State health care plan is in the works
BY WAYNE GREENE World Senior Writer
Sunday, January 13, 2013
1/13/13 at 7:39 AM
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The Fallin administration is working on a broad new approach to public health care - the "Oklahoma Plan" - designed to use federal and state funding to make Oklahomans healthier.
The plan, currently being developed by state Health Secretary Terry Cline with no specific roll-out date, would be, in part, the state's response to the Obama administration's Affordable Care Act and would rely on permission from the U.S. Department of Health and Human Services to use federal health-care funding in new ways.
Unlike the Affordable Care Act - which is largely centered on solving problems of how people pay for medical treatment - the Oklahoma plan would take a more wholistic approach, potentially looking at ways to remodel how the health system operates and how people behave, Cline said.
"There are several different tools that you can use to actually improve health," Cline said. "The question would be: How do you actually prioritize and strategically reach those objectives and goals?"
The key to the plan would be a Medicaid waiver or waivers - permission from federal officials to use funding differently.
Waivers are so common in state Medicaid programs that the common joke among health bureaucrats is: "When you've seen one state Medicaid system, you've seen one Medicaid system," but the Affordable Care Act comes with pages of new congressional mandates on how federal money will be used.
Cline said the law doesn't rule out new ideas.
"Some people are under the misconception that now, all of sudden, every state is going to look alike," Cline said. "That's not true."
There is strong evidence that Oklahoma's most prominent Medicaid waiver - the Insure Oklahoma program - won't survive 2014's full implementation of the Affordable Care Act.
Insure Oklahoma uses federal Medicaid funding, state tobacco tax revenue, contributions from small employers and their workers to fund private health insurance for low-income people, but federal officials have made it clear they don't intend to continue that sort of waiver once Affordable Care Act-mandated health insurance exchanges go into effect Jan. 1, 2014.
A little more than 22,000 of the 30,700 Insure Oklahoma clients will be eligible for private insurance with heavy federal subsidies through an exchange, according to Oklahoma Health Care Authority statistics.
But about 155,000 people who are too poor to qualify for exchange participation will be left out of Affordable Care Act coverage because Gov. Mary Fallin rejected expanded Medicaid funding under the law, leading to speculation that Fallin might be looking for a way to redirect the Insure Oklahoma program to deal with some of the state's poorest citizens.
But Cline said the Oklahoma Plan would take a different approach to health-care issues and break the singular concentration on paying for health care.
Academic studies have shown that about 10 percent of overall health in the U.S. is determined by access to health care, Cline said.
By contrast, 40 percent is attributable to behaviors. That brings issues such as smoking and obesity, which are prevalent in Oklahoma, into the equation.
"I'm not downplaying that 10 percent. That needs to be there. It is critical," Cline said. "But when we're talking about putting billions of dollars into our state every single year ... the question then becomes: Are we being strategic with the utilization of those dollars as we should be? I say no."
A recent state-by-state ranking of America's health puts Oklahoma 43rd in the nation in the wellness of its residents. The state ranked 49th in a similar survey in 2009.
Last week, Fallin spoke at the National Press Club in Washington on behalf of the National Governors Association, and she used part of that presentation to emphasize the need for more flexibility in how states can use Medicaid funding.
"We believe that the states have a great deal of potential to change the delivery of health care and Medicaid, and that our states are the vehicle for that coming change," Fallin said in her speech.
She called on the Obama administration to look at Medicaid waiver requests with open minds and to act quickly on innovative ideas.
While Fallin made an extended reference to the success of the Insure Oklahoma program in her speech, Cline said she wasn't pushing for a continuation of that model as much as she was advocating that the administration allow similar levels of flexibility in future programs.
"States will continue to look different," Cline said. "What the governor's pushing for is to allow us to continue to have the flexibility to make informed decisions for our own population."
Legislators file bills to nullify Obamacare
Two Broken Arrow legislators have filed bills to nullify the provisions of the Affordable Care Act in Oklahoma.
"Depriving citizens of the right to make their own choices about health care runs contrary to American ideals," said Sen. Nathan Dahm, R-Broken Arrow.
"If we want a health-care system that is innovative, efficient, and controls costs, we need to allow the free market to work," he said. "Health care is not a right, it is an enterprise, and it works best with fewer market distortions and the incentive to improve the services it offers customers."
Rep. Mike Ritze, R-Broken Arrow, said the federal health-care law is unwelcome in Oklahoma.
"Oklahomans have clearly indicated that they would prefer a different approach to health care than the federal law offers," Ritze said. "I think we have the tools to improve the health-care system in Oklahoma without involvement from the federal government."
Original Print Headline: State health plan in the works
Wayne Greene 918-581-8308
Terry Cline: "What the governor is advocating for ... is to have the flexibility to make informed decisions for our own population."