Another day, another reminder that Oklahoma’s politically-motivated refusal to expand health coverage for low-income residents is having a real impact in limiting access to health care for tens of thousands of Oklahomans.
It’s been two years since the Affordable Care Act’s largest provisions expanding health coverage to the uninsured took effect. In August, Gallup-Healthways Well Being Index released a study comparing the number of uninsured in 2013 with the number of uninsured in the first half of 2015 across all 50 states. The poll found that states that have embraced two primary state-level components of the Affordable Care Act – expanding access to coverage for low-income residents and establishing state-run health insurance marketplaces – have generally seen more progress in reducing the percent of residents without health insurance than states that have not.
According to Gallup’s polling, Oklahoma now has the third-highest uninsured rate in the US (17.7 percent), surpassed only by Wyoming (18.2 percent) and Texas (20.8 percent). Since 2013, Oklahoma has seen the sixth-lowest percent change in the uninsured. The state’s uninsured rate has only dropped by 3.7 percentage points in the last year and a half. With the exception of Texas, Oklahoma’s uninsured rate far outpaces that of any neighboring state.
Nationwide, five states saw their uninsured rate drop by 10 points or more over that same time period. The uninsured rates of both Arkansas and Kentucky – states which have both expanded coverage – have gone from above than 20 percent to less than 10 percent. Overall, states that expanded coverage and operate their own marketplaces have seen a 44 percent drop in their uninsured rate (7.1 percentage points). By contrast, states with only expanded coverage or a state-operated marketplace or neither have only seen a 28 percent drop in their uninsured rate (5.3 percentage points).
The Gallup data clearly shows that constructing a state-based marketplace and expanding coverage lower a state’s uninsured rate – decisions that are entirely in lawmakers’ hands. In 2014, the Commonwealth Fund found that Oklahoma was one of only five states in which state officials were declining to play any role in implementing key provisions of the Affordable Care Act. Oklahoma won and then returned at $54.4 million grant to construct a state-based marketplace. The state has refused to accept federal funds to expand health coverage to low-income Oklahomans, while Oklahomans get sick and die from preventable causes – from cancer to heart disease to diabetes – at higher rates than almost any other state.
Thus Oklahoma’s uninsured rate remains high because of policy decisions – and policy decisions can bring the uninsured rate down. It’s likely too late for the state to build its own health insurance marketplace (that $54 million probably isn’t coming back, at any rate). However, it’s not too late for the state to accept federal funds to expand coverage. In fact, by refusing the funds, the state gives up $2.3 million dollars per day. In the meantime, taxes paid by hardworking Oklahoma families are helping to pay for health care reforms in North Dakota, Arkansas, Iowa, and dozens of other states. This tax transfer of more than $1 billion over a decade that could be used to pay for better health much closer to home.
Speaking at the Oklahoma Health Care Authority Strategic Planning Conference in August, Rep. Doug Cox (R-Grove) put it bluntly when he said that there is no fiscal or policy reason to continue to refuse expanding coverage – that the opposition is purely political. But that political opposition concretely impacts the lives, health and bank accounts of thousands of Oklahomans.