With health reform mandates looming a little more than a year away ...

They were glad to have the medical coverage, Hansen said. Still, their share of the premiums was exorbitant — nearly $1,200 a month, including $580 for him alone, he said.

“There wasn't much left over from my wife's check,” he said. “It was like she was working just for health insurance.”

Hansen, 40, recently saved his household some $400 a month by rolling off his wife's health plan and retaining Salerno Health, a new Oklahoma City startup that offers direct primary, specialty and surgical care on a prepaid basis, starting at $49 a month for individual primary care.

Hansen, who bought a catastrophic policy in case he needed emergency or hospital care, since has trumpeted the Salerno option with his employees and anyone else who'll listen.

Meanwhile, with the major health care reform mandates just more than a year away, MedEncentive, another Oklahoma City startup, has won the attention of two of the nation's top reinsurance companies for its Internet-based patient-doctor wellness product that's been proven to cut costs through better managed care.

Counting the costs

Meanwhile, employers statewide are trying to figure out how mandates will affect their bottom lines.

Hundreds of human resources professionals statewide attended Crowe & Dunlevy's labor and employment seminars last week in Tulsa and Oklahoma City, where director Cori Loomis gave the keynote luncheon presentation “Holy Healthcare, Batman! The Affordable Care Act Was Upheld. Now What Do We Do?”

The answers for employers aren't as simple as initially thought, Loomis said.

“Many may be subject to the ACA and not realize it,” Loomis said. The law requires businesses with 50 or more full-time-equivalent employees to provide health insurance, but the key is the word “equivalent.” Part-time employees, or those who work fewer than 30 hours, are included in the calculation, she said.

Companies — such as restaurants, clothing stores, tax preparers and Oklahoma City's Sunbelt Staffing, whose vice president, Marla Robinson, attended the conference — need to run calculations, Loomis said.

Robinson said Sunbelt, which employs six full-time workers and 40 to 150 temporary workers annually, is looking at pairing a high-deductible health plan with a health savings account, which provides tax-sheltered benefits to Sunbelt and offers workers a way to save for their medical costs with an account that rolls year to year.

Meanwhile, larger employers can't simply compare their annual cost of providing health insurance with the cost of annual penalties, Loomis said. She gave the example of BancFirst, whose executives recently told state legislators that it would be cheaper to pay health care for the additional employees they estimate covering, with the health care act's automatic enrollment mandate for companies with 200 or more employers, than not to provide health insurance — $410,000 annually compared with some $1.2 million.

The bank's estimates accounted not only for the various penalties but also the cost of increasing salaries so employees could buy insurance elsewhere, Loomis said. If Oklahoma chooses not to expand its state-federal “SoonerCare” Medicaid program, lower-income employees who would have qualified under the expanded program will be looking to their employers for the health insurance the Affordable Care Act requires them to have, starting in January 2014, Loomis said.

SoonerCare is in a wait-and-see mode, spokeswoman Jo Kilgore said.

“It's up to the state leadership whether the program expands or not,” Kilgore said. If it does, the state expects to cover about 200,000 qualified Oklahomans in addition to its estimated 1 million current members, she said.

Curiously, enrollment in Insure Oklahoma, a SoonerCare program that subsidizes low-income self-employed workers and those who work at businesses with 99 or fewer workers, has dipped, Kilgore said. Member and employer enrollment was 9,213 in September, compared with 10,032 a year ago.

Oklahoma City independent insurance broker Michael Shaw of Andreini & Co. isn't surprised.