With Many Uninsured, State Pushes Insure Oklahoma Plan

By Warren Vieth, Oklahoma Watch

The social media blitz started in late July. The radio and TV spots showed up in mid-August, along with six billboards placed along key interstate highways. A sleeker website will be unveiled soon.

The message: Insure Oklahoma is still open for business, and ready to grow.

The $450,000 marketing campaign comes after five years of steady shrinkage in the 10-year-old, tax-supported health insurance program for Oklahoma’s working poor.

In a state that refused to accept federal money to expand Medicaid, some officials say Insure Oklahoma is the best available option to cover more of the uninsured.

The marketing campaign was launched to reverse a decline that began about the same time as congressional debate and enactment of the Affordable Care Act in 2010.

“That was a game-changer,” said Nico Gomez, CEO of the Oklahoma Health Care Authority.

 “There were a lot of court cases, there were a lot of changes, just a tremendous amount of chaos in the health care market.”

Businesses became wary of staying in or signing up for a state program that kept being extended a year at a time, while state and federal officials were in a political standoff over health care policy, he said. Even today, Insure Oklahoma is operating under an extension that will expire at the end of next year.

“They (businesses) did not want to get involved in a program and provide a benefit to their employees that they would then have to take away,” Gomez said.

The number of small businesses participating in the program has fallen by 35 percent over five, years, from 5,632 to 3,639. The number of people covered has dropped by 47 percent over a four-year period,  from 32,735 to 17,327.

About 7,000 people dropped off the rolls on Jan. 1, 2014, when the state lowered the income limit for individuals who can receive subsidized coverage through Insure Oklahoma. But that accounted for less than half of the total shrinkage, data shows.

The Health Care Authority, which administers the program, essentially shut down its marketing and recruitment efforts when the Affordable Care Act was passed in 2010. Gomez said he decided to crank it back up this year because he’s convinced Insure Oklahoma is the most viable platform to expand health care coverage in the state.

Such an expansion faces challenges.

Among them is an unresolved impasse between Gov. Mary Fallin’s office and the Obama administration over Oklahoma’s refusal to go along with a proposed expansion of the state’s Medicaid program, called SoonerCare.

“There are federal dollars available to expand Medicaid. Our state is not interested in doing that,” said Craig Jones, president of the Oklahoma Hospital Association.

“We keep talking about Oklahoma wanting its own plan,” Jones said. “Oklahoma has its own plan. It’s called Insure Oklahoma. But it’s only benefiting 17,000 people right now.”

In its current form, Insure Oklahoma provides subsidized health insurance to working people earning as much as 200 percent of the federal poverty level. Those who receive policies through participating employers pay 15 percent of the premium cost. The employer pays 25 percent, the state pays 23 percent and the federal government covers the remaining 37 percent.

The program is open to employees of businesses with fewer than 100 workers as well as some self-employed people, disabled people and students. Unemployed people can qualify under some circumstances.

The latest headcount, for July 2015, includes 13,165 workers, spouses, students and other dependents enrolled in the employer-sponsored plan, and 4,162 people enrolled in the individual plan.

The state’s contribution comes entirely from tobacco tax revenue. Because that funding pool is limited, Insure Oklahoma could accommodate no more than about 35,000 people, or about double the current number, before it ran out of state money.

It’s not clear how long the federal government might continue offering one-year extensions of Insure Oklahoma. The latest one will expire Dec. 31, 2016. A new president will take office in early 2017, and the Affordable Care Act might undergo significant changes at the hands of Congress.

But it’s only a fraction of Oklahoma’s low-income uninsured population.  About 104,000 Oklahomans are in a “coverage crater” caused by Oklahoma’s rejection of the Obama administration’s Medicaid expansion proposal, according to recent estimates by the Henry J. Kaiser Family Foundation.

The Oklahoma Hospital Association estimates that as many as 200,000 Oklahomans could obtain health coverage if Insure Oklahoma were expanded. That would require passing legislation to broaden eligibility criteria and striking a deal with the federal government to use funds originally intended for Medicaid expansion.

Teresa Meinders Burkett, a Tulsa health care attorney who is encouraging state officials to strike such a bargain, says the state is losing about $2 million a day by rejecting federal funds available for Medicaid expansion, including state-based alternatives.

Burkett noted that the state of Arkansas obtained federal approval to use Medicaid expansion money to finance a state-operated program that is similar in many respects to Insure Oklahoma.

“Insure Oklahoma is popular,” Burkett said. Working within its framework might be the best way to expand health coverage in Oklahoma, she said. “I think everybody knows really that this is good for Oklahoma.”

In her January 2013 state of the state address, Fallin promised to develop an "Oklahoma Plan" to address the state's health issues, including improved access to "quality and affordable health care."

Later in 2013, a private consulting firm hired by the state recommended that Oklahoma develop an alternative to Medicaid expansion, using Insure Oklahoma as the platform. The plan proposed by Leavitt Partners was not adopted.

The governor's office said in a statement Thursday that an expansion of Insure Oklahoma was something the Legislature could consider in 2016.

"Insure Oklahoma has been successful in its present form, and Gov. Fallin’s administration continues to work with federal officials to make the program permanent," said Alex Weintz, the governor's spokesman. "Gov. Fallin believes Insure Oklahomans the kind of state-based health care option the federal government should be supporting."

State Rep. Doug Cox, R-Grove, chairman of the Conference Committee on Public Health, said discussions are under way that could lead to an expansion of Insure Oklahoma.

“I think it’s a good idea,” Cox said. “They have to make it more politically acceptable than just a straight Medicaid expansion. That’s why the public-private partnership that involves Insure Oklahoma, which has worked so well, might be feasible.”

Hospital Association President Jones said his organization sees Insure Oklahoma as the the best bet to expand access to affordable health care for uninsured Oklahomans.

“ ’Obamacare’ … is just a toxic term in the current political environment,” Jones said.

“This is not Obamacare. It is within the framework of what the Affordable Care Act outlined. But really, what we’re doing is taking available dollars through that plan and applying them as Oklahoma wants to apply them. No different than what we’re doing with roads, no different than what we’re doing with education.”

Oklahoma Watch is a nonprofit, nonpartisan media organization that produces in-depth and investigative content on a range of public-policy issues in the state. For more Oklahoma Watch content, go to www.oklahomawatch.org.