POSTED ON JUNE 26, 2013:
Program focuses on healthcare for working adults
To David Blatt, an advocate for expanding Medicaid in Oklahoma, Insure Oklahoma just doesn't measure up.
"We had this program, people liked it. But it was always limited to 30,000 people, 35,000 people," said Blatt, director of the Oklahoma Policy Institute. In contrast, "the Affordable Care Act provides a much more comprehensive and universal approach to the problems of low-income uninsured," he said.
Most accounts estimate that 180,000 Oklahomans could receive coverage should the state agree to Medicaid expansion.
But Blatt doesn't have the authority of Gov. Mary Fallin, who appears to be steadfast in her resolve to not have Oklahoma take part. Instead, the state is awaiting a full report from a consultant, Leavitt Partners, before deciding how exactly to move forward.
Early reports indicate that the consultant group seeks to save Insure Oklahoma, a program that could potentially be eliminated or have features that may play an even bigger role in the way the state approaches health care coverage options for those without insurance.
Already, Insure Oklahoma has undergone some pretty substantial changes since it formally launched in November 2005. It's dependent on private, federal and state funding, with the state public funds in place after voters in 2004 approved a reworking of the way Oklahoma taxes cigarettes.
The Insure Oklahoma plan took its shape through the findings of a legislative task force, said Carter Kimble, a spokesman for the Oklahoma Health Care Authority.
"They actually came to find out that a large portion of people without insurance in Oklahoma were working and were just low-wage employees, and predominately in small businesses," Kimble said.
The program's initial intent "was to kind of bridge the gap for those small businesses who couldn't afford to offer coverage to their low-wage, low-income employees," Kimble said.
That remains a key focus of the program. According to the authority's latest statistics, 941 businesses in Tulsa County take part in Insure Oklahoma.
The state looks at household income to judge employee eligibility. According to the latest statistics, 2,367 people receive subsidized health care coverage through their employer in Tulsa County. Kimble said the state does not disclose the name of individual businesses participating in the program.
The coverage isn't free for anyone. "The idea is that the employer pays 25 percent of the premium, the employee pays 15 percent, and then the health care authority pays the remaining 60 percent," Kimble said.
The household income cap currently is 200 percent of the federal poverty level, but that wasn't always the case. Adjusting the cap upward is one of several substantive changes that have already taken place with Insure Oklahoma.
Kimble said one major component of the plan -- allowing individuals to take part independently of their employer -- simply took time to get off the ground, with individuals allowed to buy their way in starting in 2007.
"Essentially, those who were self-employed or employed individually, whose employer didn't want to participate, could still access the small group health plan," Kimble said.
Notably, people in this group don't pay a market-based premium, but rather make a payment to the state and receive services identical to SoonerCare, the state's name for Medicaid coverage. The same income cap applies.
"And then, in 2009, we expanded the individual plan to full-time Oklahoma college students," Kimble said. In 2010, coverage was expanded to dependent children of adults receiving Insure Oklahoma coverage. In Tulsa County, 1,865 people receive coverage through an individual plan.
Despite the expansion, the state has remained below its capped enrollment numbers. Now, in part because the program has a cap, federal regulators have stated they don't plan to continue funding Insure Oklahoma.
Blatt, the advocate for Medicaid expansion, said Insure Oklahoma is "redundant" when considered alongside Medicaid expansion, which would have a lower income threshold, 138 percent of the federal poverty level.
However, Blatt noted that the Affordable Care Act includes a provision to establish insurance exchanges envisioned as a way for many to purchase health insurance on their own. Many -- though not all -- of those receiving coverage through Insure Oklahoma could get insurance through this exchange, he said.
Of course, Fallin disagrees that Insure Oklahoma is no longer relevant. She has pleaded publicly to have the federal funding component of Insure Oklahoma continue.
Blatt was reticent to handicap the odds that some sort of compromise could be worked out. "What the federal government has said is, 'Look, we'll talk to you,'" Blatt said. But he emphasized that a program like Insure Oklahoma not only doesn't cover as many people as Medicaid expansion would, but it also costs the state more money, as the federal government has said they plan to pay most of the costs of Medicaid expansion.
The Tulsa Regional Chamber, as part of its OneVoice agenda, earlier lobbied for Medicaid expansion, as have many in the health care field.
It's not a complete mystery what the Leavitt Partners will recommend. According to published reports, statements made in a preliminary briefing by the consultants indicate that they will recommend a plan with many features similar to Insure Oklahoma.
Many in Oklahoma are anxiously waiting to hear the details of what sort of alternate effort might be feasible.
In May, the Tulsa chamber and other businesses groups released a statement outlining the urgency of the situation: "We must find a way to reduce Oklahoma's high rates of uninsured. Without a creative solution, thousands of hard-working Oklahomans will be without health care, and Oklahoma's businesses and families will continue to face rising premium costs resulting from cost-shifting."
Mike Neal, president and chief executive officer of the Tulsa Regional Chamber, continued: "In order for our state and the business community to remain competitive, we must craft an Oklahoma plan. Or, we risk not only losing a proven program in Insure Oklahoma, but also further burdening our state's economy."
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