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Health care’s reform gets mixed reactions in Oklahoma

BY PAULA BURKES | Published: April 18, 2010 Comment on this article

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Did you know?

• Of Oklahoma adults 65 and younger, 20 percent lack health insurance. About half — roughly 200,000 — are poor enough to qualify for Medicaid in 2014, when the state-federal program will be expanded sharply to include adults without dependent children.

• Sixty-three percent of increased health care costs is due to an increasingly unhealthy population with high blood pressure, cholesterol and diabetes. Thirty percent can be tracked to obesity alone, of which Oklahomans have the highest incidence nationwide.

SOURCE: The Oklahoma Health Care Authority and the University of Oklahoma College of Public Health

Impact of health care reform

Already in effect

Most Medicare beneficiaries who enter the Part D coverage gap, known as the "doughnut hole,” can receive a one-time $250 rebate to pay for prescription drugs. Beginning next year, federal subsidies and deep drug company discounts will gradually reduce the gap, eliminating it by 2020.

By June 1

Insurers may not deny coverage to a dependent child under age 19 because of pre-existing conditions. Specific rules are pending from the Department of Health and Human Services (HHS) on what constitutes a qualifying event.

Effective July 1

Individuals who have pre-existing conditions and who’ve been without coverage for at least six months may obtain coverage through a federal high-risk health insurance pool, which states have the option of running. The estimated 2,100 individuals covered in Oklahoma’s existing high-risk pool can’t move to the new pool, though premiums will be cheaper — 100 percent of the weighted average of market rate versus 150 percent.

Effective Sept. 23

• Insurers may not rescind coverage when you get sick, except in cases of fraud.

• Insurers may not impose lifetime coverage limits and, until 2014, may set only restricted annual limits for comprehensive health benefits, including mental health and substance abuse. Effective on plans’ renewal dates after Sept. 23.

• Insurers must cover A- and B-level preventive services such as screenings and immunizations, recommended by the U.S. Preventive Services Task Force, with no co-payments or deductibles.

• Children who don’t receive health care coverage from their employers may stay on their parents’ plans until age 26, regardless of marital or student status.

Effective 2011

• Government payments to Medicare Advantage, the private-plan part of Medicare, will be frozen, and cut in the following years. If you’re an enrollee, you could lose extra benefits such as free eyeglasses, hearing aids and gym memberships.

• Voluntary long-term care insurance will be available through pretaxed payroll deductions. Age-based premiums will average $120 a month, with benefits valued at about $60 a day.

Effective 2013

• Contributions to health flexible spending accounts will be limited to $2,500 per year, and qualified payments, starting in 2011, will exclude reimbursements for over-the-counter medications.

• The threshold for deducting unreimbursed medical expenses will increase from 7.5 percent of adjusted gross income to 10 percent. This change is postponed until 2017 for taxpayers age 65 and older.

• Payroll and investment taxes will increase for wealthier Americans (see Q&A).

Effective 2014

• States will create new insurance marketplaces, or "exchanges,” and all insurers will be banned from rejecting applicants with pre-existing medical conditions. Insurers can base premiums on only age, tobacco use, geographic area and whether coverage is for an individual or a family. Plans will cover essential care and severely limit out-of-pocket expenses other than premiums.

• Annual limits on coverage will be banned.

• Most Americans and legal residents will be required to have insurance by 2014 or pay a penalty, which will start at $95, or up to 1 percent of income, and rise to $695, or 2.5 percent of income, by 2016. Families have a limit of $2,085. No taxpayer will be subject to IRS liens or levies, or jail time, for failing to disclose insurance information to the IRS. The agency expects to receive simple forms, similar to 1099s, as a way to document acceptable coverage and extend tax credits. Any audits will be the responsibility of HHS.

• If your income doesn’t exceed 133 percent of the federal poverty level (currently $14,404 for individuals; $29,326 for a family of four), you’ll be eligible for Medicaid, the state-federal program for the poor and disabled, which in 2014 will expand sharply to include adults without dependent children.

• Those who are ineligible for Medicaid but have incomes below 400 percent of the poverty level ($43,320 for individuals; $88,200 for a family of four) will be eligible for sliding scale government subsidies to help pay for private insurance. A family of four with an income of $88,200 will have to pay 9.5 percent of household income, or $8,379.

SOURCES: Oklahoma Insurance Department,

Kaiser Foundation, McAfee & Taft law firm,

Internal Revenue Service

"My daughter would die if this bill didn’t go into effect,” Shreve tells naysayers.

After her daughter turned 25 and was dropped from the family health plan, Shreve frantically phoned state agencies for help. Medicaid officials told her they couldn’t help unless her daughter was pregnant, she said, and premiums for the state’s high-risk pool are too expensive for Shreve and her husband, a mechanic.

Meanwhile, her daughter, who’s too sick to work, nearly died last summer, Shreve said. Vomiting uncontrollably, her daughter went to the emergency room at St. Anthony Hospital, where she was admitted for 10 days.

"Now my goal is to keep her alive until 2014 (when Medicaid will be extended to adults without children) or until she gets disability through Medicaid,” she said.

Shreve, who volunteers at a free health clinic two Thursday nights a month, sees the shortcomings in medical care outside her own family.

"The traditional health care setting only helps a fraction of the people in need,” she said.

Infrastructure change

While families like Shreve’s look to the major health reform mandates that are slated to come in four years, state officials, hospital executives and physicians are trying to plan for infrastructure changes and initiatives that take effect within 60 days and soon after.

"There’s so much information yet to come as to how this will all take place,” Insurance Commissioner Kim Holland said. In many places throughout the 3,000-page bill — like with the pressing coverage for children with pre-existing conditions — it says the secretary of the Department of Health and Human Services will issue rules that allows citizen input and the ability to provide information to state policymakers, Holland said.

"I think most agree health care should be available to all, though many Oklahomans have a problem with how we‘re going to pay for it,” she said. "The impact on the individual, businesses, insurers and medical community is huge. We don’t really know what the outcome will be.

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