We’re in this together

We’re in this together
Point of View Health coverage

BY DAVID BLATT

Published: November 16, 2008

With more than one in five non-elderly Oklahomans lacking health insurance and health care costs posing an ever-growing burden on businesses and families, identifying options to expand access to health insurance coverage is likely to be a major priority for Oklahoma policymakers during next year’s legislative session. This fall, legislators and others have been working as part of a House task force aimed at developing recommendations to chart a path forward.

We believe Oklahoma can best move forward by building upon the foundations of our mixed private-public health care system and upon programs and policies adopted in recent years. In particular, the state should continue to expand the Insure Oklahoma program, which provides a public subsidy for low-income employees and their spouses to purchase employer-sponsored insurance when that is offered, or to buy in directly to a public product when employer-sponsored coverage is unavailable.

Insure Oklahoma represents a flexible public-private partnership that can help small and medium-sized businesses provide coverage to their employees. While enrollment in Insure Oklahoma has been slow to grow, real progress seems likely if and when Oklahoma receives federal approval to move ahead with expanding the program to firms with up to 250 employees and employees up to 250 percent of the poverty level. At the same time, the Legislature should consider expanding eligibility for traditional Medicaid to adults below the poverty level. This would help cover a population that has very high rates of uninsured and often finds even the subsidized cost-sharing obligations of the Insure Oklahoma program to be unaffordable.

While recent policy initiatives are moving Oklahoma in the right direction, we must be extremely careful that efforts to expand coverage don’t come at the expense of eroding the quality of health insurance in the group and individual markets. Some are tempted to relax coverage standards and offer more choices for bare-bones, low-cost coverage. This is seen as especially attractive to the young and healthy, who currently may only be offered more benefits than they want at a cost they cannot afford or choose not to pay.

The basic problem with this approach is that affordable coverage for those with the greatest health care needs — especially women of child-bearing age, persons with chronic physical and mental health conditions and older workers — can only remain available is if there is a large, diverse pool that includes younger, healthier individuals. If that population is pulled out of the risk pool by the availability of bare-bone products, we could easily descend into a downward spiral where those who most need health care will be unable to find or afford it. That won’t solve our uninsured problem and it certainly won’t make us a healthier state.

Real solutions to the crisis of the uninsured in Oklahoma will occur only if everyone — the public and private sectors, young and old, high-income and low-income, healthy and sick — is working together toward our common goals of affordable, quality care.

Blatt is director of policy for the Oklahoma Policy Institute ( http://www.okpolicy.org/).