About Oklahoma's Affordable Access to Health Care Act

In response to an increasing number of Oklahomans without health insurance, Gov. Brad Henry and the state legislature passed in 2004 the Affordable Access to Health Care Act. The Act directed the Oklahoma Health Care Authority to work with Medicare and Medicaid to expand access to health care, help small business owners offer health insurance to employees, and re-design available health-care packages to make them more flexible.

History

• In 2003, 20.4 percent of Oklahomans had no health insurance coverage. Just since 2002, more than 3 percent of Oklahomans had been added to the no-insurance ranks. The percentage of uninsured Oklahomans was considerably above the national average. The problem was particularly prevalent among lower-income workers and their families, leading to a health crisis and a drain on the state's economy.

Significance

• Oklahoma's Affordable Access to Health Care Act created the Oklahoma Employer/Employee Partnership for Insurance Coverage (O-EPIC) to provide financial subsidies to small businesses and employees to help pay health-insurance premiums. The O-EPIC program targets low-income individuals and small employers under two programs: the Premium Assistance Partnership Program and the Premium Assistance Public Program.

  Funding from Federal Medicaid funds is combined with funds generated from an increased tobacco sales tax to provide a base on which to support lowered individual and employer premiums--thus expanding the base of health-insurance coverage to a formerly under-served group. More than 600 small business and 1,200 employees enrolled in O-EPIC in its first year of operation. The program is designed to serve up to 70,000 Oklahomans. Individuals contribute up to 15 percent of their health-insurance costs, with the rest covered by the subsidy. Participating employers pay 25 percent of the cost of employee premiums.

Benefits

• The programs created by the Affordable Access to Health Care Act are limited to low-income adults, ages 19 to 64, with their children covered under an existing SoonerCare program for low-income children. Employers with less than 50 employees can participate in O-EPIC to offer coverage for their employees.

  Rather than creating a new insurance plan, O-EPIC utilizes existing private insurance plans. The state contracts with employers and pays the employers the state's portion of the premium coverage; the employer works directly with an insurance company of his choosing.
  Plans approved for the programs are required to cover hospital services, physician services, laboratory services, X-ray services, pharmacy and office visits. Co-pays, pharmacy and out-of-pocket amounts are fixed within the plan and designed with affordable limits for participant payments.

Sustaining Funds

• The State of Oklahoma contributes up to $50 million per year to fund the Affordable Access to Health Care Act. The funds are generated through a tobacco tax that took effect in January 2005. These funds are matched with $100 million annually in federal funds. The partnership between the state and federal agencies is expected to significantly reduce the number of uninsured low-income Oklahomans, many of whom lost their previous insurance coverage because of high premium costs.

Potential

• The plans encourage wellness exams, preventative health-care services and behavioral health services, positively impacting the overall health of lower-income Oklahomans. Business owners, in an O-EPIC follow-up survey, noted that providing health-insurance coverage to their employees had improved not only health, but morale and productivity. The plans also helped them attract new employees.

  As of June 2009, the program is expanding. The state plans to widen the parameters to raise the income cap--currently set at 185 percent of the federal poverty level-- to 200 percent to make more low-income Oklahomans eligible.