid coverage. It is available to employees of small businesses with fewer than 100 employees who are not eligible for employer-based coverage, self-employed adults, the temporarily unemployed, and some adults with disabilities. Members pay up to 5 percent of their income towards the cost of coverage, with the remainder paid for by Medicaid.

Insure Oklahoma currently covers 30,693 members, of whom 54 percent (16,620) are insured through Employer-Sponsored Insurance and 46 percent (14,073) through the Individual Plan. Currently, 96 percent of IO members are adults, with the remainder being dependent children and students.

The Affordable Care Act has, in some ways, made a program like Insure Oklahoma redundant. IO members with income above 100 percent of the federal poverty level – some 22,000 individuals – will qualify for tax credits, paid for entirely with federal funds, to purchase insurance on the new health insurance exchanges, which, in Oklahoma, will be operated by the federal government. IO members with incomes below the poverty level, some 8,600 current members, were expected to become eligible for Medicaid, with the federal government assuming 100 percent of the cost for the first three years (2014-16) and 90 percent from 2020 onwards. With Governor Fallin’s rejection of Medicaid expansion, IO members with incomes below the poverty level are likely to join the ranks of the roughly 130,000 uninsured working-age Oklahomans who will be stuck in a coverage crater, earning too little to qualify for tax credits.

What will happen to Insure Oklahoma beyond 2013? The Tulsa World reported in December that federal officials informed the Oklahoma Health Care Authority they are not interested in continuing partnerships like the Insure Oklahoma program once the ACA’s new coverage options kick in. More recently, sources have indicated that states have been told they can request extensions of premium assistance waiver programs, although waivers are unlikely to be approved in their present forms. Yet even if Oklahoma were to gain approval for an extension of Insure Oklahoma, it would be fiscally irresponsible to follow that route since the state would be required to pay the traditional Medicaid state match of roughly 35 percent, rather than having the federal government foot 90 to 100 percent of the bill.

At the same time, the federal government is signaling a clear willingness to allow states that expand Medicaid increased flexibility in shaping coverage for those newly eligible for Medicaid.  In a recent set of Questions and Answers to Governors, Health and Human Services Kathleen Sebelius wrote:

For the newly eligible adults, states will have flexibility under the statute to provide benefits benchmarked to commercial plans and they can design different benefit packages for different populations. We also intend to propose further changes related to cost sharing.

In addition, Oklahoma could retain a premium assistance component as part of its Medicaid expansion through what are known as  Section 1906 premium assistance programs, which many other states already do as part of their regular Medicaid program.

The Governor has said publicly that she plans to reduce the number of uninsured and the costs of healthcare.  Yet by rejecting Medicaid expansion, Oklahoma gives up the chance to have federal funds cover the lion’s share of the costs of insuring a large share of the state’s uninsured population, while leaving itself in a worse position to continue the Insure Oklahoma model in some future form. That sounds like no plan at all.


Crappy Holidays: Retail work in Oklahoma

by | January 8th, 2013 | Posted in Blog, Healthcare | Comments (0)

473b59c0-002fd-0344d-400cb8e1Early January is a busy time of year for retail stores.  Shoppers flock to malls and shopping centers to take advantage of storewide after-holiday sales, spend their gift cards, and return or exchange items.  While many consumers find the holiday shopping environment stressful, the stress of the season is likely to fall heavier on retail employees dealing with sharp increases in workload, but not necessarily increased compensation.  Inadequate pay and benefits means Oklahomans working retail are on precarious financial footing, and are likely to stay that way regardless of how hard or how much they work.

Every year in early Fall, retailers typically hire additional workers to handle the seasonal sales boost.   If sales fall short of retailer’s expectations, those hours are cut back and many employees work vastly fewer hours than they expected or were promised.  Since seasonal labor costs are the easiest cost to cut, part-time workers are especially vulnerable during the holiday season.

continue reading Crappy Holidays: Retail work in Oklahoma

Graph of the Day: Off Medicaid and ‘back to work’?

by | December 27th, 2012 | Posted in Blog, Healthcare | Comments (0)

Incoming House Speaker T.W. Shannon recently suggested that SoonerCare/Medicaid enrollees in Oklahoma should get “off of Medicaid and back to work.”  The idea that the Medicaid program is providing health care to adults who are choosing not to work is simply mistaken: the vast majority of those enrolled are children and low-income women during pregnancy (74 percent), and seniors and people with disabilities (19 percent).  Only 7 percent of Medicaid enrollees in Oklahoma are able bodied working-aged adults; such adults are only eligible if they have dependent children and earn less than $7,063/yr for a family of three.  

This analysis excludes SoonerPlan enrollees, who receive only a limited family planning benefit and are not enrolled in comprehensive Medicaid coverage.  A small number of enrollees categorized as disabled and/or chronically ill were also excluded because of discrepancies reconciling with total enrollment.

The Governor, with the support of legislative leadership, recently announced that she would not be participating in a Medicaid expansion to cover more uninsured low-income adults, leaving roughly 150,000 uninsured adults in Oklahoma with no options for health coverage.  Over 600,000 Oklahomans are without health insurance coverage; one out of two adults with income below the poverty level are uninsured.

Guest Blog (Dr. John Schumann): 'Help Wanted' for Medicaid expansion

by | July 30th, 2012 | Posted in Blog, Healthcare | Comments (3)

John Henning Schumann is a writer and doctor in Tulsa. He runs the Internal Medicine residency at the University of Oklahoma School of Community Medicine. He created the blog and is on Twitter @GlassHospital.

Despite its complexities and its politics, I support the Affordable Care Act (aka “Obamacare”).  As I’ve written elsewhere, I think it would be both morally and economically wrong for Governor Fallin and the Oklahoma legislature to opt out of the ACA’s vast Medicaid expansion – a position shared by Oklahoma Policy Institute.  So if Oklahoma does the right thing and opts to expand Medicaid for adults with incomes at or below 133 percent of the federal poverty level, what will happen?

Oklahoma faces a serious shortage of primary care access. The Oklahoma Health Care Authority, the agency in charge of administering Medicaid, recently compiled county-by-county maps, color-coded to classify areas of severe physician shortage based on presumptive levels of Medicaid expansion.  At a glance, these maps reveal something we already know: rural areas are hurting for physicians and populous counties seem to have more capacity.  In my opinion, however, the maps don’t paint a full picture of the eventual shortfall.

continue reading Guest Blog (Dr. John Schumann): 'Help Wanted' for Medicaid expansion

(Summer Re-Run) Medicaid Matters: Study finds coverage boosts health outcomes and financial security

by | July 17th, 2012 | Posted in Blog, Healthcare | Comments (1)

In the wake of the Supreme Court’s ruling on the Affordable Care Act, states must decide whether to expand Medicaid to cover adults with incomes below 133 percent of the federal poverty level.  This post originally ran on our blog in July 2011 and is part of an ongoing series of posts examining the Affordable Care Act. For links to other posts and resources, please visit the health care reform page on our website.

As states and Washington grapple with ongoing budget shortfalls, the Medicaid program is often in the crosshairs of those calling for major reductions in government spending. But while the costs of funding Medicaid are readily apparent, we should not forget the program’s crucial role in providing health care for those who may be too poor or too unhealthy to buy coverage in the commercial insurance market. Recently, a path-breaking new study reported that when those without health insurance are enrolled in Medicaid, they see wide-ranging benefits in terms of access to health care services, better physical and mental health, and financial stability. These findings should assume great importance in ongoing state and federal debates on Medicaid and health care reform.

continue reading (Summer Re-Run) Medicaid Matters: Study finds coverage boosts health outcomes and financial security

STATEMENT: Supreme Court ruling means it's time to move forward

by | June 28th, 2012 | Posted in Blog, Healthcare | Comments (0)

David Blatt, Director of Oklahoma Policy Institute, released the following statement in response to the Supreme Court’s ruling on the Affordable Care Act:

The Supreme Court ruling to uphold the constitutionality of the Affordable Care Act is a significant victory for consumers, providers, and payers alike. It’s also a wake-up call for Oklahoma, where our leaders have gambled on a wait-and-see strategy that’s left us ill prepared for reform. The decision today underscores the state’s obligation under federal law to move forward with implementation.

As major provisions of the law take effect in the next two years, many of the state’s 600,000 uninsured residents will gain access to health care coverage. Oklahoma will soon be required to operate an online competitive market for health insurance known as an ‘exchange’ – a one-stop-shop for residents to explore their coverage options. We now need to move quickly towards participating in the creation of a robust, consumer-friendly exchange for users to browse, compare, and purchase private plans and/or determine their eligibility for public programs and premium assistance tax credits.The Supreme Court also upheld expansion of the Medicaid program, a provision that will particularly benefit low-income uninsured Oklahomans, paid for almost entirely by the federal government.

For the 1.7 million Oklahomans who are privately insured and happy with their plan, coverage is now more secure and comprehensive. Insurers can no longer deny their claims or drop their coverage without oversight. Their insurer will now cover routine preventive care, like immunizations and cancer screenings, for no co-pay or additional out-of-pocket cost.

The health law is already working to strengthen consumer protections and ensure that Oklahomans are getting what they pay for from their insurers and providers. It’s now up to state leaders, regardless of their personal political preferences, to move forward quickly to implement the Affordable Care Act.

  • For the full text of the Supreme Court’s ACA ruling, click here.
  • For ongoing, thorough, and expert coverage of today’s ruling, check out SCOTUSblog.
  • For more information about the federal healthcare law and healthcare in Oklahoma, visit our website.

Why total spending has gone up as budgets are cut

by | June 11th, 2012 | Posted in Blog, Budget | Comments (2)

OK Policy has spent a lot of time focusing on the real and continuing damage caused by repeated state budget cuts over the past three years, as well as the fact that state tax collections are at historic lows. Meanwhile, the folks at the Oklahoma Council on Public Affairs have chosen to emphasize that total state expenditures continue to increase each year.

How can both be true? Here’s how:

continue reading Why total spending has gone up as budgets are cut

A Rock and a Hard Place: 'Asset-tests' and Oklahoma's poor

by | May 1st, 2012 | Posted in Blog, Poverty | Comments (0)

The federal ‘Food Distribution Program on Indian Reservations‘ (FDPIR) program provides food assistance to low-income Native American households living in Indian Country.  Many households participate in FDPIR as an alternative to SNAP (Supplemental Nutrition Assistance Program), formerly the food stamp program, because they do not have easy access to SNAP offices or grocery stores.  The agency that administers the tribal food program, the U.S. Department of Agriculture (USDA), recently proposed new regulations that would eliminate the program’s ‘asset test’, currently set at $2,000-$3,250.

continue reading A Rock and a Hard Place: 'Asset-tests' and Oklahoma's poor

Kaiser Health News: Health industries weigh in on Supreme Court case

by | March 26th, 2012 | Posted in Blog, Healthcare | Comments (2)

This story was written by Jay Hancock, a staff writer for Kaiser Health News, a publication of the Kaiser Family Foundation and was originally published on March 22nd, 2012.  For a break down of the issues being debated before the Supreme Court on the Affordable Care Act, see our blog post here.

Before the raucous legislative battle to pass the health law in 2010, there was a quieter but significant process that brought health industry players to the negotiating table. Insurers, hospitals and drug makers all cut deals to help shape what would become the Affordable Care Act.

America's Health Insurance Plans President and CEO Karen Ignagni (Photo by Chip Somodevilla/Getty Images)

Now, as the Supreme Court awaits arguments in one of the most closely watched cases in years, the deals are threatened along with the law. And the industry groups are deploying different strategies as they seek to defend their interests before the High Court.

Insurers have chosen not to defend the massive dividend for their industry that many believe makes the law most vulnerable. The “individual mandate” requires almost everybody to buy health insurance or pay a fine – a major concession the lobby got at the bargaining table. But insurers are not taking a stand on whether the mandate is an unconstitutional abuse of federal power, as the law’s opponents contend.

“I don’t think the public or the courts recognize our industry for its constitutional expertise,” said Karen Ignagni, chief executive of America’s Health Insurance Plans, an industry lobby.

Insurers do express strong views on what the court should do if the mandate is tossed out. Their memo to the justices joins more than 130 other briefs, the largest number of “friend of the court” briefs ever filed for a Supreme Court case.

continue reading Kaiser Health News: Health industries weigh in on Supreme Court case

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