| By Paula Burkes, The Oklahoman, Oklahoma City | |
| Tribune Content Agency |
April 12, 2015 –Costs of individual health insurance policies in Oklahoma likely will go up again next year. And Insure Oklahoma — the state’s premium assistance health insurance program for lower-income workers of small businesses — should expand to include employers who offer self-funded plans, as well as high-deductible catastrophic policies paired with health savings accounts (HSAs).
The industry prediction — and recommendations — came from insurance experts, agents and brokers who attended an Oklahoma City Association of Health Underwriters continuing education symposium Thursday at Quail Creek Country Club.
Mike Rhodes, deputy commissioner of the state Insurance Department, predicts “the rates in round three (of open enrollment under the Affordable Care Act ) will be higher than anticipated and affordability will become an issue again.”
“The insurance carriers’ actuaries haven’t had enough time to analyze claims experience,” Rhodes said. “So, they’ll load rates, and rates will go up,” he said.
Consequently, the mandate to buy insurance will be waived for more consumers because it will cost more than 9.5 of their annual household salaries, which is an exemption under the Affordable Care Act (ACA), Rhodes said. And if younger, healthier consumers are excused from the insurance mandate due to lack of affordability, carriers will face greater financial risks in insuring a pool of mainly older, sicker patients, he said.
Nico Gomez, chief executive of the Oklahoma Health Care Authority, reported that the SoonerCare state Medicaid system added 8,000 consumers electronically referred by the federally run healthcare.gov exchange, while 10-year-old Insure Oklahoma has 17,000 participants who are at or below 200 percent of the federal poverty level and work for businesses of 99 or fewer employees.
If the federal government extends Insure Oklahoma beyond Dec. 31, the program can support up to 35,000, Gomez said.
“We have room to grow and are still open for business,” he said. The program is funded through yearly state tobacco tax revenues, matched with federal dollars.
Stephania Grober, vice president of sales and marketing for BlueCross BlueShield of Oklahoma, and Rhett Stover, president and chief executive of Oklahoma State University Medical Center, which is managed by Mercy, quoted payment lapses by new healthcare.gov customers of 15 percent and 20 percent, respectively.
Stover also said his organization, in the wake of the ACA mandates, is trying to tie provider performance to government reimbursement rates.
“We have to have a margin in order to fulfill Mercy’s mission to serve the underserved and uninsured,” he said.
To make things easier for customers, Blue Cross Blue Shield of Oklahoma has increased staffing 600 percent, Grober said, and added the option of paying real-time over the phone with credit or debit cards. She said six of 10 enrollees never had insurance before, so the company had to educate them on insurance terms and how to use insurance.
Primary care physician Fatima Jaffrey of Crescent Medical clinic in Edmond advocates for a move away from health insurance and toward direct primary care plans, teamed with HSAs — a little-known, affordable and efficient combination that she said meets ACA requirements.
In a unique practice model that is growing in popularity nationwide, Jaffrey accepts no insurance, but instead charges her patients $50 to $100 a month based on their age; $10 for those 19 and under. In return, her patients, which are limited to 600, are guaranteed office visits of 30 minutes or more and round-the-clock accessibility. She even gives patients her cell phone number.
“Health reform changed our access to health care, but did nothing to bend the cost curve,” Jaffrey said. “Controlling skyrocketing medical costs rests on our ability to innovate effective systems,” she said.
Jaffrey’s clinic, which she opened Dec. 1, currently has 50 patients employed by two separate companies. One employer is paying the monthly direct primary care membership fees for his staff, she said.
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