Oklahoma has options to insure our people. Here’s how.

When justifying their opposition to the Affordable Care Act’s provisions to extend health coverage to the uninsured, Oklahoma leaders often cite a preference for a state-specific solution. For example, Governor Mary Fallin promised an “Oklahoma plan” to address the large number of uninsured citizens in the coverage crater. And State Insurance Commissioner John Doak called for “state-based regulation that gives consumers options and the freedom to make the choices that best suit their families’ needs.”

Despite this rhetoric, state leaders have gone all out to obstruct the Affordable Care Act’s efforts to expand coverage. Simultaneously, they’ve refused to take advantage of the flexibility that the federal government has granted to other states.

 Of the 28 states that have accepted federal funds to expand health coverage, four have negotiated with the federal government for a waiver to use the funds in innovative, creative ways that are specific to their own state’s needs. A few more, like New Hampshire and Indiana, are negotiating such plans for their states. They have done exactly what Governor Fallin and Commissioner Doak claim is needed.

Here’s what they did:

Arkansas: The Health Care Independence Program (“The Private Option”)

Arkansas is frequently considered the poster child for state control over use of federal funds in expanding health coverage. It used the federal Medicaid funds to enroll eligible residents with incomes below 138 percent of the poverty level ($27,310 for a family of three) in private health plans. Because it delivers services through private plans instead of the traditional Medicaid system for all but the most medically frail populations, the Arkansas plan is frequently referred to as “the private option.”

Michigan: The Healthy Michigan Plan

The “Healthy Michigan Plan” builds on Michigan’s previously-existing Medicaid managed care system by enrolling adults  in managed care. Those between 100 and 138 percent of the federal poverty level ($19,790 – $27,310 for a family of three) are required to pay premiums that total 2 percent of their incomes. This amount can be reduced if payers take steps to improve their health, such as exercising and eating well.

Iowa: The Iowa Health and Wellness Plan

Iowa used two waivers to expand health coverage. The first uses premium assistance to help adults between 100 and 138 percent of poverty pay for Marketplace coverage (recall that in expansion states, Marketplace subsidies are typically only accessible to those at 138 percent of poverty and above). The second places adults below 100 percent of poverty on Iowa’s newly expanded managed care plan. Individuals with incomes between 50 and 138 percent of poverty may be subject to monthly premiums but, as with the Michigan plan, those obligations can be reduced if they participate in wellness activities.

Pennsylvania: Healthy PA

Although Pennsylvania initially pushed for moving its eligible population onto private health insurance plans as in Arkansas, the state ultimately got approval to enroll them in private Medicaid managed care plans instead. Beneficiaries above 100 percent of poverty are charged a premium equivalent to 2 percent of their annual income; they lose coverage if they go 90 days without making a payment. (They can then re-enroll outside of the standard open enrollment period). Like Iowa and Michigan, Pennsylvania allows beneficiaries to lower their premiums through healthy lifestyles.

Oklahoma: Insure Oklahoma?

Medicaid managed care, which has been the centerpiece of expansion plans in Pennsylvania, Iowa and Michigan, may not be an ideal model for Oklahoma, which had an earlier failed experiment with serving Medicaid patients through HMOs. However, we already have the strong public-private partnership model Arkansas had to build from scratch: Insure Oklahoma, which uses a combination of state, federal and private dollars to insure about 18,500 low-income Oklahomans.

The Leavitt Report, which was commissioned by Gov. Fallin, recommended using Insure Oklahoma to expand health coverage. Between 100 percent and 90 percent of the costs would be covered by federal dollars – much more than the current 62.3 percent. And it would provide 150,000 Oklahomans with the health care coverage they need.

The bottom line

Oklahoma has a huge opportunity to work with the federal government to expand health coverage, and save the state money to boot. Oklahomans deserve constructive solutions, not blanket obstruction. State leaders have the leverage to craft a plan that works for Oklahoma and improves the economic security and well-being of tens of thousands of Oklahomans. They only have to use it.