Oklahoma Legislature considering ACA waiver program (News OK)

By Dale Denwalt

Oklahoma is preparing to subsidize its own health insurance program to replace the Affordable Care Act marketplace.

The plan has been formulated for months as a waiver that will be submitted to the federal government.

Federal law allows states to develop an “innovation waiver” to provide residents with health insurance. Once adopted, the government could waive Oklahoma’s participation in parts of the ACA.

The bill is the next step in the process. Oklahoma Policy Institute Analyst Carly Putnam said the waiver is expected to be submitted to the Centers for Medicare and Medicaid Services this year.

House Bill 2406, which the Senate Joint Committee on Appropriations and Budget adopted Tuesday, follows the release of a recommendation paper issued by Oklahoma Health and Human Services Secretary Terry Cline.

“The concept paper that we have so far is more of a broad set of proposals. It’s a menu of options for the state to pick from,” Putnam said.

A nonprofit, state-created entity would manage the insurance program, and the Insurance Commissioner would provide administrative support. Deputy Health Secretary Julie Cox-Kain said in committee that the waiver and the bill are needed to stabilize Oklahoma’s individual insurance market.

In 2017, only one insurance carrier offered individual health insurance plans in Oklahoma, and the premium rate jumped 75 percent. A year earlier, just 31 percent of eligible Oklahomans enrolled in the individual market, according to the Henry J. Kaiser Family Foundation.

To improve those numbers, Cox-Kain said, Oklahoma would either create high-risk pools or establish reinsurance for those health insurance plans, which is a way for an insurer to mitigate risk if hospital expenses get too high.

“This is to prevent, or keep from having dramatically increasing premiums that we see today in the insurance marketplace,” said Cox-Kain.

The entity created in House Bill 2406 would determine which type of program to use for risk mitigation. Putnam said her think tank is concerned about high risk pools, but noted that reinsurance has shown success in other states.

She said that Oklahoma seems to be cooperating with the ACA, which is also known as Obamacare, after years of resisting it.

“The interesting thing is that this is really the first time the state has shown significant interest in engaging with the Affordable Care Act. That’s a positive development from our perspective,” Putnam said. “States that have been more active in working with the ACA from the beginning haven’t had the same level of problems that we’ve had.”

She said that it will be hard to estimate how successful Oklahoma’s waiver will be, if implemented, because there aren’t many details about how the program would look.

“It may result in more people having coverage than do now,” she said. “It’s not clear that more people would have coverage than would if the state would have fully bought in from the beginning.”

If the bill passes and is signed into law, Cox-Kain said the waiver will be written this summer and she expects the federal government to approve it by 2018.



Margaret (Maggie) den Harder obtained a Bachelor of Arts in Christian Theology from Seattle Pacific University and a Master of Public Administration from the University of Oklahoma. Originally from the Pacific Northwest area of Washington state, Maggie has called Tulsa home for the past 8 years. Since living in Tulsa, Maggie has worked in the legal field, higher education administration, and the nonprofit sector as well as actively volunteering in the community. Maggie also recently spent time at the City of Tulsa as a consultant and wrote the content for Resilient Tulsa, an action-oriented strategy designed to better equity in Tulsa. Through her work, community involvement, and personal experiences, Maggie is interested in the intersection of the law and mental health and addiction treatment issues, preventative and diversion programs, and maternal mental health, particularly post-partum depression and post-partum psychosis. While working at Oklahoma Policy Institute as a research intern, Maggie further developed an interest in family dynamics and stability, economic security-related stress, and intergenerational trauma.

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