Health insurance in Oklahoma
- Oklahoma uses the federally facilitated exchange.
- Open enrollment for 2019 coverage in Oklahoma ended on December 15, but enrollment is still possible for residents who have qualifying events.
- Short-term health plans are available in Oklahoma with initial plan terms up to six months.
- More than 140,000 Oklahomans purchased plans for 2018 coverage.
- Oklahoma lawmakers have been mostly opposed to the ACA, but have also tried to craft state-based health care reform.
- Oklahoma’s Medicaid/CHIP enrollment has decreased since 2013. and the state wants to impose a Medicaid work requirement.
- Oklahoma’s high-risk pool ceased operations in 2014, after the ACA made individual market coverage guaranteed-issue.
- About 18 percent of Oklahomans are enrolled in Medicare. About 18 percent of enrollees have Medicare Advantage coverage.
2019 health plan carriers, rates
Those who shop Oklahoma’s federally facilitated exchange have a choice of insurers for 2019, with Medica joining the exchange to offer coverage statewide. Open enrollment for 2019 coverage ended on December 15, but enrollment is still possible for residents who have qualifying events.
Blue Cross Blue Shield of Oklahoma, which was previously the only insurer offering plans in the exchange, is reducing their average premiums by 2 percent for 2019.
Oklahoma was ahead of the pack in terms of funding for cost-sharing reductions (CSR). Blue Cross Blue Shield of Oklahoma added the cost of CSR to premiums for all their ACA-compliant individual market plans for 2017, a year ahead of the rest of the country (and a year before the Trump Administration actually cut off funding for CSR).
Starting in 2018, and again for 2019, the cost of CSR has been concentrate on silver plan rates (ie, “silver loading”), resulting in premium subsidies that are larger than they would otherwise have been (subsidies are based on the cost of the benchmark silver plan, so when silver plan rates increase, subsidies also increase)
Oklahoma enrollment in qualified health plans
140,184 people purchased plans in Oklahoma’s exchange during open enrollment for 2018 coverage. That was about 4 percent lower than the 146,286 people who enrolled the year before. As of early 2018, effectuated enrollment in Oklahoma’s exchange stood at 130,902.
Oklahoma and the Affordable Care Act
Oklahoma is one of five states considered “diehard hold outs” against Obamacare, according to a 2014 study from Georgetown University. The state defaulted to a federally run exchange and has refused to expand Medicaid.
In 2010, both of Oklahoma’s U.S. Senators, Republicans Thomas Coburn and James Inhofe, voted no on the ACA. In the U.S. House, one Democrat, the second district’s Dan Boren, voted yes, while four Republican Representatives from Oklahoma voted no. Boren has since been replaced by a Republican, and the entire U.S. congressional delegation from Oklahoma is Republican.
At the state level, there’s a strong Republican majority in both the House and Senate, outgoing Oklahoma Gov. Mary Fallin is a Republican, and Governor-elect Kevin Stitt is also a Republican. There’s a small Democratic majority however, in the demographics of the state population. Gov. Fallin is strongly opposed to the ACA, and supported her Attorney General’s lawsuit against the ACA.
Fallin was the least popular governor in the United States as of 2018, but Oklahoma voters have elected another Republican, Kevin Stitt, to replace her. Stitt opposes Medicaid expansion and believes that selling health insurance across state lines is a key to reducing premiums (Oklahoma enacted legislation in 2017 to allow this, but like the handful of other states that have done the same thing, they’ve had no interest from insurers wanting to participate).
But Oklahoma has also worked to try to create state-based health care reform solutions within the framework of the ACA. In 2017, Oklahoma submitted a 1332 waiver proposal to CMS, seeking federal pass-through funding for a reinsurance program (and the state was planning extensive additional reform via additional 1332 waivers that were to be submitted subsequently). But Oklahoma ultimately withdrew the waiver proposal amid delays in the federal approval process, when it was clear that the approval wouldn’t happen in time for rates to decrease for 2018.
Oklahoma enacted another bill, in 2018, authorizing the state to seek federal funding for a reinsurance program, but the state did not submit a waiver proposal in 2018, so there is still no reinsurance program in Oklahoma as we head into 2019.
Oklahoma has strict limits on short-term health plans
Although Oklahoma tends to defer to the federal government on health care reform issues, the state has fairly strict regulations for short-term health insurance plans. Short-term plans in Oklahoma cannot last more than six months, and cannot be renewed. So the Trump Administration’s rules for short-term plans (allowing for initial terms of up to 364 days and total duration, including renewals, of up to 36 months) are not applicable in Oklahoma.
Read more about short-term health insurance in Oklahoma.
Oklahoma Medicaid/CHIP enrollment
As of August 2018, there were 783,143 Oklahoma residents enrolled in Medicaid (SoonerCare) and CHIP in Oklahoma. That’s a decrease of 1 percent since 2013; Oklahoma and Wyoming are the only two states where enrollment has declined. Nationwide, enrollment in Medicaid/CHIP has increased by 27 percent.
Governor-elect Kevin Stitt wants to audit Medicaid in Oklahoma, but plans to continue to reject federal funding to expand Medicaid.
In 2016, there was a flurry of news articles indicating that Oklahoma might be on the brink of agreeing to Medicaid expansion. But the legislation in question did not pass, and wouldn’t necessarily have expanded Medicaid, even if it had passed.
And despite the fact that Oklahoma has not expanded Medicaid and only about an eighth of the state’s Medicaid population is non-elderly adults, Oklahoma is pursuing a waiver that would allow for a Medicaid work requirement. The waiver proposal is a result of an executive order signed by Governor Fallin in March 2018, and HB2932, enacted in May 2018, both of which directed the Oklahoma Health Care Authority to submit a waiver to the federal government, seeking permission to implement a Medicaid work requirement.
The state estimates that about 6,000 low-income parents would be subject to the work requirement, and would have to work at least 20 hours per week in order to retain their Medicaid coverage. The waiver proposal had been drafted but not yet submitted to CMS as of early November 2018.
Medicare in Oklahoma
In 2018, a little more than 18 percent of the state’s population was enrolled in Medicare coverage. That’s comparable to the percentage enrolled nationally. Average spending on these beneficiaries was about $10,278 per beneficiary as of 2016.
Of those beneficiaries, about 18 percent – about 141,000 Oklahomans – are enrolled in Medicare Advantage plans.
As of 2016, there were about 188,000 enrollees with Medigap coverage, and roughly half of the state’s Medicare beneficiaries – about 363,000 people – had prescription drug coverage under stand-alone Part D plans.
Does Oklahoma have a high-risk pool?
Prior to 2014, individual health insurance was underwritten in nearly every state, including Oklahoma. This meant that pre-existing conditions could prevent an applicant from getting coverage, or could result in significantly higher premiums or policy exclusions.
The Oklahoma Health Insurance High Risk Pool (administered by Blue Cross Blue Shield of Oklahoma) was created in 1995 to provide an alternative for people who were ineligible to purchase individual health insurance because of their medical history.
Implementation of the ACA and a guaranteed issue individual market have eliminated the need for high-risk pools, and the Oklahoma Health Insurance High Risk Pool ended operations as of December 31, 2014.
State-based health reform legislation
Here’s a summary of recent Oklahoma bills related to public health and healthcare reform: