Archive for 2013

What’s unaffordable?

by | February 26th, 2013 | Posted in Blog, Education, Healthcare | Comments (2)

In her 2013 State of the State address, Governor Mary Fallin reiterated her opposition to accepting federal dollars to provide coverage to uninsured Oklahomans through Medicaid, as provided under the Affordable Care Act. In states that extend Medicaid, the federal government will pay 100 percent of the cost for the newly-eligible population for three years (2014-16) and 90 percent from 2020 onwards. Yet the Governor claims that extending Medicaid would impose large and unaffordable costs on the state:

According to a report from the Kaiser Commission on Medicaid and the Uninsured, the proposed expansion of Medicaid would result in a $689 million increase in state Medicaid costs between 2013 and 2022. Expanding Medicaid as proposed by the president would mean that a huge sum of money would be diverted from other priorities, like education and public safety, as well as existing health care programs.

The Governor’s assertion that extending Medicaid is unaffordable to Oklahoma is unconvincing in at least two respects. First, the study on which she bases her cost estimates makes clear that extending Medicaid would have a very modest fiscal cost to the state and would bring in over twelve new federal dollars for every additional dollar of state spending. Secondly, the state cost of extending Medicaid would be less than half the cost of the Governor’s proposed 0.25 percentage point cut to the top income tax rate over the same period.

In November, the Kaiser Commission on Medicaid and the Uninsured released the report which estimated that Oklahoma would spend $689 million more from 2013-2022 by extending Medicaid under the ACA (1). This estimate is significantly higher than the one developed by the Oklahoma Health Care Authority (OHCA), which had previously formed the basis of discussions of the cost of Medicaid expansion. In part, this is because the Kaiser Commission’s projections run through 2022, adding two years when the state share would be 10 percent. In addition, unlike OHCA, the Kaiser Commission assumes that extending Medicaid eligibility to 138 percent of the federal poverty level for working age adults will lead some people who  currently have employer-sponsored coverage or individual coverage to drop that coverage and enroll in Medicaid instead. The Kaiser Commission projects 204,000 more Oklahomans will enroll in Medicaid, of whom 126,000 are currently uninsured.

A careful look at the full Kaiser Commission report shows, however, that the actual cost to Oklahoma of extending Medicaid are modest and would yield tremendous benefits:

  • Kaiser_federal&stateFrom 2013-2022, the federal government would spend an additional $8.561 billion on the newly-eligible Medicaid population, or more than $12 for every dollar in state spending. The federal government would assume 92.5 percent of the total cost from 2013-2022.
  • The $689 million state cost of Medicaid expansion would be offset by $205 million in savings in reduced uncompensated care costs, reducing the net cost to $485 million (Table ES-4). This does not take into account savings from shifting services currently paid for with state-only dollars to Medicaid; Oklahoma currently spends an estimated $48 million annually on health services for low-income adults who could become Medicaid-eligible. Nor does it include revenue gains from the boost to state economic activity resulting from increased federal dollars.
  • The state costs would be especially modest in the early years. The state cost is projected to be just $11 million in 2016, which is less than the $23 million the state would save that year in uncompensated care costs (Table 15).
  • Extending Medicaid eligibility would increase state spending on Medicaid by just 2.7 percent from 2014 – 2022 (Table 6).
  • Medicaid payments to Oklahoma hospitals alone would increase by $3.6 billion from 2013-2022, an 18.5 percent increase  (Table 13).
  • Medicaid expansion would reduce the number of uninsured Oklahomans by 126,000 (Table 12). Currently nearly one in two working age Oklahomans with income below 133 percent of the federal poverty level are without insurance.

cost-tax-cut-MedicaidAccepting the Kaiser Commission’s cost estimates, Oklahoma can expect to spend an additional $485  million between now and 2022, net of reduced uncompensated care costs. The Governor contends that this spending would detract significantly from Oklahoma’s ability to make necessary investments in education, public safety, and other health care programs. Yet the Governor proposes cutting Oklahoma’s top income tax rate from 5.25 to 5.0 percent. This tax cut would cost about $125 million in 2014 and $1.48 billion from 2013-2022 (see Table), which is double or triple the state cost of extending Medicaid over the same period. More than two in five Oklahoma households would get no benefit at all from the tax cut, and the median benefit would be just $39 per household in 2014, as we discussed in this blog post. By contrast, extending Medicaid would provide health coverage for 125,000 uninsured Oklahomans. The economic benefits of an infusion of $8.56 billion in federal funds for health care over nine years would dwarf those of a $1.48 billion tax cut.

If we want to make the best decision for our state’s health and prosperity, turning down federal dollars to extend Medicaid to low-income Oklahomans is the truly unaffordable choice.

For a fact sheet version of this blog post, click here. For more analysis and information on expanding Medicaid, click here

(1) This number does not include  the “woodwork” population of those currently eligible but not enrolled in Medicaid. This population is expected to enroll in Medicaid whether or note the state extends Medicaid eligibility.

Where the Affordable Care Act fits into the gun control debate

by | February 20th, 2013 | Posted in Blog, Healthcare | Comments (1)

329644_1507Since the tragic shooting at Sandy Hook Elementary School, the debate surrounding gun violence, gun control, and mental health has gained renewed prominence. Last month, President Obama laid out proposals to reduce gun violence which include increasing access to mental health services.  The affordable access to these services has been a constant barrier to some Americans in need of treatment. There have been multiple pieces of bipartisan legislation introduced since the Connecticut shooting, addressing the need for increased access and training in mental health services. Starting January of 2014, the Affordable Care Act (ACA) will help to reduce barriers to mental health services by increasing access to mental health benefits.  Embracing the implementation of the ACA will be one solution to preventing another tragic mass shooting. 

The ACA allows states to expand Medicaid coverage to working individuals with income levels up to 133 percent of the Federal Poverty Line (FPL). The expansion of Medicaid will potentially cover 13.4 million uninsured people with mental and behavioral health conditions. In addition to Medicaid expansion, employers with more than fifty full time employees will now be required to offer affordable health insurance.The act also establishes insurance marketplaces for individuals who are not Medicaid eligible and don’t have access to affordable health insurance through their employer.  Individuals with income levels up to four times the FPL will be eligible for premium tax credits to purchase insurance through the marketplace.

Insurance companies will be required to offer “qualified health plans” through the insurance marketplaces. While qualified health plans have not been specifically defined as of yet, they must all provide “minimum essential benefits” as defined by the ACA. Mental health services are included under the minimum essential benefits. With access to health insurance through Medicaid, an employer, or the insurance marketplace, individuals will be guaranteed the same level of mental health benefits as medical and surgical benefits.

In addition to the ACA, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) exist to ensure parity in mental health benefits. The MHPAEA aimed to create “parity” by eliminating historical differences in group health insurance coverage for mental health and substance abuse benefits and medical/surgical benefits. Getting mental health parity legislation passed and implemented has been a long and difficult journey. Efforts in achieving mental health parity date back 50 years, starting when President John Kennedy called for parity in mental health benefits for federal employee health insurance plans.

In 1997, Senators Pete Domenici from New Mexico and Paul Wellstone from Minnesota succeeded in getting the Mental Health Parity Act passed. The legislation required group health plans with fifty or more employees that offered mental health benefits to apply the same lifetime and annual dollar limits to mental health coverage as those applied to coverage for medical and surgical benefits. Efforts to improve the legislation continued for more than a decade. It wasn’t until the passage of the MHPAEA did true parity between mental health and medical/surgical benefits begin to occur.

However, there are several limitations to the MHPAEA and ACA. The MHPAEA doesn’t require employers to offer mental health benefits. The ACA requires insurance plans sold through the insurance marketplaces to offer mental health benefits, but exempts employers who already provide affordable health insurance to their employees from offering mental health benefits if they are not currently offering the benefits. Also, when the Supreme Court ruled on the constitutionality of the ACA, the Court gave the states the option of expanding Medicaid. As of mid-February, only 21 states and the District of Columbia have decided to expand Medicaid in compliance with the ACA. As a result, those individuals who are unable to receive coverage under Medicaid will be unable to access affordable health insurance which will include mental health benefits.

Now that the gun control debate is back in the national spotlight and President Obama has committed his administration to working on solutions to curb gun violence, the MHPAEA and the ACA are two mechanisms that will ensure individuals will have access to mental health services. Both Congressional Senators from Oklahoma, Tom Coburn and Jim Inhofe agreed with President Obama’s efforts to increase mental health services as one solution to preventing gun violence. In her State of the State address, Governor Mary Fallin, emphasized the need for more resources to be put towards the Department of Mental Health and Substance Abuse Services to assist children and their families who suffer from emotional disturbances.

Unfortunately, Governor Fallin has failed to take the extra vital step in getting uninsured working Oklahomans access to needed health insurance including mental health benefits by refusing to accept federal funds to expand the Medicaid program in Oklahoma. The full implementation and acceptance of the ACA will demonstrate the country’s willingness to ensure individuals are getting the mental health services they need and hopefully avert the next tragic mass shooting.



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

What Governor Fallin’s healthcare decisions mean for Oklahomans

by | December 18th, 2012 | Posted in Blog, Healthcare | Comments (2)

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

How medical debt erodes Oklahomans’ financial security

by | December 17th, 2012 | Posted in Blog, Healthcare, Poverty & Opportunity | Comments (2)

Medical debt is money owed for medical goods or services, like doctor’s visits, lab fees, or hospital stays.  One survey of low-income households in eight states, including Oklahoma, found that 46 percent of low-income households carried medical debt.  National survey research has found that 41 percent of adults of all income levels have either accumulated medical debt, or had difficulty paying medical bills in full.  Medical bills burden too many Oklahoma households with financial insecurity, debt collections that damage credit history, and bankruptcy.  

Financial insecurity

Without health insurance, households at any income level can be financially devastated by a serious illness that requires frequent doctor visits, expensive treatment, or surgical intervention.  But even relatively minor illness can threaten the financial security of low-income households, whether they have insurance or not.  Co-pays and medical bills that aren’t covered by insurance, and lost income or employment from time-off work, can become insurmountable obstacles for those already living paycheck to paycheck.  Those without sufficient income to pay off their medical bills face few good options: spending down their savings, charging the balance to a credit card, taking out a loan or a 2nd mortgage, leaving other bills unpaid, or some combination of all four.

continue reading How medical debt erodes Oklahomans’ financial security

Leadership urged to reconsider Medicaid expansion decision

by | December 12th, 2012 | Posted in Blog, Healthcare, OK Policy | Comments (1)

In a letter from its Board of Directors, Oklahoma Policy Institute has urged Governor Fallin and legislative leaders to reconsider the Governor’s decision not to participate in the expansion of Medicaid for uninsured low-income adults.

“The practical benefits of accepting these benefits would be positive for Oklahoma families, healthcare providers, businesses, and the state’s economy as a whole”, the letter states.

The bipartisan seven-member Board of Directors is chaired by Vincent LoVoi and includes Don Millican, Nancy Robertson, Albert “Kell” Kelly, Steve Burrage, Susan Neal and Linda Edmondson.

continue reading Leadership urged to reconsider Medicaid expansion decision

New Census data shows many still left out of Oklahoma's prosperity

by | September 20th, 2012 | Posted in Blog, Poverty | Comments (1)

Almost 1 in 4 Oklahoma children lived in families that fell below the poverty line in 2011, according to new Census Bureau data released today. The poverty rate for Oklahomans under 18 was estimated at 23.0 percent in 2011, an increase of 3.1 percentage points since 2001.

The change in poverty rates among all Oklahomans was not statisically significant from 2010 to 2011, but it has increased significantly since 2009, going from 16.2 percent to 17.2 percent. The national poverty rate was 15.9 percent in 2011. Poverty continues to rise in Oklahoma, despite a dropping unemployment rate and other signs of economic recovery. Median household income also remained flat at $43,225 in 2011.

continue reading New Census data shows many still left out of Oklahoma's prosperity

Avoiding the Medicaid 'coverage crater'

by | August 13th, 2012 | Posted in Blog, Healthcare | Comments (1)

When Congress approved a prescription drug benefit for the Medicare program in the mid-2000s, it created the infamous ‘Medicare donut hole‘ – a large gap in coverage of prescription drug costs.

The Affordable Care Act (ACA), the landmark health care law, brought about important changes that gradually eliminates the ‘donut hole’ by 2020. But now, as a result of the Supreme Court’s recent ruling, low-income Oklahomans could find themselves in a similar situation,  stuck in a ‘coverage crater’, without access to public or private coverage and consigned to the ranks of the uninsured.

The ACA adopts two primary mechanisms to cover the uninsured. The first is to expand Medicaid, the federal-state insurance program that primarily covers low-income children, seniors, and persons with disabilities. In Oklahoma, like in many states, Medicaid coverage for working-age adults is extremely limited. Only parents of dependent children with incomes below roughly $7,000 per year for a family of three (37 percent of the federal poverty level) are eligible. Working-age adults without children are ineligible for Medicaid regardless of how little they earn. The uninsured rate for this population is extremely high, nearing 50 percent in Oklahoma. This population is especially likely to suffer from chronic physical and mental health conditions that make earning a steady income difficult.

The ACA makes adults with income up to 133 percent of poverty eligible for Medicaid as of January 1, 2014. To ensure that states go along with the expansion, the law provided both a large carrot and a heavy stick. The incentive is a federal commitment to cover the lion’s share of the costs of the newly-eligible Medicaid population – 100 percent for three years, then phasing down to 90 percent in 2020 and subsequent years. For states that didn’t adopt the expansion, the federal government could withdraw all federal funds for the Medicaid program.

The Supreme Court, however, ruled that the threat of withholding all federal Medicaid funds for a state that does not expand  coverage for low-income adults was unconstitutional. As SCOTUSblog explains:

continue reading Avoiding the Medicaid 'coverage crater'

(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

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

by | February 7th, 2012 | Posted in Blog, Healthcare | Comments (1)

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

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