With Oklahoma's health statistics continuing to rank in the bottom nationally, state and local policymakers are creating initiatives to insure more Oklahomans and improve the state's health as a whole.
While the diagnosis is disturbing, the prognosis may be brighter than it at first might appear for the health of the patient named Oklahoma.
Its 3.5 million residents lead it to rank at or near the bottom of every health index, according to those trying to treat the problem.
The 2008 report “America’s Health Rankings: A Call to Action for Individuals & Their Communities” places Oklahoma 44th on its ranking of states from most to least healthy. On par with Arkansas (43rd) and ahead of Florida (45th) and Texas (46th), Oklahoma has actually moved up four slots since 2007, when it was 47th.
The report lists among the state’s challenges a high prevalence of smoking, a high rate of cardiovascular deaths and limited access to primary care. Since 1990, the prevalence of obesity in the state has increased by 148 percent. Oklahomans rank 48th in smoking and 43rd in obesity.
“I have been shocked by the health situation in Oklahoma,” says one health care leader.
Earl Denning, CEO of Tulsa’s OSU Medical Center and president of Hillcrest Health Care System, says as a Southerner he is not unfamiliar with cardiovascular disease, obesity and diabetes statistics.
“Oklahoma is right up there with the worst of the worst,” he says. “We have to educate people on how to live a healthier lifestyle, and the hard news is that it will take generations. It’s a journey.”
On the positive side, according to the report, Oklahoma has strong per capita public health funding, due to the work of many in the public and private sectors dedicated to improving Oklahoma’s health picture.
Three recent measures serve as evidence of this commitment.
1. Core Health Benefit Task Force. Passed by the legislature in the spring 2007, it included 40 OK CHAT sessions in 31 communities to obtain citizen input for a report that the task force presented to the Legislature in December 2007. OK CHAT sessions helped the task force determine what participants felt mattered most to have covered in basic health insurance. The task force’s report did not set forth a specific plan. Instead it recommended areas for further research and provided a list of elements those designing such a plan should consider — for example, that the program promote personal responsibility and good health through effective financial and/or benefit incentives and that private insurance companies offer it.
2. The Health Care Reform Task Force. In July 2008, House Speaker Chris Benge, R-Tulsa, appointed seven lawmakers to the task force. Its charge was to examine the state’s health care system and look at the “problems fueling growth in the number of uninsured Oklahomans” and to find “common-sense solutions” that help families. It has wrapped up its work and its final report is forthcoming.
Rep. Doug Cox, R-Grove, who has practiced medicine for 28 years — 11 of those in emergency rooms — and Rep. Kris Steele, R-Shawnee, co-chaired the group. Oklahoma Insurance Commissioner Kim Holland served on its 30-member advisory committee.
But task force leaders seem well aware of the causes of the state’s low ratings.
“Tobacco is the No. 1 cause of preventable illness in Oklahoma,” says Cox, the only medical doctor in the Legislature.
He adds, “We continue to have too many high school dropouts and not enough college graduates. We know that the better educated you are, the more you value insurance, and the higher your income is the more you can afford it.
“Oklahoma also has many small employers who are less likely to offer insurance plans.”
Cos also contents that Oklahoma's health care delivery approach needs improvement. Those without insurance, he says, tend to turn to emergency rooms for help rather than to doctors they can't afford.
A 1986 law titled the Emergency Medical Treatment and Labor Act requires all hospitals that offer emergency services and participate in Medicare to provide a medical screening to anyone seeking emergency care. If the person has an emergency medical condition, the hospital must provide treatment or transfer the patient to another facility for required care.
“I would say that 80 percent of what I see in the emergency room here in a small town would be better served in a physician’s office,” he says. “The care is better because there’s more continuity. It’s also less costly ultimately because of preventive care and of the relationships patients form with their doctors.
“We have to increase insurance availability to get to that situation to improve the state’s health picture.”
3. Insure Oklahoma. To increase the availability of insurance, the Oklahoma Legislature passed Senate Bill 1546 in April 2004 authorizing the Oklahoma Health Care Authority to develop such a program. The program offered the option of health insurance to those from 19 to 64 years old who did not exceed 185 percent of the federal poverty level — either by paying a portion of their private health plan premium or providing coverage under state Medicaid.
In November 2004, Oklahomans voted SQ 713 into law, increasing the sales tax on tobacco products to assist the new program.
Insure Oklahoma — or O-Epic, Oklahoma Employer/Employee Partnership for Insurance Coverage — has two options, one for small businesses and one for individuals. The small-business plan began in November 2005, originally covering businesses with 25 or fewer workers, and later to 50. In mid-January, Gov. Brad Henry approved emergency rules to expand the coverage to include businesses with up to 99 employees and ultimately, 250 employees.
The individual plan began in January 2007, says Melissa Pratt, Insure Oklahoma outreach manager.
“We are a public/private partnership,” she says. “We refer individuals to qualified insurance agents for help in selecting coverage.
“We have more than 16,000 individuals enrolled in both options. Those 16,000 individuals who would otherwise most likely not have health insurance generally pay some amount toward the premium, but one they can afford.
In the Employee Sponsored Insurance plan, the business pays 25 percent, the employee 15 percent and state government 60 percent.
The Individual Plan premiums are decided on a sliding scale with no premium to exceed 4 percent of someone’s annual household income.
The 185 percent of federal poverty level requirement has now increased to 200 percent, meaning that an individual can make up to $20,800 and still qualify for help. A single individual working for a qualifying business can earn up to $23,680.
In 2007, Benge and Sen. Johnnie Crutchfield, D-Ardmore, co-sponsored HB 1225 Expansion of the Premium Assistance Program to increase the business size to 250 employees to bring many more Oklahoma businesses and Oklahomans into eligibility.
After 19 months, it still hasn’t come to a vote, but Pratt says she hopes for action now that the 2008 election is over.
Another bill related to health care could come before Oklahoma lawmakers this year, SB 424 The All Kids Act, directing the Oklahoma Health Care Authority to establish a program to provide medical coverage assistance to children 18 or younger whose family incomes are between 185 percent and 300 percent of the federal poverty level.
Insurance Commissioner Holland says she believes hard work is making the state’s prognosis better but that no simple cure exists for such a systemic problem.
“You don’t push a boulder uphill in a hurry,” she says. “I don’t have unrealistic expectations.
Sometimes, things feels as if they are moving faster than I’m ready for and other times not nearly as fast as I want. But as long as we’re making progress, speed isn’t really relevant. The issues are huge, and to do justice to them well, we have to proceed with deliberation.”