Oklahoma’s new insurance commissioner opposes the federal health care overhaul adopted last year, and his agency is working to implement the measure’s requirements. Insurance Commissioner John Doak, who took office in January, last week reiterated complaints about the health care reforms he made often on the campaign trail. “I truly believe many parts of it are unconstitutional,” he said. “It’s going to continue to be dismantled piece by piece.” Doak has pledged to work with the state’s congressional delegation and the National Association of Insurance Commissioners to express those concerns. In the meantime, Doak is trying to get situated in his new job while implementing the law’s requirements. Assistant Insurance Commissioner Rick Farmer said Doak remains resolute in his opposition. “But he also recognizes the reality that it is the law,” Farmer said. “If we don’t take certain steps, the federal government will impose those steps upon us. He wants to make certain that Oklahomans can control their own health care plan.” It’s a process taking place in many states that, like Oklahoma, have challenged the legality of the law and yet are working to implement it. On Jan. 21, Oklahoma became the 28th state to challenge the law when Attorney General Scott Pruitt filed a lawsuit seeking to have parts of the health care law ruled unconstitutional in order to prevent the entire law from being enforced.Comments
Getting startedThe state has obtained a $1 million federal grant to plan how to establish required health insurance exchanges, which must be in place by 2014. The Oklahoma Insurance Department and Oklahoma Health Care Authority were given the responsibility to create a work group, made up of representatives of various stakeholder groups, to advance that process. But at a recent meeting of the work group, at least one attendee was distressed by the Insurance Department’s lack of input. Dan Ramsey, president of the Independent Insurance Agents of Oklahoma, said Doak, who attended the meeting, wasn’t acknowledged until the event was nearly complete. “I think they should be driving this train,” Ramsey said. “That’s not fair for Commissioner Doak and his staff to not be included.” Doak hopes his agency will have a central role in setting up the health insurance exchanges. “It’s a health insurance exchange, not a health care exchange,” Doak said. “The health insurance exchange needs to be put together and managed by the Insurance Department professionals. ... We have the industry expertise.” Farmer said the meetings, the first of which happened during previous Insurance Commissioner Kim Holland’s term, are aimed at planning how to set up a state-based health insurance exchange, rather than actually establishing the mandated exchanges. Doak “feels very strongly that the department needs to be very engaged in the planning process,” Farmer said.
Other mandatesThe new law also requires states to expand Medicaid coverage and tighten regulations. Under Doak’s leadership, Farmer said the department hasn’t canceled or voided any actions that already were under way. Much work remains to be done absorbing and enacting the state’s responsibilities related to the massive new law, Farmer said. “It’s a 2,000-page bill. I don’t have personal knowledge of all of the aspects of how we’re trying to engage that federal mandate other than the commissioner supports the attorney general’s lawsuit. He supports the public’s expression in State Question 756 (which added a provision to the state’s constitution that residents can’t be forced to participate in a health care system),” Farmer said. “He’s going to do everything that he can to fight it.” Doak conceded his position is “a balancing act.” But Farmer said the Insurance Department is meeting its obligations. “He can take a very strong stance against it, he can work with all the parties opposing it while ... making certain we are putting in place the things we have to have in order for Oklahoma to control it instead of the federal government.”
TimelineThis timeline shows when some aspects of the health reform law that affect states must be or have been implemented.
2010â†’Requires the federal government to create a process, with states, where insurers must justify unreasonable premium increases. Provides grants to states for reviewing premium increases. â†’Creates a state option to provide Medicaid coverage to childless adults with incomes up to 133 percent of the federal poverty level. (States will be required to provide this coverage in 2014.) â†’Creates a temporary program to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least six months. The plan will be operated by the states or the federal government. â†’Provides states with new options for offering home- and community-based services through a Medicaid state plan amendment, and permits states to extend full Medicaid benefits to individuals receiving home and community-based services under a state plan.
2011â†’Creates a new Medicaid state option to let certain Medicaid enrollees designate a provider as a health home and provides states taking up the option 90 percent federal matching payments for two years for health home-related services. â†’Provides three-year grants to states to develop programs to provide Medicaid enrollees with incentives to participate in comprehensive health lifestyle programs and meet certain health behavior targets. â†’Authorizes $50 million for five-year demonstration grants to states to develop, implement and evaluate alternatives to current tort litigations. â†’Provides grants to states to begin planning for the establishment of health insurance exchanges, which facilitate the purchase of insurance by individuals and small employers.
2012â†’Creates new demonstration projects in Medicaid for up to eight states to pay bundled payments for episodes of care that include hospitalizations and to allow pediatric medical providers organized as accountable care organizations to share in cost-savings.
2013â†’Increases Medicaid payments for primary care services provided by primary care doctors to 100 percent of the Medicare payment rate for 2013 and 2014, paid with federal funding.
2014â†’Creates state-based health insurance exchanges, administered by a governmental agency or nonprofit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. â†’Requires U.S. citizens and legal residents to have qualifying health coverage (there is a phased-in tax penalty for those without coverage, with certain exemptions). â†’Expands Medicaid to all individuals not eligible for Medicare under age 65 with incomes up to 133 percent of the poverty level and provides enhanced federal matching payments for new eligibles.
2016â†’Permits states to form health care choice compacts and allows insurers to sell policies in any state participating in the compact. SOURCE: Kaiser Family Foundation