More than 693,000 Oklahomans - 18.7 percent of the state population - do not have health insurance, according to figures released last week by the U.S. Census Bureau.
In Tulsa, the portion of the population without health coverage is even higher - 22.8 percent - according to the American Community Survey.
The figures represent estimates for 2011, before most of the significant changes of the federal Affordable Care Act went into effect, meaning they represent more of a diagnosis of the state's situation than an update on change.
It probably won't surprise anyone that the distribution of health coverage across demographic groups is uneven in the state.
Whites, native-born citizens, the well-educated and the wealthy had considerably higher insurance rates than other Oklahomans, but the degree of the discrepancies may raise some eyebrows.
A Hispanic Oklahoman is more than twice as likely to lack insurance as a white Oklahoman, the study shows. Well over a third of the state's Hispanic population is uninsured.
That number goes even higher - 61.3 percent - among the state's foreign-born, noncitizen population, a demographic dominated by undocumented immigrants, who are specifically excluded from coverage under the Affordable Care Act.
Working-age Oklahomans are far more likely not to have insurance coverage than children or seniors, the survey shows.
Some 26 percent of Oklahomans ages 18-64 don't have insurance, compared to 10.6 percent of those younger than age 19 and 0.6 percent of those older than 64.
The figures are significant as the state considers one pending change that comes with the Affordable Care Act, the offer by the federal government to largely underwrite a major expansion of the Medicaid program.
Currently, the vast majority of Oklahoma Medicaid recipients are children or older adults, who also are largely covered by Medicare.
Under the federal law, Oklahoma can expand coverage to cover adults in households that earn up to 133 percent of the federal poverty level - which currently would be $30,657 for a family of four. The federal government would cover 100 percent of the cost of the newly enrolled Medicaid patients for the first three years.
After that, the state share would increase, capping at 10 percent in 2020.
State officials estimate that the offered expansion would increase Oklahoma Medicaid rolls by about 200,000 and another 50,000 people who were already eligible would also sign up.
Medicaid enrollment of 250,000 people would have reduced the portion of the state population without insurance to less than 12 percent.
Gov. Mary Fallin hasn't announced whether she thinks Oklahoma should pursue the Medicaid expansion.
The study does offer feedback on one element of the Affordable Care Act that was largely in place in 2011 - a requirement that insurance companies allow parents to carry their adult children on their insurance plans to age 26.
The law's change didn't mandate that parents cover their children, but mandated that insurance companies offer the insurance.
From 2009 to 2011, the number of insured Oklahomans age 19-24 went up from 61.7 percent to 64.9 percent. That figure includes private and public insurance, such as Medicaid. The number of young adults on private insurance plans went from 54.2 percent to 56.5 percent. The Census Bureau said both changes were statistically significant.
Nationally, the young adult population insurance rate went from 68.3 percent in 2009 to 71.8 percent in 2011, a statistically significant increase. The number of young adults on private insurance also rose nationally by nearly 3 percentage points, a significant increase, the bureau reported.
Dr. Gerard Clancy, president of the University of Oklahoma-Tulsa and a health policy expert, said the impact of the Affordable Care Act can't be judged on the basis of 2011 statistics because the most important parts of the law, including the individual mandate and the tax on employers who don't provide qualifying health care to their workers, don't go into effect until 2014.
The statistics on who does and doesn't have insurance correspond with the experiences of OU physicians treating indigent Tulsans, he said.
The number of Oklahomans who don't have insurance should be an important issue to Oklahomans who have insurance because the uninsured will still get sick, but they are more likely to delay treatment for their conditions until the situation is urgent and then seek care in the most expensive location available - the emergency room.
That will slow medical services to insured Oklahomans waiting in emergency rooms and result in unpaid hospital bills being passed along to the insured in the form of higher hospital charges and higher insurance premiums, he said.
Clancy said extending insurance to more Oklahomans will make the state's population healthier eventually, but immediately it will result in an increase in disease statistics as poor people with insurance for the first time bring more medical problems to physicians.
"You have to take a long-term view," Clancy said.
Oklahomans without health insurance in 2011
| Total population |
18.7 percent |
| Under 18 |
10.6 percent |
| 18-64 |
26.0 percent |
| 65 and older |
0.6 percent |
| White |
16.2 percent |
| Black |
20.7 percent |
| Hispanic |
37.6 percent |
| Native-born citizens |
17 percent |
| Foreign-born, naturalized |
20.5 percent |
| Foreign-born, noncitizen |
61.3 percent |
| Adults with less than high school education |
34.9 percent |
| Adults, bachelor's degree or higher |
6.8 percent |
| Employed |
21.1 percent |
| Unemployed |
58.9 percent |
| Household income less than $25,000 |
28.8 percent |
| Household income $100,000 or more |
7.2 percent |
Source: American Community Study, U.S. Census Bureau 2012
Wayne Greene 918-581-8308
wayne.greene@tulsaworld.com
Original Print Headline: No health insurance for 693,000 in Oklahoma
