Gov. Fallin looks at options to reduce uninsured Oklahomans
BY WAYNE GREENE World Senior Writer
Tuesday, December 18, 2012
12/18/12 at 9:22 AM
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OKLAHOMA CITY - Gov. Mary Fallin wants an Oklahoma solution to reducing the number of uninsured Oklahomans, but it's unclear what options the state has available.
Look for Fallin to outline principles for an "Oklahoma option" to deal with the issue, possibly including an expansion of the Insure Oklahoma plan in the coming months.
Other elements of that plan could include a new design to give doctors and hospitals incentives for healthy outcomes instead of the traditional fee-for-service format, and financial incentive to push patients to invest in their own health, state Health Commissioner Terry Cline said.
But with key elements of a program already ruled out by federal health officials, Fallin's options seem limited.
One impact of Fallin's decision not to accept federal Medicaid funding under the Affordable Care Act is the creation of a "coverage crater," Oklahomans who don't earn enough money to qualify to purchase insurance through a health insurance exchange but aren't categorically qualified for Medicaid.
Based on 2011 U.S. Census Bureau data, the Oklahoma Health Care Authority estimates there are 155,306 uninsured Oklahomans below the federal poverty level. That makes them too poor to participate in an exchange while they remain categorically ineligible for Medicaid.
If Fallin had accepted Medicaid expansion any Oklahoma household up to 133 percent of the federal poverty level - currently $30,657 for a family of four - would have been eligible for Medicaid coverage with the federal government picking up 100 percent of the cost of the new benefits for the first three years.
Nico Gomez, spokesman for the Oklahoma Health Care Authority, said he is optimistic about the opportunities to deal with the issue, but it won't be without difficulties.
Federal officials have indicated they are not interested in continuing Medicaid partnerships like the Insure Oklahoma program, which mixes federal Medicaid funding, state tobacco tax money, employer contributions and individual payments to fund private insurance purchases. Instead, it is pushing states to expand Medicaid eligibility, but Gomez holds out hope for some third option, perhaps one that hasn't even been discussed yet.
"I'm going to remain optimistic," Gomez said. "I understand the federal government has given us some bad news in terms of long-term federal funding for Insure Oklahoma, but it doesn't prevent us from coming up with some kind of innovative way to either renegotiate a future waiver or come up with some other options that no one's thought of right now."
Cline said he also remains optimistic for the hopes of an Oklahoma option, despite "mixed messages" from the federal government.
"We need to - and the governor's in absolute agreement we want to - have more people insured," Cline said. "Then she would go on to say we want to ensure that more people have access to quality health care and we want to make sure we have our incentives in the system lined up in the right places to produce a healthier population.
"Just growing the existing system misses several of those fundamental concerns with our current 'sick care' system," he said.
About Insure Oklahoma
Insure Oklahoma combines federal Medicaid funding, state tobacco tax money, employer contributions and individual payments to fund health insurance purchases for Oklahomans who earn up to 200 percent of the federal poverty level.
Currently, 15,369 people are in the employer-sponsored program and another 13,875 are in the individual program.
Some 8,583 Insure Oklahoma participants are below 100 percent of the federal poverty level.
The average monthly cost is nearly $2.7 million for individuals below the federal poverty level. For the 21,392 Insure Oklahoma clients who are above the federal poverty level, the monthly cost is $6.7 million.
The federal government has indicated it isn't interested in continuing to participate in programs like Insure Oklahoma, preferring to push states to expand Medicaid coverage under the Affordable Care Act.
Original Print Headline: Fallin looks at options to reduce uninsured
Wayne Greene 918-581-8308
Gov. Mary Fallin