Statewide view needed for health care policy
OUR VIEWS: Oklahoma’s uninsured

The Oklahoman Editorial

Published: November 24, 2008

As data continue to surface in support of or opposition to Tulsa’s vociferous claim that it gets shafted in public health care funding, new numbers paint a more complete picture of Oklahoma’s uninsured problem. Meanwhile, efforts to address that problem with a hospital provider tax are advancing.

Perhaps lost in the discussion of whether Oklahoma City gets a disproportionate share of public health care funding is the fact that reducing the state’s overall rate of uninsured will mitigate any alleged funding imbalances.

Members of the Oklahoma Health Care Authority’s board of directors were presented data on the uninsured at a meeting Nov. 13. The portrait that emerges from these numbers includes a drop in the rate of uninsured from 18.1 percent in 2004 to 16.7 percent in 2008.

The typical uninsured Oklahoma resident is 25 to 34 years old, male, Hispanic, unemployed and attempting to live on less than 100 percent of the federal poverty level. Adults in the latter category are uninsured at a 43.3 percent rate; for children, the rate is 10.5 percent.

As for geography, a key element of the Tulsa funding disparity argument, Tulsans are the least likely to be uninsured while those in central Oklahoma are the most likely.

What about those who are insured? A declining percentage of these citizens is covered by group insurance policies, typically in cooperation with an employer. An increasing percentage is covered by public health insurance. American Indians have a relatively high uninsured rate, but they’re considered uninsured even if eligible for tribal health care programs.

The decline in employer-based health insurance is troubling because of current economic conditions. An OHCA report says fewer Oklahomans may have access to employer-based coverage as the calendar turns toward 2009.

The next Legislature will consider a hospital provider fee to raise state funds that would be used to leverage more federal Medicaid money. A projected $1.1 billion could be raised by this means. A portion of this would go to increase hospital reimbursement rates, but most of the money could be used to expand Oklahoma’s innovative public-private insurance program that would significantly cut the rate of the uninsured among working adults.

OHCA Executive Director Mike Fogarty is perhaps overly optimistic that a provider fee could reduce the state’s uninsured rate to the best in the nation. Surely, though, he’s right in saying the fee would provide a financial lifeline to hospitals that serve indigent patients.

This statewide view, rather than the tiresome Tulsa-Oklahoma City squabble, should be the focus of health care policy in 2009.

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