A foundation already is in place to expand health insurance coverage to poor Oklahomans who do not qualify for Medicaid, but how exactly the state will negotiate and pay for that is yet to be determined, a consultant told state officials Thursday.
Michael Deily, senior adviser for Leavitt Partners, told the Oklahoma Health Care Authority that the focus should be on finding a way to extend Insure Oklahoma next year and then possibly expand it by 2015.
“It's going to require lots of care coordination, case management and behavioral health” for such an expansion to work, said Deily, whose group has been hired by the state at a cost of $250,000 to help devise a health care strategy for the state.
A preliminary report given to authority board members was not made available to the public even though it was paid for with taxpayer dollars.
A spokeswoman for the authority said its attorneys determined the report was exempted from the Oklahoma Open Records Act because it concerned personally created notes and materials prepared as an aid to adopting public policy. In March, Gov. Mary Fallin's office released thousands of pages of emails and correspondence regarding health care, but also withheld some, claiming executive privilege and “deliberative process” exemptions, neither of which exist in the act.
Deily outlined general recommendations in a slideshow presentation.
Oklahoma's health care policy developers should develop a plan that leverages premium tax credits to enable the purchase of individual insurance, focus on preventive care and preventable hospitalizations, and work toward a multi-payer model in its pursuit of expanded insurance coverage, he said.
The plan should push uninsured residents to purchase commercial insurance rather than enroll in Medicaid, should force participants to share plan costs through co-payments and should provide health care providers incentives for efficiency and positive health outcomes, he said.
Perhaps most significantly, the state should modify its current Insure Oklahoma plan so that the state might continue to qualify for a federal waiver to continue — and ultimately expand — its capacity, he said. A federal agency said in a letter Tuesday to state health officials that Insure Oklahoma as it is currently operating can't continue past the end of this year.
About 30,000 people are enrolled in Insure Oklahoma, which matches employer and employee contributions with about $50 million in state tobacco tax dollars and $70 million in federal funds.
More than half of Insure Oklahoma participants would be covered by a health care exchange under the Affordable Care Act. Gov. Mary Fallin has said she intends to develop a program to cover the rest, as well as about 200,000 uninsured Oklahomans who do not currently qualify for Medicaid.
Nico Gomez, the authority's chief executive officer, said he believes the state can renegotiate the extension of Insure Oklahoma through 2014 by allowing for enrollment beyond the 35,000-person cap currently in place, opening up the program to individuals beyond those working at participating small businesses, and reducing co-payments to within federal guidelines.
To expand it would require legislative support and untold amounts of dollars. Funding was not discussed in Deily's presentation, but Fallin last year rejected about $3.6 billion in expanded Medicaid dollars over the course of seven years.
Like a plan recently adopted in Arkansas, expanding Insure Oklahoma would require additional federal funding, but instead of a federal entitlement program, it would be to support a locally built program, he said.
“The thing I take away from it is we have a state innovative program called Insure Oklahoma that we've had since 2004 and we'd like to figure out a way to keep that operation because it's doing exactly what the Affordable Care Act is attempting to do but in a more responsible way,” Gomez said. “My takeaway from the meeting is we have the infrastructure here … now we need flexibility, and that's something we'll have to work toward.”
Deily said a finalized report, including a cost analysis, is expected in June.