This editorial appeared in the February 2, 2017 issue of The Oklahoman
DUE in part to fierce resistance to adopting Obamacare wholesale, a new report shows Oklahoma faces less negative impact from repeal of the Affordable Care Act than almost any other state. At the same time, repeal will open the door to improving health care coverage in Oklahoma.
A report by WalletHub, which compares “the 50 states and the District of Columbia across seven key indicators of both economic and coverage losses,” finds 47 states will face greater impact from repeal of Obamacare than Oklahoma.
“What is clear from the prospect of the ACA's dissolution is that certain states stand to suffer more than others,” the WalletHub report notes.
Thus, repeal of Obamcare appears unlikely to result in dramatic upheaval in Oklahoma. What repeal does offer, however, is a chance to improve health care access in Oklahoma in reasonable ways — something the ACA failed to do.
In a recent USA Today column, former U.S. Sen. Tom Coburn, R-Muskogee, and Paul Howard, senior fellow at the Manhattan Institute, note the Trump administration can allow states to “take the lead on replacement” of Obamacare through the Department of Health and Human Services' ability to authorize “state innovation waivers” that exempt states from many Obamacare regulations.
Coburn and Howard suggest the Trump administration also grant states greater flexibility in their management of state Medicaid programs via so-called “1115 waivers.”
By combining those two approaches, they argue, state officials can implement significant reforms even as Congress works out the logistics of formal repeal and replacement of the current law.
They highlight several reforms that states like Oklahoma could adopt via federal waivers.
“States could make high-deductible health plans with health savings accounts (HSAs) the default standard to qualify for subsidies on the exchanges,” Coburn and Howard write. “For Medicaid recipients, they could add work-search requirements and expand access to direct primary-care plans (those that provide unlimited access to basic health services for a flat monthly fee.) Others might aim to shift more money to poor residents directly by boosting refundable tax credits, which would improve the lives of the poor much more than simply handing them an insurance card.”
They suggest states should allow insurers on Obamacare exchanges to charge lower rates to young, healthy citizens, a currently banned practice that has prompted many young people to forgo insurance altogether because of its high cost. (That proposal would also mean older citizens, who have more health costs, would likely face higher premium costs more in line with their usage.) Greater flexibility in defining “essential benefits” could lead to a better range of insurance products at better prices than what is allowed under the existing system.
The waiver approach also allows states like California to retain the existing Obamacare system if officials in that state choose to do so, although Coburn and Howard argue those states should pay 100 percent of associated costs above a baseline amount funded by the federal government.
Coburn and Howard offer some sound ideas, and Oklahoma officials should be planning for how they will handle the coming opportunity. Repeal of Obamacare won't mark the end of the health care debate, but its beginning.
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This piece originally appeared in The Oklahoman