Oklahoma and Health Reform

Oklahoma tried to sue HHS Secretary Kathleen Sebelius in refusal to comply with the individual mandate. Another lawsuit against the Affordable Care Act was created by Oklahoma-based franchise Hobby Lobby stating the requirement of employers to cover birth control was against their religious beliefs as a company. The state has certainly been a voice against the health care law, as one of the 26 states involved in the Supreme Court case resolved in June, and continues to object as 2014 draws nearer. While there are also residents in favor, those who make the laws are generally against whatever part of the law they can attempt to repeal.

Health reform is a federal law, however, and until Oklahoma can get any progress on their court cases, they will have to comply with the ACA. This means many citizens can benefit from revised health plan requirements for conditions and benefits, and others have already experienced the moderate changes made since the law’s inception in 2010.

 

Current Health Reform Laws in Oklahoma

Oklahoma insurers and state laws must already accept certain regulations made in the past few years. The doughnut hole for Medicare was phased out and eliminated, giving seniors continuous prescription coverage. Also, the private health insurance market changed by now offering the protection of no rescissions or lifetime maximums. Coverage was also extended to age 26 for dependent children living in Oklahoma on their parent’s health plan. As a result, 49,000 young adults gained coverage in the state between March 2010 and December 2011.

Insurers are also now monitored by the 80/20 rule, which provided rebate checks for Oklahomans whose health plans did not spend 80 percent of their premium income on improving their services for members. Preventive care was also added as a free service, not subject to deductibles or copays with any health plan’s network. Additional preventive care services were also added to the list of necessary benefits for every insurer, such as women’s health care services and contraceptives, as Hobby Lobby is well aware.

Coverage for Oklahoma residents under age 19 with pre-exisiting conditions is now permissible under every carrier, as they cannot be rejected based on their health. Insurance companies are still free to increase their premiums, but not over a certain amount. The law also brought a federal angle to the Oklahoma Health Insurance High Risk Pool, offering temporary coverage for adults who have been turned down for an individual plan because of their conditions.

 

Oklahoma Health Reform in 2014

Against the beliefs and wishes of many Oklahomans, the state will be required to follow the individual mandate (unless they win their case) requiring all residents to apply for creditable coverage, and insure all individuals with pre-existing conditions fairly equally. Those who have a pre-existing condition can look forward to a health plan from any Oklahoma insurance company without being rated up more than 10 percent of the normal premium.

Oklahoma has announced that it will not set up its own exchange, though the program will exist regardless, as they have chosen for the federal government to operate it instead. This will add a new form of health insurance to the Oklahoma market for individuals and families who do not have access to group insurance. Exchanges will include essential health benefits, which will also be required by every insurer. All plans in the state will have to cover ten categories of benefits, which are usually covered by a comprehensive plan. A few EHBs are maternity, emergency care, prescriptions, preventive and wellness, and hospital benefits.

Another refusal to accept the law comes in the form of not expanding SoonerCare, Oklahoma’s Medicaid program, in 2014. All states have the option of receiving funding to extend the program to a larger amount of low-income residents (up to 133 percent of FPL), but Oklahoma says no. This will leave the program as-is, and continue with the current eligibility guidelines as the Governor wildly overestimated the amount of money it would take to maintain the program.

 

Sources:

 

1. Healthcare.gov. “how the Health Care Law is Making a Difference for the People of Oklahoma.” http://www.healthcare.gov/law/resources/ok.html

2. EBN. “Oklahoma Revises Health Reform Lawsuit.” http://ebn.benefitnews.com/news/oklahoma-revises-health-reform-lawsuit-2727953-1.html

3. NewsOK.com. “Gov. Mary Fallin says no to Medicaid expansion in Oklahoma.” http://newsok.com/gov.-mary-fallin-says-no-to-medicaid-expansion-in-oklahoma/article/3730224