An earlier version of the post included incorrect information about SB 943. The post has been corrected.
In previous years, health care legislation has often come with a sense of existential crisis, as budget cuts and efforts to take away coverage have loomed large. But this year, with a new administration and a healthier budget, lawmakers have a chance to reverse course and offer more readily accessible quality health care in Oklahoma.
Medicaid expansion? …Maybe
Governor Stitt made headlines a few weeks ago, when he and legislative leaders suggested that he was interested in some type of coverage expansion to low-income Oklahomans — and then again the following week, when he seemed to backpedal in his State of the State. However, the Governor’s speech still left the door open to continuing discussion, and the sheer volume of expansion bills filed this spring suggest that the conversation will continue. While the vast majority of the expansion bills have been assigned to the House Rules committee, one — SB 605 by Sen. McCortney — was sent to Retirement and Insurance. It’s likely no coincidence that SB 605 most aligns with the type of expansion Gov. Stitt and legislative leadership had suggested they might favor, taking advantage of federal flexibility to craft a coverage expansion unique to the state, as was done in Arkansas and Indiana.
Whether legislators will be able to pull together a plan with enough support to pass is an open question, but with the threat of expansion via state ballot initiative on the horizon, they should have incentive to try.
A break in threats to care for low-income Oklahomans?
As we’ve noted, Oklahoma’s budget situation is far rosier than in recent years. It’s possible this is why there are so few bills taking aim at coverage for low-income Oklahomans. That said, there are exceptions. HB 2443 by Rep. Roberts is essentially a do-over of a bill that passed and was signed last year. That bill directed the Health Care Authority to seek federal permission to cut SoonerCare coverage for low-income adults who don’t meet a work reporting requirement. While that bill was bad, HB 2443 would be even worse — for instance, it contains no exemptions for parents of young children.
Governor Stitt and legislative leadership have also prioritized a change in the way some state agencies operate that may not immediately threaten the individuals they serve, but would introduce a new cloudiness to the process. A raft of bills (including HB 2020, HB 2481, SB 366, SB 456, HB 2023, HB 2483, SB 459) would give the Governor the authority to hire and fire the heads of the Oklahoma Health Care Authority and Oklahoma Department of Mental Health and Substance Abuse Services, among other agencies, and demote governing agency boards to an advisory role. The existing board structures of these agencies gives the public a window into agency operation and deliberation. Although Gov. Stitt suggested in the State of the State that giving his office appointment authority would mean “accountability and transparency” in agency operations, experience suggests that Oklahomans would ultimately have less understanding and oversight of agency operations.
A new threat: more junk health coverage
After years of unsuccessful attempts to repeal and replace the Affordable Care Act (ACA), federal administrators are instead encouraging states to sabotage the landmark health law by loosening regulations around less comprehensive coverage options. Making this junk coverage more readily available is bad news for Oklahoma families in a number of respects. For one, these plans don’t have to meet basic consumer protections. Because the plans don’t have to guarantee coverage for pre-existing conditions or cover important medical needs like pharmaceuticals or mental health care, people who buy these plans can be left without health care when they most need it. Additionally, because younger, healthier people are more likely to seek these plans out, premiums for ACA marketplace coverage may spike as older or less healthy enrollees become a greater share of the risk pool. In short, these plans are bad news all around.
Unfortunately for Oklahomans, a set of bills would seek to relax needed regulation on this junk coverage. HB 1053 (Rep. McEntire) would loosen the definition of “association,” while SB 943 (Sen. Treat) would go further by allowing association plans to charge members more based on age, gender, geography, and industry, and allow them to duck providing important benefits such as treatment for substance use disorders or prescription medications. Association health plans have had a poor reputation due to such problems as insolvency and fraud. Similarly, SB 505 (Sen. Newhouse) and SB 993 (Sen. Dahm) would rewrite regulations around short-term limited-duration health plans such that they could no longer really be considered short-term, as both bills would allow plans to cover up to 364 days, instead of the current six months. Similarly, they could hardly be considered limited-duration; under current law, these plans can’t be renewed, but both bills would allow them to be renewed for a maximum of 36 months. Consumers have understandable expectations of what their health plans should cover, but a review of short-term limited-duration health plans available in the Oklahoma City area found that not even 2 in 3 covered mental health needs; just 1 in 3 covered substance use disorder treatment; and none covered maternity care. Both association health plans and short-term limited-duration health plans represent a return to the pre-ACA days of playing roulette with health insurers, and it’s not a path Oklahoma legislators should pursue.