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As Obamacare 'puzzle' takes shape, many in Oklahoma remain unaware of changes

Though new federal health care laws are eight months away, many Americans know little about the mandates, survey shows.
by Paula Burkes Published: April 16, 2013

With little more than eight months before key mandates of health care reform take effect, new research shows almost half of Americans don't know much if anything at all about the new federal laws.

Come Jan. 1, reforms require most individuals to have insurance or pay taxes, larger businesses to offer affordable health insurance or pay annual penalties, and insurers to follow new plan regulations.

Only 10 percent of Americans surveyed said they are very knowledgeable about the Affordable Care Act, or Obamacare, according to a survey conducted by Princeton Survey Research Association International and released by, based in San Francisco, this month. Twenty-eight percent said they aren't too knowledgeable, and 31 percent said they're somewhat knowledgeable.

Meanwhile, 90 percent of Americans don't know new health insurance exchanges will be available for online and telephone enrollments Oct. 1. Oklahoma's federally-run exchange will let residents and employers with up to 100 workers compare and buy health insurance policies, much like they shop online for travel packages.

Considering this lack of awareness, it's no surprise Crowe & Dunlevy chose a puzzle theme for its annual employer health care conference last week at the Skirvin Hilton Hotel. Jigsaw pieces and Rubik's Cubes adorned tables, and some 150 attendees were invited to complete Affordable Care Act crosswords. The opening update was titled “The Puzzle Is Taking Shape.”

Karen Rieger, who directs Crowe's health care practice, said the fact that Oklahoma has chosen not to expand Medicaid, which would have provided health care to the state's working poor — combined with what many perceive as ineffective, low penalty taxes for individuals without coverage — have made for weak price controls.

Industry observers predict employer-sponsored health plans will cost 2 to 3 percent more next year, she said. Other small employers attending, including the office manager of a 17-employee dermatology practice, expect increases as high as 35 percent.

Many healthy, young professionals will pay the penalty without buying the insurance, Rieger said. And the uninsured — including some 180,000 who theoretically were to be covered by Medicaid — will continue to use emergency rooms for care, prompting higher medical costs for those who have coverage.

Based on family incomes, some 20 to 30 percent of Oklahomans are estimated to qualify for tax credits to buy insurance on a federally-run exchange in Oklahoma, Rieger said. Crowe's president, Kevin Gordon, expects hardship allowances will come for the state's working poor so they, too, may shop the exchange.

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by Paula Burkes
A 1981 journalism graduate of Oklahoma State University, Paula Burkes has more than 30 years experience writing and editing award-winning material for newspapers and healthcare, educational and telecommunications institutions in Tulsa, Oklahoma...
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New mandates coming

Insurers will be banned from rejecting applicants with pre-existing medical conditions. Annual dollar limits on coverage will be banned; lifetime limits were banned in September 2010.

Plans must cover essential care and severely limit out-of-pocket expenses other than premiums — which can be based only on age (those 64 and older can't be charged more than three times what 21-year-olds are charged), tobacco use, whether coverage is for an individual or a family, and geographic area. Oklahoma will have five geographic areas: Oklahoma City, Tulsa, Lawton, Fort Smith, Ark., metropolitan areas and outlying areas as a whole.

Individuals must have health insurance or pay an annual penalty/tax of $95 or 1 percent of income; the penalty increases to $695 or 2.5 percent of income by 2016, with caps for families. The federal government will use simple tax forms, similar to 1099s, to document acceptable coverage and levy taxes. Exemptions include residents with incomes below the tax return filing threshold and members of Indian tribes.

Businesses with 50 or more full-time equivalent employees must offer health insurance or pay annual penalties of $2,000 per full-time employee, excluding their first 30. Fines can be $3,000 per employee if a company's insurance is deemed inadequate (covers less than 60 percent of essential benefits) or unaffordable (costs more than 9.5 percent of a worker's salary, or $117.67 monthly for a minimum-wage worker).

Legal residents between 133 percent of the federal poverty level ($15,282 for 2013, or $31,322 for a family of four) and 400 percent ($45,960, or $94,200 for a family of four) can buy health insurance through Oklahoma's federally-run exchange and be eligible for variable tax credits based on annual income and family size. Online or phone enrollment begins Oct. 1; coverage is effective Jan. 1.

SOURCES: Families USA, Kaiser Foundation, Oklahoma Insurance Department, Crowe & Dunlevy law firm


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