State leadership made waves in January when both Gov. Kevin Stitt and Senate President Pro Tem Greg Treat suggested that they were in favor of accepting federal dollars to expand access to health coverage in Oklahoma. Although Gov. Stitt later walked his comments back, many legislators have said that they’re nonetheless still committed to some form of expansion. When a preliminary expansion bill, SB 605, cleared the Senate Retirement and Insurance Committee with unanimous support in February, it was the first time in Oklahoma that any coverage expansion bill had been heard in committee, let alone passed. That bill didn’t advance in time for the next legislative deadline, but lawmakers may yet craft and release an expansion plan later this session.
In any case, it’s been a few years since coverage expansion has been seriously entertained by state leadership, and both the state and federal landscape has shifted significantly in the meantime. Here’s a refresher of who should be covered. We’ll discuss how that could be done in a later post.
More than 100,000 Oklahomans are currently uninsured because Oklahoma didn’t expand coverage
When the Affordable Care Act (ACA) was originally drafted, it was with the intent that nearly all low- and moderate-income Americans would have some form of access to health coverage. Federal premium subsidies and cost-sharing protections would make comprehensive care available for people above the poverty line ($12,490 for a single person). To cover people below the poverty level, the federal government offered states huge infusions of new federal dollars to expand their Medicaid programs.
That’s not what happened. In 2012, the US Supreme Court made Medicaid expansion optional for states, and the result has been a patchwork of health coverage across the US. To date, 37 states, including Washington, D.C., have expanded access to care. Fourteen, including Oklahoma, haven’t. As a result, many low-income residents of those 14 states don’t have health care, even though their counterparts in the rest of the country do.
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In Oklahoma, this means that more than 100,000 working-age adults are uninsured because the state hasn’t yet expanded access to care. People in this “coverage crater” typically don’t have access to other forms of health insurance:
- SoonerCare, Oklahoma’s Medicaid program, only covers parents if they are very low-income (earning under $8,000 per year for a single parent with one child);
- SoonerCare doesn’t cover childless, working-age adults without significant disabilities at all;
- Premium subsidies for coverage on Healthcare.gov aren’t available to people below the federal poverty level;
- Employer-sponsored coverage is rarely an option for people in poverty. Just 1 in 5 Oklahoma working-age adults in poverty gets their health coverage through an employer, compared to 45 percent of the state’s general population who have employer-sponsored health insurance.
- Insure Oklahoma, a small program that uses a combination of state and federal dollars to subsidize private coverage for some low-income individuals, isn’t readily available to many people. Both the employer-sponsored plans and individual plans generally only cover people who work for businesses with 250 or fewer employees or meet similar restrictions.
In short, most Oklahomans in the coverage crater don’t have options for health coverage outside emergency departments and charity clinics. But by accepting federal dollars to expand coverage for working-age adults up to 138 percent of the federal poverty level ($12,490 per year for a single person), Oklahoma could ensure that more than 100,000 people could get the care they need.
It’s not just people made newly eligible for health coverage through expansion who would benefit. Although between 111,000 and 153,000 currently uninsured Oklahomans would gain access to health care if the state were to expand coverage, those gains would include people who are currently eligible for SoonerCare or Marketplace coverage but not enrolled. In addition, some currently insured people would transfer from Marketplace or employer-sponsored insurance to the new expansion coverage. According to one estimate, 233,000 Oklahomans could be covered if the state expanded coverage. This so-called “welcome mat effect” would even help drive down Oklahoma’s child uninsured rate, which is among the nation’s highest, as newly eligible parents enroll themselves and their previously eligible children in health coverage.
We can fix this
Too many Oklahomans don’t have consistent access to quality health coverage, but it doesn’t have to be this way. Oklahoma can bring needed health coverage to the people who need it. And although most states have simply used their Medicaid programs to do so, Oklahoma doesn’t have to. Other states have created their own, albeit more complex, options. To date, a handful of states, including Arkansas, New Hampshire, and Iowa, have obtained federal permission to use federal expansion funds to subsidize private coverage for people in the coverage crater. This is the path Oklahoma is most likely to explore.
Ultimately, whatever plan Oklahoma develops needs to be one that’s designed to maximize access to care for the people who need it. More than 100,000 Oklahomans deserve a system that ensures that they can see a doctor, fill a prescription, and get treatment for chronic mental or physical illness. We’ll discuss how Oklahoma can do that in our next post.