Consultants to state: Expand current health plan instead of Medicaid

Oklahoma’s Republican leadership has repeatedly voiced that the state will not expand its Medicaid program, a key provision of the Affordable Care Act.

Health care experts Thursday recommended that the state take millions of dollars it would have received for Medicaid expansion and use the funds to expand Insure Oklahoma, an established health care program.

“This approach is using the enhanced federal funds, but we believe it is beneficial to Oklahoma because it does it in a way that allows Oklahoma to target and develop a program to meet the specific needs of its population, as well as the objectives of the state,” said Laura Summers, director of state intelligence at Leavitt Partners.

Whether the federal government would approve such a plan is yet to be determined.

The Insure Oklahoma program uses Medicaid and Oklahoma tobacco tax money to help about 30,000 people buy private insurance, but the federal government has denied a waiver that would allow the program to operate. The Insure Oklahoma program is set to expire Dec. 31.

At Thursday’s Oklahoma Health Care Authority meeting, Summers and two other health care experts from Leavitt outlined how changing who’s eligible to enroll in Insure Oklahoma would work.

Nico Gomez, the Oklahoma Health Care Authority CEO, said Insure Oklahoma is critically important to the health and economy of Oklahoma, and it will take time to assess how the state moves forward.

“The significance of the decisions that will be made should be given their due diligence,” he said in a statement. “I, as well as the staff of the Oklahoma Health Care Authority, look forward to working with state leadership in our effort to provide the citizens of Oklahoma access to quality, affordable health coverage.”

Insurance for most

Leavitt Partners, a Utah health care consulting firm, was hired in February to assess how Oklahoma can provide health insurance for more low-income residents at an affordable cost to the state.

In November, Gov. Mary Fallin announced Oklahoma would not expand its Medicaid program, a key provision in the Affordable Care Act, sometimes referred to as Obamacare.

If the state were to expand its program, as many as 200,000 Oklahoma residents would qualify for Medicaid. Fallin said the expansion would be unaffordable, costing the state up to $475 million through 2020.

Instead, she has proposed the state come up with the “Oklahoma Plan.” Leavitt’s presentation Thursday included details that could be a part of that plan.

To streamline the state’s current Medicaid system, Leavitt Partners also recommended that the Oklahoma Health Care Authority transition currently eligible Medicaid enrollees with incomes above 138 percent of the federal poverty level into buying commercial insurance through the federal health care exchange.

The Medicaid enrollees would use federal tax credits to purchase the commercial insurance. This change would transition an estimated 26,000 current Medicaid enrollees to exchange coverage.

Michael Deily, a senior adviser at Leavitt, said Oklahoma should “aggressively” move forward in pushing the federal government to allow the state to expand Insure Oklahoma, a program Oklahoma created in 2004 to bridge the gap in the health care coverage for low-income working adults.

“You could end up with a much more streamlined system, and it’s not just a matter of being streamlined, there’s a matter of accountability there, (and) it’s also a matter of access,” he said. “One of the things that helps increase access is simplicity, people understanding where they need to go in order to obtain insurance. Right now, it’s almost impossible for a person out on the street to understand if they’re eligible for Medicaid (or) for the exchange.”

Hospitals say yes

The Oklahoma Hospital Association has been lobbying the state to expand its Medicaid program.

Association President Craig Jones said expanding Insure Oklahoma is a step in the right direction.

“It is imperative that we work together to find solutions, as we have done in the past with the Insure Oklahoma program, to use available state and federal funds to lessen the burden of the uninsured on Oklahomans,” he said in a statement.

“Oklahoma hospitals have had a longstanding interest in decreasing the number of uninsured in Oklahoma, toward a goal of ‘coverage for all, paid for by all.’ We all know that care of the uninsured is currently paid for by everyone who pays their hospital bill or has insurance.”

About 30,000 Oklahoma adult residents are currently insured under Insure Oklahoma. If the eligibility requirements were expanded, an estimated 187,000 to 275,000 residents could enroll in the program.

Assuming 200,000 people actually enrolled, Leavitt Partners estimated the direct cost for Oklahoma to implement the program would be $850 million over a 10year period.

But if the Oklahoma Health Care Authority moves people onto the exchange, that would generate savings and bring the cost down. If those savings are taken into account, the cost is closer to $640 million, according to the Leavitt report.

Additionally, Oklahoma could see savings in other areas, according to the report. Expanding the program could result in cost savings with the state’s mental health, corrections and public health agencies.

This would mean the net cost over a 10year period would be $158 million.

Deily said Oklahoma has an opportunity to use a plan to try out innovative ideas with clear financial gain and little risk to the state.

“It really allows you to try out some different things, and if they work, then take them into your basic Medicaid program, as well,” he said.