Here in Oklahoma we have an interesting story to tell. Our economy is growing through sectors

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1 HEALTH CARE It goes without saying that health care reform remains the focus of a great deal of debate and attention even after all the years since the Patient Protection and Affordable Care Act, or Obamacare, became law in On a seemingly daily basis we hear of insurance exchanges, premium costs, and tax subsidies. But what is Obamacare, really, how has it changed our health care landscape, and is this the best health care policy for Oklahoma and our nation? Republican or Democrat alike, you are bound to hear some praises for Obamacare. The law requires insurance companies to provide coverage regardless of pre-existing conditions and allows children to stay on their parent s policy through age 26. It also bans lifetime limits of insurance payouts, a critically important feature to those with chronic medical conditions. You are just as likely to hear criticisms and ideas from both sides of the political spectrum on how the law can be improved. If we are to reform Obamacare, though, what should we change and why? Here in Oklahoma we have an interesting story to tell. Our economy is growing through sectors 1 like aviation and manufacturing, energy and mining, and tourism and hospitality. Our 2 unemployment rate is less than the national average. Our universities and researchers are developing cutting-edge medical advancements. Yet compared to almost every other state a 3 greater share of Sooner s are uninsured and our insurance costs continue to climb. Recent studies from the Centers for Disease Control show that an estimated 36 million Americans had no health insurance in 2014, about 11.5% of the population. Oklahoma had an uninsured rate of over 18%. The facts are even worse for working-age Sooners, those aged 18 64, with an uninsured rate of 21.5%. A high percentage of children in Oklahoma are also 4 uninsured, 10.1% of aged 0 17; nearly twice the national rate of 5.5%. Unfortunately, historical trends do not brighten the health care picture for us. From 2012 to 2015, Oklahoma s uninsured rate increased by 1.5% while the national uninsured rate fell by 5 4.7%. The promise, at the inception of Obamacare, that health care reform would lower the uninsured rate is still unfulfilled in Oklahoma. Obamacare was also designed to make health insurance more affordable. Much like the rates of uninsured, we are not yet seeing in Oklahoma Obamacare s projected decrease for insurance costs. In 2015, deductibles across all plans on Oklahoma s health insurance exchange increased v3.pdf

2 6 by 17%. As for premiums, the cheapest Bronze plan for an individual in Oklahoma City would cost $148 per month, before a tax credit. That same plan in 2014 was 15% less, at $129 per 7 month. Similarly, the more expensive Silver plan also increased in 2015 by 8.8%, to $219. Some experts believe that Obamacare is still too new to judge accurately and costs will level out over time. While that may be true, sticker shock is about to be felt once again for many Sooners: a major insurance provider in Oklahoma, Blue Cross Blue Shield Oklahoma, is seeking premium increases averaging a whopping 31%. So how did we get here? In 2010, Obamacare became the law after a bitter partisan debate on Capitol Hill. Obamacare, has three main goals: increase the quality and affordability of health insurance, reduce the 9 amount of uninsured Americans, and reduce the cost of health care. Accomplishing those goals required creation of new tools for federal and state governments, like a mandate that all Americans have insurance coverage, creation of new state and federally-run insurance marketplaces, and tax subsidies to offset costs for individuals and families. As a whole, Obamacare was the most sweeping change to our health insurance system in generations. Public opinion surveys taken when Obamacare was being crafted show sizeable populations of Americans on either side of the issue, many with strongly held beliefs befitting this huge shift in 10 federal health care policy. Several states, ours included, pursued constitutional amendments against Obamacare. In 2010, voters amended our state constitution to include the Oklahoma Health Care Freedom Amendment to prohibit forcing an individual, employer, or health care 11 provider to participate in a health care system. While it was strongly approved with 65% of voters in favor, this state constitutional amendment does not supersede the federal Obamacare law. The sentiment of the vote, however, led Governor Mary Fallin to decline creation of an 12 Oklahoma-run health insurance exchange as part of Obamacare. Over two dozen other states decided likewise against running their own exchange, in which case the federal government 13 assumed responsibility to provide an online marketplace at healthcare.gov. 6 ms 7 nce-marketplaces/ b-569b-b957-53e8bdf0073d.html

3 Purchasing insurance through the exchange whether as an individual, family, or business owner is designed to be a relatively simple process, though computer glitches have proved problematic since the start of the program. On healthcare.gov, when you submit the required personal information a determination is made on your eligibility for Medicaid or cost subsidies. Information about all insurance plans offered in your area are then displayed in escalating tiers of Bronze, with the least coverage and lowest cost premium; Silver, Gold, and Platinum, with the most coverage and highest cost premium. Catastrophic coverage is also available for some. 14 Current polls show much the same picture as five years ago: we as a nation are largely split on 15 whether we support Obamacare or not. Even so, nearly 11.7 million people purchased health insurance via an Obamacare exchange in That includes a total of 171,584 Sooners, of which 54% are new to the program since 2014 and 81% receive some amount of federal 16 subsidy to help offset the cost. Criticisms and critiques of Obamacare, though, are many. First is the tax penalty imposed on individuals without insurance. This fine starts at $95 or 1% of income and rises to $695, or 2.5% 17 of income in Businesses with more than 50 employees could face a different tax penalty if the federal government has subsidized a full-time employee s health care through a tax deduction. Those same businesses must provide health insurance coverage to employees 18 with 30 or more hours worked in a week. Economists argue this 30 Hour Rule redefines the traditional work week and has resulted in fewer hours and pay for workers. The nonpartisan Congressional Budget Office believes it will cost America s economy two million full-time jobs 19 from when the law took effect through Yet another criticism centers on Obamacare s definition of affordable coverage. Workers are not eligible to receive federal tax subsidies to offset health care costs if their employer provides affordable coverage, defined as costing the worker no more than 9.5% of their household income. Confusingly, however, the IRS has ruled that only the cost of covering the individual 20 employee is factored in to the 9.5% benchmark, not the cost of insurance for his or her family. This bureaucratic blunder has some families paying unsubsidized health care costs that far and away exceed the 9.5% income threshold. The New York Times has reported this could leave 2-4 million people unable to afford family coverage under an employer s plan and yet ineligible for 21 subsidies to buy insurance elsewhere

4 The often heard phrase If you like your plan, you can keep it also has yet to prove true. Here in Oklahoma we are seeing turmoil in insurance providers from year to year. From 2014 to 2015 our state as a whole dropped from six carriers offering insurance plans through the 22 exchange to four. In rural areas its even less, from six down to three. The downward trend statewide is poised to continue in 2016 with another drop in insurers after a shuffle of two 23 more carriers leaving Oklahoma s exchange and one entering. As many have learned, it is up to each affected insurance policy holder to find their own new insurance provider when their plan ends. Amidst the pluses and minuses of Obamacare a great debate continues in Washington, D.C. and state capitals around the country on how best to reform the law. Even more broadly, there is debate about whether to simply tweak the current law or repeal and replace the whole thing. For example, some experts believe minor adjustments like increasing transparency on the costs and quality of health care and prescription drugs could greatly reduce Obamacare s costs while 24 increasing its value. On the other hand, wholesale deregulation of our nation s health care system is advocated by some who see it as a path for increased competition, lower prices, and 25 more efficient care. Most reform plans in the Repeal and Replace category would continue to require coverage of pre-existing conditions and allow children to remain on parents insurance until age 26 while also scrapping provisions like the individual mandate. Differences vary beyond there. A recent proposal from a group of Republican Senators and Representatives would allow insurance companies to sell policies across state lines to allow greater competition nationally and cap monetary damages available from medical malpractice lawsuits. It would continue some form of tax credits to encourage people to purchase insurance, though there would be no 26 fine if you chose to go without. Other experts recommend a reform package that would replace Obamacare s government-run healthcare.gov marketplace with free-market exchanges that allow innovative, lower cost insurance products. Medicare and Medicaid beneficiaries could be slowly phased into the new exchanges via premium supports so those individuals could benefit from the greater competition and value from the market like what has been seen from Medicare Part D. These reforms, some believe, would produce better and cheaper health insurance policies than 22 ms care-system 26

5 Obamacare by putting individuals and families in charge of their own health care spending 27 rather than bureaucrats and government regulators. Still another proposal would offer an off ramp to help states transition away from Obamacare gradually. States would be allowed to waive the individual and employer mandates while enacting policies to encourage a wider range of plans than currently offered through federal and state exchanges. Here too a tax credit would be offered, though available for delivery at any time, not just tax season; and the amount would change based on your age. Seniors, with 28 typically higher insurance costs, would be offered a larger tax subsidy than young adults. Amidst all the ideas legislators, governors, and interest groups have proposed to tinker with or fully replace Obamacare, a commonality remains that costs are too high and the quality is poor. The debate on how to reform our health care system is sure to continue. In the short term, though, President Obama and the Republican-led Congress are unlikely to agree on any substantive changes. As much as health care reform has been one of the most important issues to consider in recent elections, we can expect it to remain front and center in the race for

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