As a family physician for more than 30 years, I hope state leaders will endorse and begin implementation of the recently released Leavitt Partners recommendations on how Oklahoma can provide cost-effective health insurance coverage for low-income, uninsured citizens.
We must improve Oklahoma's health status if we're going to be an economically competitive state. The Leavitt Partners approach provides a golden opportunity that we can't afford to pass up.
While some support services are available to this population, many of these services go unpaid, resulting in uncompensated care costs. These costs are ultimately borne by those who are insured, increasing their costs. Physicians and other health providers also have increased practice costs from this uncompensated care, making it difficult for the state to attract providers, especially to rural areas. In addition, federal assistance for Oklahoma hospitals to care for the uninsured will soon be eliminated, putting many community hospitals at risk of closing.
Developing avenues for the uninsured to access appropriate preventive and coordinated care could improve the efficiency and effectiveness in how care is provided, reducing costs over time. While the proposal is expected to increase direct costs to the state over a 10-year period, these monies would be coming primarily from the $50 million tobacco-associated revenues previously approved for Insure Oklahoma. The overall net effect is a positive economic benefit to the state of $13.6 billion to $17.3 billion. That's an amazing return on investment.
The Leavitt Partners' proposal would be based on the current well-regarded and successful Insure Oklahoma program. They suggest the state should request federal approval to streamline and simplify the existing Medicaid program by eliminating optional Medicaid coverage where individuals would be either eligible for basic Medicaid or get a tax credit to help them buy commercial coverage through an exchange. With the increased federal assistance, this program could increase the number of people covered potentially ninefold — from 30,000 to as many as 275,000.
The Leavitt consultants recognize that this population has tremendous challenges, including many who engage in risky behaviors and have significant mental health disorders. The consultants suggest several approaches that would increase individual accountability and provide incentives to encourage healthy choices. They also suggest implementing new ways to pay providers to encourage them to be more efficient and focus on improved health outcomes.
To enhance accountability to all entities, Leavitt Partners recommends the Medicaid agency create a steering committee made up of key executive, legislative and community stakeholders that would consider issues such as working toward multi-payer models for the program's health home system, developing a strong evaluation component, demonstrating cost-effectiveness, and how best to leverage current OHCA initiatives as well as integrate public health initiatives into the approach.
This process will help ensure the approach maintains a broader focus on health outcomes and improving the state's overall health. This is truly a win-win-win proposal for citizens, health providers and the state.
Crawford practices medicine in Oklahoma City.