Editor’s Note: Oklahoma has three, government run health insurance plans (not including Sooner Care, the state’s Medicaid program). They include Insure Oklahoma and two, health insurance high risk pools for those with serious, pre-existing health problems. In a three-part series, the City Sentinel will illuminate the features of these programs and their general eligibility criteria.)
Insure Oklahoma or O-EPIC, has hit its stride, and continues to encourage low- and moderate income, working Oklahomans to apply, said director Matthew Lucas.
If I were to say one thing to people, it would be “‘apply!’” said Lucas. “We want to help more people.”
Membership is now 32,000. Its current budgetary limit is 35,000 people. An expansion beyond that would require enabling legislation to allocate more funding. It is funded by a portion of the state tobacco tax and matched on a two-to-one basis by federal dollars.
Oklahoma Health Care Authority administers Insure Oklahoma. It was originally envisioned as a program that would insure low income, adults, and offer to subsidize private health insurance for small businesses. The original goal was 50,000 members.
The program is open to Oklahomans who are ages 19 to 64 and who are U.S. citizens. Recently, children under 19 and under were added; certain circumstances apply.
Administrators cut capacity to 35,000 members because revenues were lower and costs greater than originally expected. Insure Oklahoma architects created the program with no identical model from which to work.
There are no pre-existing condition limitations for the individual plan and Insure Oklahoma covers most any healthcare need. Individual plan applicants pay premiums based on a sliding income scale, but premiums are no higher than about $65 monthly. The maximum income for eligibility is based on family size but for a family of four, it’s $44,100 annually.
Businesses with less than 99 employees also qualify, although each worker wanting an Insure Oklahoma premium subsidy must apply and qualify based on the income rules. Higher income employees won’t qualify, according to present guidelines.
But program guidelines have been expanded a little every year to make Insure Oklahoma available to more uninsured people. The latest expansion is inclusion of members’ (ideally not working) children up to age 19.
Working children’s incomes are added into the calculation for the household limit, easily causing ineligibility, officials said.
Lucas said the program has been fortunate to have some immunity to Oklahoma’s fiscal problems, but by no means has escaped budget pressures. Funding fluctuates along with the numbers of smokers. But the prime budget pressure is members’ high use of healthcare services, which Lucas said is understandable, given that many members have been probably been uninsured awhile.
Insure Oklahoma essentially spared members a premium increase, instead, slightly trimming benefits and doctor reimbursements. Restoring doctor reimbursements is one of the healthcare authority’s top five budget requests for the upcoming legislative session.
The program is now near its initial goal of 35,000 members. That means 3,000 spots remain. Lucas’ mission is to fill all available spots to help working Oklahomans.
The program limit is 35,000 people. Initially, 50,000 was the limit, but that turned out to be overly ambitious due to expenses.
Estimates are that about 600,000 Oklahomans are without health insurance. The legislature created Insure Oklahoma specifically to help the lower income and working poor who can’t access health insurance or can’t afford it.
The program began its existence without a model to upon which to base it. Along the way, there have been a few bumps and learning experiences, but the program leverages its recourse well and provides almost every benefit private insurers do. People can apply online or by mail. For aspiring members, Lucas has several caveats.
The most important thing is to provide required documentation, within the allotted time (typically 20 days after conditional approval). Once a member, people should pay their premiums faithfully, and on time to avoid cancellation. If cancelled it takes up to 90 days to rejoin. The program is only available to U.S. citizens.
So is Insure Oklahoma a model that government health insurance can work?
“Sure, especially when you consider the partnerships with private insurance companies,” Lucas said. “We can work things both (on a public basis) and with private industry and help both sides. Of course the biggest government run insurance plan is Medicare and I think a lot of people are happy with that.”
The program’s web site contains detailed information on the program, benefits, eligibility, and frequently asked questions: www.insureoklahoma.org.
Anyone interested can speak to live advisors by calling the helpline, 1-888-365-3742.