Despite improvements, Oklahoma’s health insurance marketplace enrollment lags

ASISTENCIA_MEDICAAmanda Rightler was an OK Policy intern. She recently graduated from the University of Tulsa with majors in chemistry and economics.

New national data shows that 90 percent of Americans had health insurance in 2015, due in large part to the Affordable Care Act. Between subsidized coverage and Medicaid expansion, the US uninsured rate is at its lowest recorded level ever. Unfortunately, Oklahoma is missing out: the decline in uninsured rate between 2014 and 2015 in our state was statistically insignificant.

This means Oklahomans aren’t realizing the benefits of broad access to health coverage the way other states’s residents are. Here’s why and what can be done to fix it.

Despite significant improvement, Oklahoma marketplace enrollment remains low

A landmark feature of the Affordable Care is the online marketplaces ( for most states) where people can sign up for health insurance during annual Open Enrollment Periods. By the end of Open Enrollment in 2016, more than 145,000 Oklahomans had signed up for a marketplace plan, a 13 percent increase over 2015 enrollment and one of the largest increases measured. But only 34 percent of Oklahomans who are estimated to be eligible to enroll in coverage have done so, versus 46 percent nationwide


It’s worth keeping in mind that low health coverage enrollment isn’t limited to the marketplace population. An analysis earlier this year found that while 25 percent of Oklahoma’s uninsured population was eligible to purchase coverage on the exchange with premium tax credits, another 19 percent of the uninsured are eligible for Medicaid coverage.

That said, Oklahomans who have enrolled in marketplace coverage appear to be making informed decisions about the right plan for their needs. Of those enrolled, almost three-quarters could have chosen a plan with a monthly premium of $50 or less after the advance premium tax credit, but fewer than half of those selecting plans did so. This indicates that Oklahoma’s enrollees are choosing plans based on their needs, instead of simply picking the cheapest plan.

Lack of awareness of available subsidies may be driving down enrollment

Of Oklahoma marketplace enrollees, 38 percent are from the lowest income bracket at which subsidies are available – a relatively high percentage compared to other states. This suggests that low-income enrollees aren’t disproportionately deferring enrollment due to cost. However, low Oklahoma marketplace enrollment overall indicates that many Oklahomans simply aren’t aware of what they’re eligible for.

This is borne out by national data. A 2015 survey found that almost two-thirds of uninsured individuals do not understand or are unaware of the subsidies that can dramatically lower the overall cost of marketplace coverage. This is unfortunate, given the remarkable impact of the subsidy. Despite highly-publicized marketplace premium increases for 2016 in Oklahoma, subsidies meant that the average monthly payment for enrollees actually decreased slightly, from $89 per month to $80 per month. Increasing awareness of available assistance could encourage more eligible enrollees to sign up. (Fewer inaccurate statements by state leadership would probably help, too.)

Increasing enrollment efforts would benefit Oklahoma

Increasing marketplace enrollment in Oklahoma would have a range of benefits, from regular access to preventive care to greater financial security for families to lower spending on uncompensated care by health care providers. Unfortunately, Oklahoma has so far opted out of two significant drivers of marketplace enrollment: constructing a state-based marketplace instead of using and accepting federal funds to expand coverage to the low-income uninsured. With regards to the latter, Oklahoma actually won a $54.6 million federal grant to develop a state-based marketplace in 2011 – and then gave it back. However, accepting federal funds to extend coverage to the low-income uninsured is still very much on the table. This would save the state an estimated $400 million over the next decade while providing needed health coverage to more than 100,000 uninsured Oklahomans.

The story isn’t all doom and gloom; we still saw 145,000 Oklahomans enrolled in comprehensive health coverage during the 2015-2016 Open Enrollment Period. That’s good, but we can do better — and fortunately, we have some idea of how. We just need to show the political will to do it.

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