Health Care Reform (7): It's more than a mandate

This is the seventh in an ongoing series of posts examining the Affordable Care Act, including previous posts on the Temporary High Risk Pool, health insurance exchanges and tax credits for small businesses.  You can also visit the health care reform page on our website for more resources and information.  If you have thoughts on health care reform, we encourage you to comment below or contribute a guest blog.

It’s been almost a year since President Obama signed major health care reform legislation into law.  On the opening day of Oklahoma’s 53rd legislature, Governor Fallin made it clear that her administration would join other state’s in challenging one of the most controversial parts of the Affordable Care Act (ACA):

Many Oklahomans, including myself, feel that the federal mandate is unconstitutional and wrong. That’s why Attorney General Scott Pruitt and I have acted to add Oklahoma to the list of states that are now challenging the president’s health care law in court.

How does the governor’s – and by extensions the state’s – stance on the individual mandate affect the myriad other ACA changes?  For now, their position has no effect on the millions of dollars allocated to the states under the new law to address acute health care needs.  Beyond the individual mandate, which goes into effect in 2014, the ACA asks the states to make fundamental improvements in health care infrastructure and expand insurance coverage to the 671,663 Oklahomans who are currently uninsured.

The Affordable Care Act (ACA) contains two types of private insurance reforms: reforms to make the market fairer for people not in perfect health (and isn’t that all of us, really?) and reforms to make insurance more affordable.  Fans of OKPolicy’s budget outlook briefs and regular readers of this blog familiar with our recent gloomy assessments of the state’s budget might be doubting Oklahoma’s capacity to execute major structural reforms at a time when even core public services appear to be on the chopping block.  Fortunately, millions of dollars have already been made available in Oklahoma for programs that improve access to affordable care and affordable insurance.  Far from being a financial or regulatory burden on businesses or consumers, the measures listed below are already in place in Oklahoma and are actively easing the cost of care.

Early Retiree Subsidies for Employers: The federal government will pay employers a share of early retirees’ high-cost claims.  This helps employers keep premiums low for new health plan enrollees.  Oklahoma businesses already receiving funds include the City of Edmond, OG&E, the City of Altus, Devon Energy Corporation, Oklahoma Publishing Company and the University of Oklahoma.  Click here for a comprehensive list updated monthly.  Employers interested in the Early Retiree Reinsurance Program (EERP) should click here.

Pre-Existing Condition Insurance: 148 uninsured Oklahomans and counting have enrolled so far in the state’s new Pre-Existing Condition Insurance Plan program run by the Oklahoma Health Insurance High Risk Pool.  This plan provides a health coverage option for citizens who have been uninsured for at least six months, have a pre-existing condition or have been denied health coverage because of their health condition.  See OK Policy’s coverage of high risk pools in segment three of our ongoing series on health care reform.

‘Donut Hole’ Rebate Checks: 33,307 Oklahoma Medicare beneficiaries have received a one-time, tax free $250 rebate to help pay for prescriptions in the “donut hole” coverage gap.

Small Business Tax Credit:  Businesses subsidizing health care of up to 25 full-time employees can receive tax credits of up to 35 percent of their premium contribution for an average-cost plan.  Try this easy online interactive calculator to determine your business’s credit, or visit the IRS website for a more detailed explanation of eligibility rules.

Crack Down on Unreasonable Insurance Premium Increases: In Oklahoma, small group health plans are reviewed to guarantee that 60 percent of premium dollars collected are being spent on medical care and the state intends to create a consumer website to publicly post information on rate review.  Under the ACA, if states find a plan’s premium increases unreasonable, they can bar the plan from participating in state insurance exchanges. States can apply to receive up to $1 million in federal grants to strengthen their review of insurance premium increases.

$55.6 Million for Exchange Planning:  Oklahoma has already received federal funding to begin planning for the establishment of a health benefit exchange in 2014.  Our previous post on this topic delves into exchanges in greater detail, but basically the goal is for small businesses and individual consumers to pool their buying power and negotiate for higher quality and lower cost coverage from the private insurance market.  Oklahoma also recently received a 54.6 million dollar Early Innovator Grant to help design and support the information technology that will be needed to operate an effective health insurance exchange.

These federal dollars and programs are offered to states regardless of their stance on the individual mandate.  State leaders have indicated that health care is a public priority and are asking citizens to take responsibility for their own health.  Given that Oklahoma currently ranks 46th in the nation in citizen health, we hope that state leadership will couple their words of encouragement with adequate funding of public health initiatives and health care infrastructure.  Thanks to the ACA, they should be off to a running start.


2 thoughts on “Health Care Reform (7): It's more than a mandate

  1. Although Oklahoma did receive a $55.6 million for the Early Innovator Grant, the State turned it down due to political reasons. Oklahoma now has to find another way to fund that $55.6 million.

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