Perhaps the best thing that can be said about this year’s legislative session from a health care perspective is that, refreshingly, this was the first in recent years that didn’t include a full-scale attack on access to SoonerCare. The legislature once again chose not to expand health care to more than 100,000 low-income Oklahomans and slashed important regulations around dangerous health coverage products. However, it made small steps towards some consumer protections and continued last year’s trend of slowly reversing years of underfunding.
Another legislative session, another failure to expand coverage
This session started strong on the coverage expansion front when SB 605 became the first expansion bill ever heard in committee and cleared unanimously. However, the bill failed the next legislative deadline, and efforts to craft a plan and introduce it later in session through the budget process fizzled, even with firm commitments from key Republicans and the support of hundreds of Oklahomans rallying at the Capitol in April. Governor Kevin Stitt has committed to a summer working group to develop a far-reaching “Oklahoma plan” to be introduced in next year’s legislative session. This sets up a likely collision course with a Medicaid expansion initiative petition to put the issue on a ballot in 2020.
Better access to bad health plans
When the Trump administration rolled back important regulations around a dangerous class of health coverage products, states had the opportunity to step up to protect consumers. Instead, the Oklahoma Legislature went the opposite way and cut state regulations around short-term limited-duration health plans and association health plans, which don’t have to have important protections such as covering pre-existing conditions or prescription medication. This will have consequences for Oklahomans: consumers often don’t understand the plans’ limitations even when they’re clearly presented, and a recent study from the American Cancer Society called these plans “devastatingly inadequate.” Oklahoma’s high uninsured rate is a big problem, but making it easier for people to buy coverage that doesn’t have to cover major health issues doesn’t fix it.
But still, some bright spots
Not all was doom and gloom on the health care front. Two bills bringing important reforms to health insurance were signed into law. One establishes limits around the use of step therapy, which gives doctors rather than insurers greater say in treatment decisions. The other requires third-party companies administering insurers’ prescription drug plans to include pharmacies close to the bulk of enrollees. In addition, the Legislature appropriated $1.9 million for the state’s community health centers, their first appropriation since the Uncompensated Care Fund was eliminated in 2017. Similarly, Medicaid providers received a 5 percent increase, and the legislature set aside growth from federal Medicaid funding to protect provider rates when the federal match eventually falls. Lastly, a $2 million increase to DHS will help serve 200 of the 5,500 Oklahomans with developmental disabilities on the waiting list for home- and community-based care.
Oklahoma has seen worse legislative sessions for health care. However, until the state stops nibbling around the edges of health care access and finally expands coverage, these efforts will be far less effective than they could be. Health insurance doesn’t fix all health access issues, as the bills on step therapy and pharmacy access remind us, but it’s still a central piece of the health care access puzzle.