Results on the first year of Obamacare are in. What’s it look like for Oklahoma?

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Image by Will O’Neill used under a Creative Commons license

The Affordable Care Act’s first open enrollment period, when eligible Americans could compare and purchase health insurance on the online marketplaces, was a bit of a roller coaster. But despite considerable hiccups with the launch of in October, eight million people had signed up nationwide when enrollment closed on March 31st, a number that exceeded earlier estimates. The nationwide uninsured rate has dropped precipitously thanks to the marketplaces and to expansions of Medicaid coverage in states that accepted federal funds. And those with new health insurance coverage report being pleased with it.

However, much of the ACA’s positive benefits in Oklahoma have been muted by the state government’s obstruction of the law, especially by its refusal to accept federal funds and expand coverage. Here’s what’s happening.

The picture at the national level is broadly optimistic. The nationwide uninsured rate has dropped from 20 percent (July-September 2013) to 15 percent (April-June 2014). Three in five adults who purchased insurance on the exchange and two in three newly covered by Medicaid were previously uninsured. The uninsured rate for Americans ages 19 to 34 fell from 28 percent to 18 percent over the same time period, which was responsible for more than half of the decline of the overall uninsured rate. The uninsured rate among Latinos fell from 36 percent to 23 percent – the single largest decline among measured races and ethnicities.

Furthermore, enrollees are positive about their new insurance. Overall, four in five of those polled, including Republicans, reported feeling “somewhat optimistic” or “very optimistic” that their new insurance would help them get the health care they need. And a majority of those polled said they were “better off” with new insurance. Of the three in five adults who had used their plan prior to the poll, sixty percent said they would have been unable to access needed care without it. And most were able to locate a doctor and be seen quickly.

In Oklahoma, the picture is less rosy. Out of 446,000 eligible enrollees, 69,221 Oklahomans signed up on the marketplace. In other words, just fifteen percent of those eligible enrolled for marketplace coverage – the seventh-lowest enrollment of all fifty states and Washington DC. This is disappointing, but perhaps not surprising: Oklahoma was one of five states where the state government declined to play any role in implementing key provisions of the ACA. Misinformation from key elected officials probably hasn’t helped.

Of Oklahomans who purchased health insurance on the marketplace, 79 percent – some 55,000 – received financial assistance in the form of tax credits. But several lawsuits – including one filed by Oklahoma Attorney General Scott Pruitt – argue that the tax credits are illegal in states that elected not to build their own online health insurance marketplaces, including Oklahoma. Were the lawsuits to be successful, tens of thousands of newly-insured Oklahomans would lose the subsidies integral to making their health insurance affordable. 

Oklahoma did see a substantial ‘woodwork effect,’ a term used to describe increased Medicaid enrollment by people who were already eligible but hadn’t previously signed up. Some 38,278 Oklahomans enrolled in Medicaid and CHIP between October 1 and March 31 – an increase of nearly five percent. Only six other states saw higher woodwork effects.

Many Oklahomans now have access to affordable, quality health care, but there’s still considerable progress to be made. Organizers are confident that increased awareness around the Affordable Care Act and its successes will mean an uptick in marketplace enrollment during the next open enrollment period. However, increased marketplace enrollment won’t help the low-income Oklahomans left out by the state’s refusal to accept federal funds and expand coverage.

Right now, about 148,000 Oklahomans earn below 100 percent of the federal poverty level ($19,790 for a family of three) but are still ineligible for Medicaid and don’t have access to affordable health insurance. The Council of Economic Advisors estimates that, had Oklahoma accepted federal Medicaid expansion funds in 2014, 123,000 additional Oklahomans would have insurance coverage in 2016. The state would have seen an infusion of an additional $520 million of federal funds into the state in 2014 alone ($1,650 million by 2016). Over ten years, Oklahoma will see a massive tax transfer out of state if it doesn’t accept the funds, as our tax dollars pay for health care in Arkansas, Kentucky and other states – but not Oklahoma.

Instead, Oklahoma’s Medicaid program is facing a budget shortfall. In the last month, Oklahoma Health Care Authority slashed reimbursements for health care providers and hiked copayments for Medicaid recipients to the federal maximum

The Affordable Care Act has been a net positive, both in the US and Oklahoma. But if the state leaders would stop obstructing its benefits, the gains would be even stronger.

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Carly Putnam joined OK Policy in 2013. As Policy Director, she supervises policy research and strategy. She previously worked as an OK Policy intern, and she was OK Policy's health care policy analyst through July 2020. She graduated from the University of Tulsa in 2013. As a student, she was a participant in the National Education for Women (N.E.W.) Leadership Institute and interned with Planned Parenthood. Carly is a graduate of the Oklahoma Center for Nonprofits Nonprofit Management Certification; the Oklahoma Developmental Disabilities Council’s Partners in Policymaking; The Mine, a social entrepreneurship fellowship in Tulsa; and Leadership Tulsa Class 62. She currently serves on the boards of Restore Hope Ministries and The Arc of Oklahoma. In her free time, she enjoys reading, cooking, and doing battle with her hundred year-old house.

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