OK-SAFE, Inc. Blog

February 22, 2012

Joint Committee Finally Releases Report – Big Surprise! They Want Exchange AND Another Trust

OK-SAFE, Inc. – After almost a two month delay, the Joint Legislative Committee on Federal Health Care Reform has finally released it’s final report, 3 weeks after the start of OK legislative session.

The Governor and Leadership had seen the committee report much earlier, and legislation implementing the committee’s findings has already been planned and reserved.

No Big Surprises

The Legislature’s February 22, 2012 press release contained no big surprises, especially for those who have been following this state’s years-long implementation of health care reform, via both the HITECH Act of 2009 and PPACA (“Obama Care”).

There was no real surprise either, when yesterday (2/21/12) it was confirmed that SB 1116, a bill to repeal the title of law that created the Oklahoma Health Information Exchange Trust (OHIET), would not get a hearing in the Senate.

The Senate Leadership, and it’s author Sen. Brian Crain, made sure the bill would not get heard.

February 22, 2012 Press Release Excerpt:

“The committee’s final report (attached) recommends that Oklahoma: Continue to fight the federal health care law in court; better educate the public about ways to improve their health; prepare for a dramatic expansion of Medicaid eligibility due to PPACA; begin developing a market-based state health insurance exchange in order to prevent imposition of a federal exchange in Oklahoma; form a permanent legislative committee to monitor issues related to the federal health care law; and increase medical residency programs in order to address current and future doctor shortages – particularly in rural areas.

What the committee is not mentioning here is the fact the work to align Oklahoma with all the technology provisions of both the HITECH Act of 2009, and the PPACA, has already been started, facilitated by legislation creating electronic health records, and by the creation of a public trust called the Oklahoma Health Information Exchange Trust, or OHIET.  If the state builds an exchange, it may say OKLAHOMA (Insure Oklahoma) on the outside, but the inside functionality, and IT standards, will be all federally compliant and interoperable.

The release continues:

“Regarding health insurance exchanges, the report recommends Oklahoma begin taking steps to implement a state-based, free market health insurance exchange. The recommended exchange is similar to the one in development by the state of Utah since before PPACA’s existence. Utah’s exchange model was recommended to the committee by U.S. Sen. Tom Coburn. The recommended Oklahoma exchange would be housed in Insure Oklahoma, which would be spun off from the Oklahoma Health Care Authority and turned into a public trust.”

Besides pointing out the clear contradiction in the statement “state-based, free market health insurance exchange”, (you can’t have both state involvement AND be free-market), this release just confirms the state of Oklahoma, under Republican leadership, is ready to implement a federally compliant exchange, while giving the appearance of fighting “Obama Care”.

Another Trust?

The OHIET is a public-beneficiary trust that was created by stealth in the last week of May 2010.  It is responsible for the implementation of the technology infrastructure in this state that makes “Obama Care” work, establishing the ‘network of networks’ linking the patient (that’s you), the providers, and the payers.   The OHIET operates with no legislative oversight, and as the State Designated Entity (SDE), they can solicit and receive federal grants, award contracts, issue bonds, and incur debt.

In fact, due to timeline extensions by the HHS they could end up soliciting the very same $54M Early Innovator Grant that Gov. Fallin “rejected” in the spring of 2011.

The OHIET is currently using federal grant money to operate (see the Challenge Grant), and are busy awarding each other contracts for health information exchange.

The OHIET trust model was drafted by the law firm Crowe and Dunlevy.  One assumes that this same firm has had a hand in drafting the proposed insurance exchange trust language, transforming Insure Oklahoma into an insurance exchange.

It is virtually impossible to terminate a trust; there has to be political will in the Legislature anyway to make to make it happen.  The Oklahoma legislature, under Republican Governor Mary Fallin, does not want to stop the implementation of health care reform, aka “Obama Care.”

Instead, the Republican-led OK Legislature wants to keep on doing what they’ve been doing – implementing “Obama Care” while giving the appearance of opposing “Obama Care.”

It’s an election year – time to flip some Houses.

Both Committee Chairs – Sen. Gary Stanislawski and Rep. Glen Mulready have indicated they would not have supported SB 1116, saying they prefer a patient “opt-in/out” option.  This, of course, would leave the OHIET, and it’s agenda, intact.

February 22, 2012 Press Release in it’s entirety is available here.

The Final Report of the Joint Committee on Health Care Law is available here.

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November 2, 2011

OK-SAFE to speak at 4th Meeting on Health Care Reform Law – 11-3-11 Tulsa Tech. Ctr.

November 2, 2011

JOINT COMMITTEE ON FEDERAL HEALTH CARE LAW

SUBJECT:                  Fourth Meeting

MEETING DATE:       Thursday, November 3, 2011

MEETING TIME:        9:00 A.M.

LOCATION:                Tulsa Technology Center, Riverside Campus, 801 E. 91st St., Tulsa, Oklahoma.

____________________________________________________________________________________________________________

Agenda:

1.         9:00 – 10:00 AM, Exchange options, federal, federal/state partnership, state – Krista Drobac, Director of Health Division, National Governors Association

2.         10:00 – 10:45 AM, Technology and privacy issues with exchanges – Amanda Teegarden, Executive Director, OK-SAFE, Inc.

3.         10:45 – 11:30 AM, Current Technology – David Kendrick, Director of HIT

4.         1:00 – 1:45 PM, Agent Compensation – Ryan Young, Director, Federal Government Affairs, Independent Insurance & Brokers of America

5.         1:45 – 2:45 PM, Exchange Options – Ed Haisimaier, Heritage Foundation

6.         2:45 – 3:30 PM, Exchange Providers – Josh Beckett, Benefit Focus

7.         3:30 – 4:15 PM, Exchange providers – Ceridian

8.         Other Business

 

Senate Appointees: House Appointees:
Sen. Gary Stanislawski, Co-Chair Rep. Glen Mulready, Co-Chair
Sen. Cliff Aldridge Rep. Doug Cox
Sen. Bill Brown Rep. Randy Grau
Sen. Brian Crain Rep. Jeannie McDaniel
Sen. John Sparks Rep. Jason Nelson
 

Senate Staff:

 
Jennifer Mullens, Legislative Analyst Andrew Messer, Fiscal Analyst
Alicia Emerson, Legislative Analyst Anthony Sammons, Staff Attorney
Lori Block, Staff Attorney Darrell D. Washington, Admin. Asst.

 

September 18, 2011

OK-SAFE, Inc. Reporting – 1st Joint Committee Mtg on Federal Healthcare Reform/Exchanges

OK-SAFE, Inc. –  The first meeting of the Oklahoma joint legislative committee formed in spring 2011 to examine the impact of the federal healthcare reform law/exchanges on the state of Oklahoma was held in the House Chambers on Wednesday, Sept. 14, 2011 at the OK Capitol.

Below are the notes taken during this presentation by OK-SAFE, Inc.  Included in these notes are:

  1. The minute markers for the start and stop times for the individual speakers
  2. Some notes on their presentations
  3. Some key transcriptions of the comments by two presenters – Julie Cox-Kain of the OK Dept. of Health on the exchanges, and Buffy Heater of the OK Health Care Authority on the information technology system changes required.

Consider their presentations as confirmations of what OK-SAFE and others have been researching regarding the intent and purpose of healthcare reform and the role the exchanges play:  the creation of a ‘fused’ technology system that contains comprehensive information about all individuals, connected to/interfacing with a developing federal data hub, or federal data ‘cloud’ as it was referred to.

It is confirmation of the Vision 2015 document issued by the Director of National Intelligence – a roadmap for the systemic change of our entire governmental structure.

__________________________________________________________________________________________________

Notes on First Joint Committee Meeting on Health Care Reform in Oklahoma

Wednesday, September 14, 2011

9:00 am to 4:00 pm

House Chambers, OK Capitol

Oklahoma City, OK

Link to OK House Video:  http://okhouse.granicus.com/MediaPlayer.php?view_id=2&clip_id=387

Video Minute Markers indicated in [brackets]

 

Key Excerpts:

 

Question by Rep. Nelson to Julie Cox-Kain (OK Dept. of Health)– “One other question I’ve got is, what my understanding is that probably the states’ health care authority would be where an exchange would be housed, but where are other states putting it, is that the best place for an exchange here? If the federal government produces an exchange, would they house it in Washington, would they house it here, where are these things going to be housed?”

 

Answer by Julie Cox-Kain –  “States have an option for governance of an exchange, governance and operation of an exchange, and it can be implemented through a state agency, or you could have a non-profit entity, and you can contract out certain functions of the exchange.  And so, in fact, you could even have a quasi-governmental entity. This has been addressed or mentioned some in the dialogue about how we would govern and operate an exchange. Actually could even have a trust, there are some in existence now, that govern that exchange.  There is a little bit of state flexibility in how we choose to go forward and implement and/or operationalize an exchange.  Again the question about the federal government exchange, there’s very few answers to what the federal government exchange would look like, so it is very hard to make that particular decision without that part of the equation being known.”

 

Buffy Heater (OHCA) presentation – “Now we’re going to talk about the technical aspects of information systems changes. So I think I’ll start off by addressing the question that was brought up earlier in the session about the federal data hub or the federal data exchanges that are being established as part of the ACA through both the exchange set-up as well as for the Medicaid income verification pieces.  So basically, the federal government is creating a data hub, or a data cloud, as it be, in that there will be sources from federal agencies, the IRS, the Social Security Administration, and the Department of Homeland Security, where there will be member level or individual level information that is fed up to this data cloud. 

 

Then there will be queries from the states or from a federal exchange that will be able to be sent up to that federal data hub and a match return, that basically says for this person’s last IRS data here was their modified adjusted gross income. Or validating that that individual’s social security number is as was reported matches, yes indeed, it matches on that individual’s name and date of birth. As well as the Homeland Security is going to verify individual citizenship and identity, if possible. 

 

So the federal data hub is going to require that it is a state level entity that engages in the contractual relationship between the federal government, and so the way the proposed rules that Cindy had mentioned before, right now those proposed rules do limit states in that it is restricted to only state operated  entities that can be able to engage in that federal data hub. I will tell you that the feds are specifically soliciting comment on states that might be looking at having a private entity run and operate their exchanges and how the rules might accommodate that…. the ACA requires a ‘plug’ of sorts to be ready to plug Medicaid into the exchanges….”

(Slide) New CMS IT Guidance – Service Oriented Architecture, Reusable, Interoperable, Scalable, Ease of Use.  Some states are still using legacy mainframe systems.  So federal government required (above list).

(Slide) CMS IT Funding – Enhanced funding available – Medicaid Eligibility Systems (thru 12-15-2015) – 90% match – design, development and implementation.  75% match – ongoing operations. In the past was only 50%.

_____________________________________________________________________________________________________

Opening Comments by co-chairs Rep. Glen Mulready and Sen. Gary Stanislawski [00:00:00 to 00:22:00]

 

I)                    Julie Cox-Kain, Chief Operating Officer, OK State Dept. of Health

[Minute Marker 00:22:01 to 00:53:26]

Topic – “Present State of Health Outcomes and Health Care in Oklahoma”

 

Slides:       (NOTE: Missing one slide on an OK health stat)

  1. OK has excess death and mortality & overall health rankings
    1. Chart of Determinants of health and their contribution to premature death.  Environmental, social circumstances (stressful), healthcare 10%.  Insurance reform addresses access to health care, genetic disposition, behaviors.
    2. United Health Foundation rankings for Oklahoma 2010 – showed selected health measures: cardio vascular disease, tobacco use (25%) 48th in nation, access to care measures, leads to other outcomes we’d like to track in our state.  (Prevalence of obesity in our state), preventable hospitalizations, i.e. people aren’t controlling their conditions very well; infant mortality rate (significantly higher than other states); immunization coverage, lack of health insurance; primary care physicians availability.  Overall health ranking is 46.
    3. United Health Foundation Rankings Oklahoma 2010. We track fruits and vegetables consumption.  Only 14% of our population gets 5 fruits and vegetables/day.  Other stats on people’s behaviors. How are you feeling?  19% of our population responded that they don’t feel very well.
  2. Leading causes of death in Oklahoma.
    1. Total Mortality Rate per 100,000 Population  – 2005-2007.  Source: State of our State Health Report.  Some counties earned an “F” due to chronic conditions and behaviors.
    2. Leading Causes of Death in Oklahoma – heart disease, cancer, chronic obstruction/pulmonary
    3. Heart Disease Rates – Oklahoma is in the bottom for heart disease rates. (Burden of disease.)
    4. Leading risk factors for Heart Disease: Physical inactivity, overweight and obesity, high blood pressure, smoking, high cholesterol, diabetes.
    5. Cancer Rates per 100,000 Population 2007.  OK has one of the worst rates of cancer death
  3. Cancer Death Rate per 100,000
  4. Leading Cancer Types in Oklahoma – Lung disease, etc.
  5. Risk Factors for Lung Cancer
    1. Chronic Obstructive Pulmonary Disease in US 1999-2006.  Oklahoma has high rate of burden.
  6. Chronic Lower Resp. Disease Death Rate per 100,000 Popl 2005-2007
  7. Risk Factor for COPD in OK
  8. Stroke Rates – U.S. Map
  9. Stroke Death Rate per 100,000 Population in OK
  10. Risk Factors for Stroke Death – High blood pressure, etc
  11. Hospital Cost Associated with Top Four Cause of Death in OK 2009 Heart Disease $2.1 B,
  12. Infant Mortality in Oklahoma
  13. Infant Mortality Rate per 100,000 Population 2001-2006
  14. Infant Mortality Rate per 1,000 Population 2005-?
  15. Top 3 Cause of Infant Mortality Death in Oklahoma
  16. Risk factors for Infant Mortality – lack of prenatal care, poor nutrition, etc.
  17. Health Behaviors and Risk Conditions in OK
  18. Adult Obesity – OK at 32%, trending up.  Expensive to treat, this is an economic issue.
  19. Tobacco Use – slight reductions in use, still over 25% of our population still smokes.
    1. Physical Inactivity – our citizenry is not active enough.  If more active they are well, and less sick. A lot of these are due to choice and we can contribute to that choice, to encourage them to choose health
    2. Fruit and Vegetable Consumption – we trend down.  We are teaching our children that we don’t eat enough fruits and vegetables (teaching this in our schools.)
  20. Summary of Health Status in Oklahoma.

Q & A – [00:53:27 to 1:07:30]

Q.   Mulready – cancer state question;

Q.   McDaniels – women’s health conditions;

Q.   Rep. –  obesity;

Q.   Morgan re Hospital Costs associated with top four causes of death in OK 2009.  A: These health outcomes are the result of multiple factors, per capita cost for treatment, will factor in to cost of insuring them. Mulready re United Health Care Rankings about infant mortality and access to prenatal care.  “We want mothers to get proper nutrition and supplements and get them early in her pregnancy.”

Q.   Mulready re $5 billion attributed to obesity, could you name the top three things we could do to impact that, those are public dollars.

A.    One thing we can do is create the expectation that we expect wellness, physical activity in school, we need to support communities and empower them to make good choices, increase access to fruits and vegetables.  These are available in Certified Health Communities program. Certified Healthy Business program, too.  Q. Rep. Grau re ratio of primary care physicians ranking near the bottom, physician assistance, nurse practitioners, telemedicine?

A.    Run the state office of primary care.

Q.    Grau re pancreatic cancer – outside factors that contribute?

A.   Can’t answer.

Q.   Rep. Nelson re death and mortality rate, is there any correlation between infant

mortality and teen pregnancy?

A.    High teen pregnancy rate so parents don’t have time to educate their offspring on the issue.

________________________________________________

Additional speakers included Mike Fogarty, CEO of the Oklahoma Health Care Authority (OHCA); Buffy Heater and Cindy Roberts, both with the OHCA; and Jason Sutton of OCPA. (Sutton was the only non-government presenter, and the one who provided a dose of reality about the tremendous growth of expenditures (169%) versus number of enrollees (47%)  since the creation of the OHCA.)

The rest of notes on this meeting are on the OK-SAFE, Inc. website here.

September 7, 2011

UPDATE: Revised First Joint Committee on Federal Health Care Law Meeting Notice – Sept. 14, 2011

(9/8/11 UPDATE: Below is the revised agenda for the first joint committee meeting.)

The first meeting of the joint legislative committee on the effects of the federal health care law (Affordable Care Act, aka “ObamaCare”) on Oklahoma will be held in Oklahoma City on Wednesday, September 14, 2011 at 9:00 am in the House chamber at the OK State Capitol.

This first meeting appears to be featuring some of the key members of the Health Insurance Exchange Steering Committee from the Oklahoma Health Care Authority.  The OHCA is the recipient of the federal grants to implement health care reform, including a $1 M planning grant, as well as being the intended recipient of the $54 M Early Innovator Grant the state accepted then “rejected” earlier this year.

Committee co-chairs are Sen. Gary Stanislawski and Rep. Glen Mulready. Every Oklahoman with concerns about the implementation of health insurance exchanges (now “marketplaces”), the use of electronic medical/health records and medical privacy should try to attend this meeting.  This looks to be an all-day meeting, so come prepared to spend some time.

The entire notice is below, including the joint committee members.

Future meetings are to be held in Tulsa, and then again in Oklahoma City.  Dates and times are not confirmed at this time.

____________________________________________________________________________________________________

MEETING NOTICE

Date of Notice: September 7, 2011

JOINT COMMITTEE ON FEDERAL HEALTH CARE LAW

SUBJECT:                  First Meeting

MEETING DATE:   Wednesday, September 14, 2011

MEETING TIME:        9:00 A.M.

LOCATION:                House Chamber, State Capitol Building

_________________________________________________________________________________________________________________________________________________

Agenda:

9:00 am – 11:30 am                                                                          

1.              Welcome and Introductions

2.              Present State of Health Outcomes and Health Care in Oklahoma

Julie Cox-Kain, Chief Operating Officer, Oklahoma State Department of Health

                                                Mike Fogarty, Chief Executive Officer, Oklahoma Health Care Authority

1:00 pm – 4:00 pm

 3.              PPACA: Description of Mandates, Costs, and Other Implications for the State Concerning Public                         Health

Julie Cox-Kain, Chief Operating Officer, Oklahoma State Department of Health

 4.              Medicaid and Accountable Care Organizations

Buffy Heater, Director of Planning and Development, Oklahoma Health Care Authority

                                                Cindy Roberts, Deputy Chief Executive Officer, Oklahoma Health Care Authority

                                                Jason Sutton, Policy Impact Director, Oklahoma Council of Public Affairs

5.              Other Business

Senate Appointees:                                                     House Appointees:

Senator Gary Stanislawski, Co-Chair                Rep. Glen Mulready, Co-Chair

Senator Cliff Aldridge                                                 Rep. Doug Cox

Senator Bill Brown                                                      Rep. Randy Grau

Senator Sean Burrage                                                Rep. Danny Morgan

Senator Brian Crain                                                    Rep. Jeannie McDaniel

Senator John Sparks                                                  Rep. Jason Nelson

Senate Staff:

Jennifer Mullens, Legislative Analyst

Alicia Emerson, Legislative Analyst

Lori Block, Staff Attorney

Andrew Messer, Fiscal Analyst

Anthony Sammons, Staff Attorney

Darrell D. Washington, Administrative Assistant

May 19, 2011

It’s Official! Health Insurance Exchange Bill (SB 971) Won’t Be Heard

Oklahoma City, 5/18/11 – Legislative leaders today announced that SB 971, the Senate substitute for the controversial  Health Insurance Exchange bill (HB 2130), will not be heard this session.

Instead, the OK Legislature will form a special joint legislative committee to examine how the  federal health care bill impacts Oklahoma.

This is a win for the citizens who have been lobbying against this effort all session.  (See earlier posts below for details).

If these legislators are serious about really examining the federal health care bill, and health insurance exchanges, and willing to be honest about its’ impact on Oklahomans, they will have independent citizen-researchers participating in this committee.

Below is today’s press release from the OK Legislature.

Health Care Law To Be Studied Over Interim
Direct Link to This Story

PhotoContact:Jarred Brejcha
Capitol: (405) 521-5605

Contact: John Estus
Capitol: (405) 962-7674

OKLAHOMA CITY (May 18, 2011) – Legislative leaders today announced the formation of a special joint legislative committee that will study how the new federal health care law affects Oklahoma.

As a result, legislation that would create an Oklahoma health insurance exchange will not be heard this year.

Senate Pro Tem Brian Bingman and House Speaker Kris Steele ordered the formation of the joint committee.

“Studying this issue in more depth makes for healthy legislative process,” said Steele, R-Shawnee. “The more ideas we have at the table, the better. The scope of this law is vast, so we need to make sure we are prepared to address this law in a conservative way that is best for Oklahoma.”

The joint committee will hold a series of public meetings over the legislative interim focusing on how the federal Patient Protection and Affordable Care Act affects Oklahoma. The committee will also explore how to best approach the law as the state awaits the outcome of its lawsuit challenging the law’s constitutionality.

The committee will make recommendations on how the state should address the federal health care law.

The committee will also study the costs local governments and businesses will face as a result of the federal health care law.

“The best course of action for Oklahoma to take at this point is to step back and absorb the weight of this federal law and study it in more depth so we can proceed on the right course,” said Bingman, R-Sapulpa. “In light of our opposition to the federal healthcare law, we need to have the public and private sector work together to come up with the best solutions for Oklahoma.”

The committee’s co-chairs will be Sen. Gary Stanislawski, R-Tulsa, and Rep. Glen Mulready, R-Tulsa. Additional members will be named at a later date. The committee will have bipartisan membership.

“There is widespread support and excitement among all the stakeholders about the prospect of studying this issue in more depth,” Stanislawski said. “Participation in this joint committee will be enthusiastic. We look forward to receiving a wide variety of input and coming up with recommendations that serve all of Oklahoma well.”

“Oklahomans clearly oppose the federal health care law, as evidenced by the passage last year of a state question opting out of the law and our lawsuit against the federal government challenging the law,” Mulready said. “We do not like this law, but we must responsibly address it so Oklahomans can continue to have choices rather than mandates when it comes to their health care.”

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