In Oklahoma, doors to health care shut for working families

Elizabeth Armstrong is an OK Policy intern. She is pursuing a Master’s degree in Geography at Oklahoma State University where she also works as a Graduate Research Assistant. Her free time is spent playing with her daughter.

Since the Affordable Care Act’s major provisions have come into effect, uninsured rates across the US have dropped precipitously. The nationwide uninsured rate is now below 10 percent. However, these gains have been uneven – in the 20 states that are still refusing federal dollars to cover low-income residents, uninsured rates remain significantly higher than the rest of the country. In Oklahoma, the state’s refusal to expand coverage has left some 100,000 Oklahomans in a coverage crater, unable to qualify for subsidized coverage on Healthcare.gov and ineligible for Medicaid.

A majority of Oklahomans in the coverage crater are working adults, and more than 1 in 4 have dependent children. Although we have seen significant improvements in health coverage for Oklahoma children, minimal advances have been made to insure the parents of these children. Without access to affordable health insurance, working parents may not be able to access screenings or preventive care and are more likely to be bankrupted by anything from pneumonia to injuries from a car accident. We know that healthy parents make healthy households, both physically and economically. If we deny these working parents access to healthy living, we also limit their ability to provide better social and economic opportunities for their children.

To qualify for SoonerCare, parents of dependent children must make below 37 percent of the federal poverty level ($7,433 for a family of three). This very low income requirement makes it virtually impossible for low-income working parents to qualify for Medicaid. Barely more than 10 percent of Oklahoma’s Medicaid enrollees fall into this category.

Low- and minimum-wage earners are similarly excluded from the health insurance marketplace. In Oklahoma, the annual income of a minimum wage earner is $15,080, which is several hundred dollars below the qualifying income of $15,930 to receive subsidized coverage on the marketplace. This issue disproportionately affects women, as they are more likely than men to earn minimum wage.

However, in Arkansas, Kentucky, and more than two dozen other states, low-income parents of dependent children are able to enroll either in Medicaid or heavily-subsidized private coverage. Whether low-income parents qualify for health coverage has become largely dependent on where they live.

[pullquote]”Whether low-income parents qualify for health coverage has become largely dependent on where they live.”[/pullquote]Oklahomans in the coverage crater are exempt from the requirement to carry health coverage. This means that they don’t have to pay a penalty for being uninsured – but it also means that they still don’t get the benefits of health insurance, either. What would they have to pay if they still wanted to get insurance?

We used the health insurance estimator to determine the cost of health insurance for low-income families, choosing a basic Blue Cross Blue Shield Multi-State plan for comparison. A single-parent minimum-wage earning family would have to pay up to $9,000 per year — about three-fifths of their $15,080 annual income — to purchase health insurance. Similarly, two-parent families earning $24,249 per year would be required to spend between $5,000 and $19,000 per year to insure both parents. In short, unsubsidized coverage is totally unaffordable for most families.

Because lawmakers have chosen not to expand coverage to low-income Oklahomans, a large portion of Oklahoma’s working-class parents are likely to remain uninsured.  Aside from their roles as caregivers and supporters of their own children and families, they’re disproportionately likely to work in occupations serving others. People in the coverage crater take care of our children and our elders, prepare and serve our food, clean our schools and offices, and build our homes. Failure to expand coverage also harms veterans and especially affects Black and Hispanic Oklahomans.

There are two options Oklahoma can take to extend healthcare coverage to working families 1) waivers that have traditionally extended coverage to low-income parents or 2) adoption of Medicaid expansion under the Affordable Care Act. In both cases, Oklahoma has an opportunity to help working families while saving the state money, creating jobs, and putting funds back into local economies. At a time when hard-working Oklahomans are struggling to get by, expanding health coverage for the low-income uninsured would provide a much-needed boost to families and communities. The only bad option is to continue to do nothing for these families.