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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

Gordon doesn't expect state Attorney General Scott Pruitt's challenge to the Affordable Care Act to prevail. Based on standing, “only citizens, not states, have the right to sue the federal government,” said Gordon, who expects taxpayers will bring challenges — but only after individual taxes are assessed and paid.

Crowe attorney Cori Loomis said 2013 is the critical year for employers to make adjustments to their workforce. Some, Loomis said, are limiting employees' hours to avoid mandates required of businesses with 50 or more full-time equivalent employees. Others, she said, are contracting staffing firms versus hiring employees.

Conference attendee Thomas Belding, who sells stop-loss insurance to companies that self-fund health plans versus contract fully-insured plans, said more Oklahoma companies are following a nationwide trend toward self-funding. Though employers assume more risk, they avoid many government mandates and hold down costs, Belding said.

Analysis published Thursday by the Robert Wood Johnson Foundation showed that, of Oklahoma employers who offer health plans, 38.9 percent were self-funded in 2011, up from 33.5 percent in 2001. Of those with fewer than 50 workers, 14.1 percent self-funded in 2011, up from 10.4 percent in 2001.

Patti Davis, Oklahoma Hospital Association executive vice president, said she hoped state leaders would expand Medicaid. The hospital and nursing home industries agreed to cuts in government reimbursements under the ACA in exchange for a greater number of insured patients, she said. “Without expanding Medicaid, Oklahoma not only will lack those patients, but also the federal funds,” she said. “It'll be a double whammy.”

Davis said expanding Medicaid by 2020 would bring 23,500 new high-salaried jobs to Oklahoma, with associated revenues. Most importantly, research shows increased access to health care translates into better health outcomes she said.

Robert Roswell, physician and associate dean of the University of Oklahoma College of Medicine, focused on the need to coordinate services, thereby improving care and cutting costs. “The ACA's coverage reform will be what drives payment reform, and payment reform ultimately will drive delivery reform,” he said.

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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Also ...

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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