Commissioner Doak’s press release on marketplace enrollment costs is inaccurate, disingenuous

Oklahoma Insurance Commissioner John Doak
Oklahoma Insurance Commissioner John Doak

Last week, Oklahoma State Insurance Commissioner John Doak’s office released a statement blasting the cost to enroll Oklahomans in health insurance on the federal marketplaces. Commissioner Doak’s statement is both disingenuous and inaccurate. His conclusions about the cost per enrollee are based on flawed assumptions, and the relatively high cost per enrollee is partially due to his own actions.

Commissioner Doak argues that “each Oklahoma enrollee in the federal marketplace cost taxpayers an average of $1,095” and “overall spending on the exchange has cost taxpayers nearly $7.4 billion.” He’s not wrong – but he’s also choosing not to tell the whole story. The state and federal health insurances exchanges, where Americans can compare and enroll in plans, were designed to be used for years to come – not for a single enrollment period. Calculating cost per enrollee data based on only the first year of the marketplace’s use is like building a football stadium and complaining that the first season of ticket sales didn’t pay for its construction. 

Furthermore, the state of Oklahoma was one of only five states in which the state government refused to play any role in implementing key provisions of the Affordable Care Act. Concurrently, Oklahoma saw the sixth-lowest marketplace enrollment nationwide based on the proportion of eligible enrollees signed up for health insurance in the first enrollment period (15.5 percent, nearly half the nationwide rate of 28.0 percent). 

This isn’t a coincidence. Given the state’s efforts to block the law’s enforcement, including Commissioner Doak’s sky-is-falling warning of “skyrocketing premiums” under the ACA (which was not based on real data), it is a bit rich to argue that the cost per enrollee is too high. The state has done everything in its power to keep the total number of Oklahoman enrollees as low as possible.  The cost per enrollee was in effect driven up by the state – including by Commissioner Doak’s own actions. 

In the release, Commissioner Doak says that the cost per enrollee proves “the solution is state-based regulation that gives consumers options and the freedom to make the choices that best suit their families’ needs.” Governor Fallin made the same argument in her State of the State five months ago — and indeed, when she first declined federal funds to extend health coverage to low-income Oklahomans in 2012. Had the state put the same time and energy into developing such a plan that it has put into obstructing federal law, we might have it by now. 

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Carly Putnam joined OK Policy in 2013. As Policy Director, she supervises policy research and strategy. She previously worked as an OK Policy intern, and she was OK Policy's health care policy analyst through July 2020. She graduated from the University of Tulsa in 2013. As a student, she was a participant in the National Education for Women (N.E.W.) Leadership Institute and interned with Planned Parenthood. Carly is a graduate of the Oklahoma Center for Nonprofits Nonprofit Management Certification; the Oklahoma Developmental Disabilities Council’s Partners in Policymaking; The Mine, a social entrepreneurship fellowship in Tulsa; and Leadership Tulsa Class 62. She currently serves on the boards of Restore Hope Ministries and The Arc of Oklahoma. In her free time, she enjoys reading, cooking, and doing battle with her hundred year-old house.

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