Oklahoma Enrollment Strategies: Options

1
Oklahoma Enrollment Strategies Options

• Voluntary expansion based on opportunities for
  affordable coverage
  
• Induced expansion based on good-citizen culture
  in Oklahoma plus opportunities for affordable
  coverage
  
• Presumed Oklahoma holds providers harmless for
  any uninsured care they provide
  
• Required expansion based on individual mandate
  with subsidies and opportunities for affordable
  coverage

2
Oklahoma Enrollment Strategies Voluntary
Option

• Expansion based on creating opportunities for
  people to gain affordable coverage
  
• Low-cost health plans developed and offered
  specifically to attract the currently uninsured
  
• Examples
• Insure Oklahoma employer-sponsored insurance
• Insure Oklahoma individual plan
• minimum benefit package based on CHAT
• minimum benefit package based on CHAT with
  reinsurance
  
• low-dollar plan (e.g. covers first 50,000) with
  reinsurance
  
• All low-cost plans are exempt from existing
  mandated benefits

3
Oklahoma Enrollment Strategies Voluntary
Option, contd

• Plans are operated through private sector if
  insurers are willing to participate
  
• Subsidies are provided to individuals to assist
  with purchase
  
• Source of funds for subsidies
• federal matching could be available if the
  low-cost plan meets CMS requirements, as Insure
  Oklahoma plans do
  
• otherwise, plan would require a state-only
  subsidy
  

4
Oklahoma Enrollment Strategies Induced Option

• Expansion based on appealing to good-citizen
  culture in Oklahoma together with opportunities
  for people to gain affordable coverage
  
• State law declares it is the responsibility of
  every Oklahoman to have personal means or
  insurance for health care for themselves and
  their family
• No sanction or enforcement mechanism is imposed
  for failure to comply
  
• As above, state creates opportunities for
  affordable coverage, including low-cost plans and
  subsidies to assist with purchase

5
Oklahoma Enrollment Strategies Presumed Option

• The State of Oklahoma would hold healthcare
  professionals and institutions harmless for any
  uninsured care they provide
  
• Providers would be required to treat all persons
  they care for as if they were insured
  
• A state fund would pay when people who are
  uninsured get care
  
• The individual getting care would owe a debt to
  the state rather than to the provider
  
• Payment levels and terms would be set
  prospectively

6
Oklahoma Enrollment Strategies Required Option

• Expansion based on an individual mandate along
  with opportunities for people to gain affordable
  coverage
  
• By statute, the state declares that it is the
  obligation of all Oklahomans to cover their share
  of health care costs through their own resources
  or health insurance

7
Oklahoma Enrollment Strategies Required
Option, contd

• The state sets standards for what every Oklahoman
  must do to meet their obligation
  
• Participate in health plan that meets
  requirements or,
  
• Demonstrate dedicated resources available and
  used for health care costs
  
• e.g. sufficient funds in health savings account
• funds must be used when obtaining care

8
Oklahoma Enrollment Strategies Required
Option, contd

• Presumptive eligibility default enrollment for
  anyone not meeting coverage or resource
  requirements
  
• State enrolls uncovered persons into a default
  plan
  
• Enrollment whenever uninsured are identified,
  whether at the point of service or otherwise, if
  feasible
  
• State pays or guarantees premiums for private
  default coverage or operates a state-run pool
  
• Individual incurs debt to the state for the
  premiums
  
• premium for the number of months the person was
  uninsured
  
• state collects by
• withholding tax refunds
• filing lien for amount owed
• garnishing wages
• filing civil suits to collect debts

9
Oklahoma Enrollment Strategies Required
Option Enforcement

• Possible incentives for Oklahomans to meet this
  obligation
  
• Financial penalties such as loss of state income
  tax deductions, civil fines, or a surcharge on
  premiums
  
• Forfeit any winnings in Oklahoma lottery
• Ineligible for OU or OSU season tickets, or
  in-state tuition at state colleges and
  universities
  
• Ineligible for hunting and fishing licenses
• Ineligible for gun purchases or licenses
• Withhold tags for recreational vehicles, boats,
  ski-doos
  
• Lose homestead exemption
• Lose interest deduction on 2nd residence
• Lien on 2nd residence
• Financial penalty against reportable casino
  winnings