My local paper published a map of the states and what type of health care exchange each state has opted for. I was shocked to learn my state of Oklahoma has opted for a “Federally-facilitated marketplace.” And not just my conservative state but almost all of the heartland. Just as shocking is some of the most liberal states from sea-to-shining-sea have “state-based” marketplaces. Those states include California, Oregon, Washington, Minnesota, New York, Connecticut, Vermont, Colorado and Washington D.C. Of the 26 states opting for a “Federally-facilitated marketplace” all of them have Republican governors with the exception of two, Montana and Missouri which are governed by Democrats. In the map below, the state of Utah is shown as “undecided” but other slightly more current maps show Utah as in the “Federally-facilitated marketplace.” I picked up the phone and called Oklahoma Governor Mary Fallin’s office.
The map is a tad misleading, and maybe more than a tad. Governor Fallin’s office told me Oklahoma has opted-out of “any participation and are pursuing state-based” exchanges. Along with the Oklahoma Health Care Authority, Oklahoma authorized Leavitt Partners of Utah, a health care and research consulting firm, to come up with viable options for the people of Oklahoma. Leavitt will deliver it’s final report some time this summer.
Nevertheless, the Tulsa World published this map which leads to the conclusion that Oklahoma has joined the collusion. The article headline says “Federal exchanges are expected to start on time.” Indeed, the Obama administration is busy, busy, busy ignoring Oklahoma law:
In an exclusive telephone interview with The New American, Oklahoma Insurance Commissioner John Doak reported that his office has received a letter from Center for Consumer Information and Insurance Oversight (CCIIO) Deputy Administrator and Director Gary Cohen informing him that the federal government will impose ObamaCare regulations on insurance companies in Oklahoma. The CCIIO is part of the Centers for Medicare and Medicaid Services (CMS).
According to a story in Politico, Doak’s colleagues in Missouri, Wyoming, and Texas have received these notifications, as well.
In a press release issue by his office after receiving Cohen’s letter, Doak writes that the Oklahoma Insurance Department will not be participating in a collaborative effort with the Center for Consumer Information and Insurance Oversight (CCIIO) to enforce the Affordable Care Act (ACA).
Doak’s statement continues:
The Oklahoma Insurance Department regulates the health insurance policies sold in the state and responds to consumer questions and complaints. Our consumer assistance team receives over 30,000 phone calls and our website receives over 1,000,000 visits each year. We will continue to serve these consumers by adhering to our duties under the State Constitution and Statutes. The consumers are the ones who are going to bear the costs of these unnecessary federal regulatory burdens.
In addition to adding new fees to health insurance products that will increase prices both inside and outside the exchange, the ACA requires plans to add expensive and often unnecessary coverage benefits. These costs will impact young adults most severely due to the law’s requirement that older Americans pay no more than three times the premium of young adults. A survey of insurers by the American Action Forum found that average premiums for young, healthy adults may triple going into 2014.
This is yet another example of continued overreach of the federal government on state’s rights, Doak told The New American, when asked about the conflict. This is the first shot over the bow of states which have chosen not to enforce ObamaCare’s myriad mandates, he added. Source: The New American
As the Washington Post Wonk Blog intimates: the Feds will find a hostile environment in Oklahoma.
So what is the difference in the “state-based exchanges” we have opted out of and are not participating in, and the state-based exchange we are in the process of designing? Unfortunately, I can’t answer that question. Below are the preliminary recommendations from Leavitt Partners:
Oklahoma’s health care policy developers should develop a plan that leverages premium tax credits to enable the purchase of individual insurance, focus on preventive care and preventable hospitalizations, and work toward a multi-payer model in its pursuit of expanded insurance coverage, he said.
The plan should push uninsured residents to purchase commercial insurance rather than enroll in Medicaid, should force participants to share plan costs through co-payments and should provide health care providers incentives for efficiency and positive health outcomes, he said.
Perhaps most significantly, the state should modify its current Insure Oklahoma plan so that the state might continue to qualify for a federal waiver to continue and ultimately expand its capacity, he said. A federal agency said in a letter Tuesday to state health officials that Insure Oklahoma as it is currently operating can’t continue past the end of this year. Source: NewsOK The Oklahoman’s Watchdog Team
Note that the above map is from the George Kaiser Family Foundation (Kaiser Permanente). I see several maps circulating and changing over time so Utah may be undecided or in the “Federally-facilitated Marketplace,” as the Tulsa World map shows.
Who is the decider? Who classifies a state as opting-in to a “Federally-facilitated exchange,” when a state has not opted-in to a “Federally-facilitated exchange?” You know the answer.