Insure Oklahoma companies steel themselves for program's demise

Key health care reform mandates loom Jan. 1; threaten the end to state's premium assistance program for low-income employees of small companies.
by Paula Burkes Modified: March 2, 2013 at 12:44 am •  Published: March 4, 2013

CHICKASHA — At 92 employees, Cimarron Trailers falls among the ranks of U.S. employers — those with 50 or more full time equivalent workers who, starting Jan. 1, must provide health insurance to its employees or face steep annual penalties under health care reform.

Cimarron, which makes custom aluminum stock trailers in Chickasha that are sold nationwide, has offered group health insurance since it opened February 2004. The problem: since 2009, some 42 percent of its eligible workers take advantage of slashed monthly insurance payments under Insure Oklahoma — a 7-year-old, state-run income- and family size-based premium assistance program for qualifying individuals and employees of businesses with 99 or fewer workers.

Insure Oklahoma may die in December, paradoxically, because of health reform.

“I fear for our employees, and how it will affect them, if they lose the Insure Oklahoma subsidies,” said Lynn Terry, who co-owns Cimarron with her husband, Michael.

“Even if they can get what they need from the exchanges (online marketplaces coming next year), I worry if it will be a price they can afford,” Terry said.

Insure Oklahoma cuts costs

Depending on whether workers opt for individual, spousal or full family coverage, Cimarron pays 65 percent to 78 percent of their monthly health insurance premiums, or $325 to $1,100, Terry said. For its workers in Insure Oklahoma, the state pays 60 percent; Cimarron, pays 25 percent; and participants pay no more than 15 percent, she said.

A Cimarron employee in Insure Oklahoma, for example, may pay $7 weekly to cover himself and his spouse, as opposed to $46 without assistance, she said.

If their subsidy goes away, many Cimarron workers, especially single young men, will drop coverage, Cimarron human resources director Clif Cypert suspects.

Nico Gomez, chief executive of the Oklahoma Health Care Authority (OHCA), confirmed with The Oklahoman this week that his agency has been informed by officials at the Center for Medicare & Medicaid Services that the waiver under which Insure Oklahoma was established will expire Dec. 31. That means some $79 million in annual matching federal dollars will go away for the program, which the state funds through $50.4 million in yearly state tobacco tax revenues.

But an optimistic Gomez said he continues to negotiate with federal officials about retaining federal funds to keep the program — or at least a version of it. “We've worked too hard for this program that it's not going to go away without a fight,” he said.

Program covers thousands

Current Insure Oklahoma participants include 4,789 businesses, representing 16,705 participants, Oklahoma Health Care Authority spokeswoman Jo Kilgore said.

As program administrators lobby for Insure Oklahoma's continuance, other industry observers continue to press for state expansion of Medicaid called for under health care reform, while many state businesses brace themselves for the largely unknown.

The federal government wants to end Insure Oklahoma and premium assistance programs in some 18 other states because, philosophically, there's no need for them under health reform, said Cori Loomis, a health care attorney with Crowe & Dunlevy in Oklahoma City. The federal legislation calls for expanding Medicaid, which has traditionally been offered to only women and children, and offering tax breaks to, basically, the working poor, or those Insure Oklahoma and the other assistance programs intrinsically serve, she said.


by Paula Burkes
Reporter
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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At a glance

What is Insure Oklahoma?

Established in 2005, Insure Oklahoma provides premium health insurance assistance to businesses with 99 or fewer employees and self-employed people by using state tobacco tax revenues matched with federal funds. Employees must meet age and income requirements, be Oklahoma residents, meet citizenship guidelines and pay part of the premium payments. Workers pay about 15 percent of the premium, while the employers pay 25 percent and Insure Oklahoma pays 60 percent. Spouses also may qualify through the program. About 30,300 Oklahomans are enrolled, and 4,789 small businesses are participating, representing all 77 counties in Oklahoma. For more information, go to www.insureoklahoma.org or call (888) 365-3742.

New mandates are coming

• Beginning Jan. 1, 2015, individuals must have health insurance or pay an annual penalty of $95 or 1 percent of income; $695 or 2.5 percent of income by 2016.

• Businesses of 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 100 percent of federal poverty level ($11,170, or $19,090 for a family of three) and 400 percent can buy health insurance through state- or federally-operated exchanges and be eligible for variable tax credits based on annual income and family size.

SOURCE: Kaiser Foundation

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