Insurance Exchange Bill on “Hold” Pending Supreme Court Action – OK Senate Changes Mind on SB 1629??

OK-SAFE, Inc. – In a very interesting move the OK Senate on Thursday (3/8/12) issued a press release stating that, “legislative leaders and the chairmen of the Joint Committee on Federal Health Care Law have opted to wait until the outcome of the Supreme Court proceedings before moving further forward with SB 1629.”

SB 1629 would have established the “Health Insurance Private Marketplace Network Trust”, governed by an appointed Board, that would administer a premium assistance plan (low income insurance, Medicaid), and assist small businesses and/or employees to purchase employer-sponsored insurance.

In other words, a state-based insurance exchange, tying users of Medicaid and private insurance together; a sort of public/private partnership exchange.

But, those phone calls, emails, in-person lobbying, and robo calls, all objecting to an insurance exchange (state-based or otherwise), paid off.   One bad bill has been stopped.

For now.

Score one for the people of Oklahoma!

However, in politics, there is always a Plan B.   What Oklahomans can expect is some other tactic being used to achieve the same end – the establishment of some sort of web-based insurance exchange in the state of Oklahoma, that will tie into the health information exchange, which is being advanced by the Oklahoma Health Information Exchange Trust (or OHIET), unstopped.

What may happen is the utilization of the existing HUB law (HB 2026 in 2009) passed a few years ago, to create an exchange, possibly bidding out some service to a third party.  (See details below press release.)

Send Thank Yous

If you would like to send a thank you for putting SB 1629 on hold, you may want to contact the following legislators, in addition to your own Senator:

• Senator Brian Bingman – bingman@oksenate.gov
• Senator Gary Stanislawski – stanislawski@oksenate.gov
• Rep. Kris Steele – krissteele@okhouse.gov
• Rep. Glen Mulready – mulready@oksenate.gov

 

Below is the text of the 3/8/12 Press Release, issued jointly by Senate and House leadership.

Oklahoma State Legislature

For Immediate Release: March 8, 2012

SB 1629 is on hold pending Supreme Court action

The Legislature will wait until after the U.S. Supreme Court rules on the constitutionality of the federal health care law before proceeding with Senate Bill 1629, legislators announced Thursday.

The U.S. Supreme Court is expected to rule this summer, perhaps as early as June, on a legal challenge brought by several states alleging the federal Patient Protection and Affordable Care Act is unconstitutional.

Should the high court overturn the law, the possibility exists that health insurance exchanges would not be necessary. And should the high court uphold the federal law, nuances within the majority opinion could help legislators craft the most effective Oklahoma-based marketplace possible to defend against the imposition of a federal exchange.

Given these dynamics, legislative leaders and the chairmen of the Joint Committee of Federal Health Care Law have opted to wait until the outcome of the Supreme Court proceedings before moving further forward with SB 1629. If the court upholds the law, the Legislature is already prepared to continue defending against federal intervention into the Oklahoma health care market.

“There are many common-sense solutions conservatives can agree on to lower the cost of healthcare, expand access and choices to more individuals, and increase the quality of our care – all through tried-and-true principles of the free market,” said Sen. Gary Stanislawski, R-Tulsa, co-chairman of the Joint Committee on Federal Health Care Law.

“These are ideas worth pursuing, and we eagerly await the Supreme Court’s repeal of ObamaCare so we can begin the very serious business of addressing our healthcare challenges with solutions that expand freedom instead of government,” Stanislawski said.

The Joint Committee on Federal Health Care Law met five times throughout the interim to determine the effect the law will have on Oklahoma. Among its recommendations was to craft a state-based marketplace in order to prevent the federal government from imposing a federal exchange in Oklahoma.

“If the court doesn’t reject this law as we hope, developing a state-based exchange remains our best defense against unwanted federal intervention,” said Rep. Glen Mulready, R-Tulsa, the committee’s other co-chairman. “We think we have fashioned a good plan. We are willing to wait to ensure we have the best possible solution to protect Oklahoma from federal intervention.”

Legislative leaders supported the committee co-chairmen’s decision.

“Republicans in the state Senate will do everything in our power to block ObamaCare in Oklahoma. When President Obama rammed through a trillion dollar unconstitutional assault on the healthcare freedom of Oklahomans, he proved his values are fundamentally at odds with ours,” said Senate President Pro Tempore Brian Bingman, R-Sapulpa. “The fight to preserve healthcare freedom is far from over.”

“Developing a state-based solution has always been and remains the best, most realistic way to defend against a federal exchange. The reality is we’re not yet at the point where we absolutely have to deploy that defense,” said House Speaker Kris Steele, R-Shawnee. “Should the time come, we’ll be prepared to act thanks to the groundwork the committee has laid for us.”

For more information, contact:
Nathan Atkins
405.521.5605
atkins@oksenate.gov

John Estus
405.962.7674 desk, 405.706.0084 cell
john.estus@okhouse.gov

Title 36, Section 4601 – 4603:

Article 46 – Health Care for Oklahomans Act

§ 4601. Short Title

§ 4602. Duties of Health Care for the Uninsured Board

§ 4603. Program to Encourage Individuals to Enroll in Health Insurance Programs – Referral of Uninsured Individuals to the HUB

This is the section of law last year’s HB 2130 was attempting to amend.  This will bear watching for the rest of this session.

 

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.

OK-SAFE Response to Federal Health Care Reform committee

OK-SAFE, Inc.

AP reporter Sean Murphy on Tuesday asked OK-SAFE Executive Director Amanda Teegarden for some comments about the 2011 Joint Legislative Committee and Health Care Reform Law. (Teegarden spoke to this committee on 11/3/11 in Tulsa.)

Formed at the conclusion of the last legislative session to examine the impact of the federal health care reform law on Oklahoma, this committee held its’ fifth (and final) meeting on Tuesday, 11/15/11 in the House chambers.

Video of the meetings is posted on the OK House website.

Below are the five questions asked and OK-SAFE’s responses.*

Q. 1 )   Do you think the Oklahoma Legislature should ignore the federal requirement that a health care exchange be established? If so, why?  

• Yes, we think the Oklahoma Legislature should ignore the federal requirements for an exchange.
•  While we can appreciate the complexity of the health care issue in general, we believe that the main problem with this committee’s efforts was the fact that health care reform was not defined to begin with.  Health care reform is actually about the development of the IT (information technology) framework that establishes a Nationwide Health Information Network, the creation of an electronic health record on everyone, the flow of highly personal information across jurisdictions, and government access to everyone’s health and medical records.
• Several presenters actually spoke about this Nationwide Health Information Network as a “federal data hub” – one presenter referred to what the feds are doing as being like “something out of a TV show.”
• What this “hub” does is allow the federal government access to any and all information a state may have on it’s citizens, including their health and medical records.
• The state of Oklahoma is progressively developing the infrastructure necessary to help facilitate this federal data hub, sometimes referred to a “globally integrated and networked intelligence enterprise”.

Q. 2)   What about the provision that provides if a state doesn’t establish an exchange, the feds will do it for them?

• The state of Oklahoma has been establishing “health care reform” for a while now, and in 2010 established a public-beneficiary public trust called the Oklahoma Health Information Exchange Trust (OHIET).  (SB 1373 in 2010).
• This trust is establishing the ‘network of networks’ that allow for the seamless flow of electronic health records (including medical records) throughout the state, and elsewhere.
• The OHIET’s purpose is to establish the framework for health information exchange , to establish a ‘network of networks’ and to link providers, payers and patients.
• According the OHIET’s Cooperative Agreement with the Office of the National Coordinator (the feds), the OHIET plans to align the state’s health information exchange(s) with the federal requirements.
• Because the OHIET trust has been actively implementing the technological infrastructure necessary for “ObamaCare” to function in this state, it doesn’t matter if the state establishes a state-based health insurance exchange or lets the federal government establish it for us.  The functionality of a state-based insurance exchange will be the same as the federal governments exchange and it will be linked to the health information exchanges.

The OHIET HIE logic model. Do we really want this system in Oklahoma? Do we want to make it easier for the feds to access our health records?

Q. 3)   Do you think the state should count on the health care law being overturned/dismantled by a the Supreme Court or a future administration?

• Because of the OHIETs activities and other agencies’ activities, it won’t really matter if the Court finds the individual mandate unconstitutional. The technological framework establishing the two exchanges – the health information and the health insurance exchange – and linking to the Nationwide Health Information Network, is moving forward.
• The only differences allowed in a state-based insurance exchange would be those differences that don’t make a difference.  For instance, the state has some flexibility in defining who the Navigators will be and the role they’ll play, and whether the exchange website portal functions like Expedia or not.
• All of the technological standards, interoperability and information sharing requirements, as well as government and third party access to records, will be aligned with the federal governments requirements.

Q. 4)   What are your thoughts about the ability of the tea party and other grassroots conservative groups like yours to successfully fight against the establishment of the exchanges and to resist the implementation of the federal health care law in Oklahoma?

• While we’re not speaking for all the grassroots groups in Oklahoma, we think the state should not establish a health insurance exchange. It’s contrary to what the people of Oklahoma want, and we already voted against it  (at least, we thought we did).
• Politically, it would be better to let the feds take all the blame for what is going to happen.  Any legislator who decides to move forward with an exchange – whether a state-based non-profit, a for-profit, or a hybrid – is going to be forever linked to it.
• Next year is an election year – it is my understanding that the citizens of Oklahoma will be making an issue of the health insurance exchanges.

Q. 5)   What are your thoughts in general about this task force and the work they’ve conducted, recommendations they should make?

• In general, the committee chairs leaned toward speakers that favored the establishment of a state-based insurance exchange and who advocated for following the requirements of ARRA and PPACA.  Other than two speakers from OCPA, OK-SAFE was about the only other “conservative” organization featured.
• OK-SAFE Recommendations: Don’t build a state-based exchange in any format.  Allow providers, payers and patient an escape route – they should not have to play (or pay) into this “network of networks”; let them function outside any and all exchanges without penalty.
• Further recommendation:  Terminate the OHIET trust and audit the OHCA.

*It is not known when, or if, these responses will used by the AP reporter, who sent his request on 11/15/11.

In the meantime, write your legislator and tell them we still mean NO to “Obamacare” – and this includes the exchanges.

[Go to http://www.oklegislature.gov, click on Legislators to see contact information.]

Final Health Care Reform Meeting 11/15/11 – House Chambers, OKC

OK-SAFE, Inc. – The fifth and final meeting of the joint legislative committee to examine the effects of the federal health care reform law (Affordable Care Act, aka “ObamaCare”, etc.) on Oklahoma will be held in the House Chambers on Tuesday, November 15, 2011.

Every Oklahoman with concerns about the implementation of health insurance exchanges (now “marketplaces”), electronic health records (EHRs) being shared everywhere, or infringements on your medical privacy needs to attend these meetings.

The meeting, which runs from 9 am to 12 pm, is open to the public and will  be streamed online and taped.

The agenda for the final meeting is below.

 

JOINT COMMITTEE ON FEDERAL HEALTH CARE LAW

SUBJECT:                  FIFTH MEETING – Revised

MEETING DATE:       Tuesday, November 15, 2011

MEETING TIME:         9:00 A.M – 12:00 P.M.

LOCATION:                 House Chamber, State Capitol Building.
____________________________________________________________________________________________________________

Agenda:

1.         9:00 a.m. – 10:00 a.m.   Non Profit Exchange – Mark Tozzio

2.         10:00 a.m. – 11:00 am   Non Profit Clinics

3.         11:00 a.m. – 12:00 pm  Committee Discussions

4.         Other Business and Adjournment
Committee co-chairs are Sen. Gary Stanislawski and Rep. Glen Mulready.

Contact Senator Gary Stanislawski’s or Rep. Glen Mulready’s office to express your objections to the creation of a state-based exchange (either kind), and the linking of our medicalhealth records to a “federal data hub”.

Sen. Stanislawski: 405-521-5624
Rep. Mulready:        405-557-7340
Committee Members:
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
_________________________________________________________

To call these legislators, see their contact information here.  Click on Legislators link, then Senate of House members pages.

Video/Audio

Video of three of the four other meetings is available on the House website here and on the http://www.okhealthcare.info website, which also has the speakers’ presentations.

Audio of the 10/26/11 meeting is available – it takes a while to download. The Solicitor General’s comments about the OK lawsuit, the ballot initiative and ‘opt out’ are heard in the first 20  minutes.

The fourth meeting featured seven speakers, including Amanda Teegarden, Executive Director of OK-SAFE, Inc., presenting Health Care Reform – IT, Privacy and Security Issues. 

This ppt is available on the OK-SAFE website; the video of this presentation is viewable on the 11/3/11 House video beginning at minute marker 00:56:00.

Psalm 118: 8,9 – “It is better to take refuge in the LORD, than to trust in man.  It is better to take refuge in the LORD, than to trust in princes.”

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.

 

Health Care Reform Law/Exchanges Meetings – OKC and Tulsa

OK-SAFE, Inc. – The third meeting of the joint legislative committee to examine the effects of the federal health care reform law (Affordable Care Act, aka “ObamaCare”, etc.) on Oklahoma will be held in the Senate Chambers at the Capitol on Wednesday, October 26, 2011.

The meeting will run from 9 am to approx. 4 pm and should be available for viewing online.

The third meeting features speakers addressing the impact on Indian Health; status of lawsuits, and the ballot question opposing the mandate; federal vs. state exchanges; constitutional issues; what other states are doing.

Every Oklahoman with concerns about the implementation of health insurance exchanges (now “marketplaces”), electronic health records (EHRs) being shared everywhere, or infringements on your medical privacy needs to attend these meetings.

Committee co-chairs are Sen. Gary Stanislawski and Rep. Glen Mulready.

Contact Senator Gary Stanislawski’s or Rep. Glen Mulready’s office to be notified of meetings.

Sen. Stanislawski: 405-521-5624
Rep. Mulready: 405-557-7340

The agenda for the third meeting in OKC is below, including the names of the joint committee members. This meeting will be held in the Senate Chambers and audio/visual should be available online.

[NOTE: The fourth meeting, scheduled for Thursday, November 3rd, 2011, will be held at the Tulsa Technology Center, Riverside Campus. Amanda Teegarden, Executive Director of OK-SAFE, Inc., is one of the scheduled presenters on that date, addressing the technology, security & privacy concerns associated with the implementation of health care reform. The fifth, and last, meeting will be in OKC on Nov. 15, 2011.]

_______________________________________________________________

MEETING NOTICE

JOINT COMMITTEE ON FEDERAL HEALTH CARE LAW

SUBJECT: Third Meeting

MEETING DATE: Wednesday, October 26, 2011

MEETING TIME: 9:00 A.M. – 4:00 pm (approx. end time)

LOCATION: Senate Chamber, State Capitol Building
__________________________________________________________

Agenda:

1. 9:00 – 10:00 – Affordable Care Act impact on Indian Health – Jefferson Keel, Lt. Governor, Chickasaw Nation

2. 10:00 – 10:45 – Status of PPACA lawsuits, what the ballot question did for Oklahoma – Pat Wyrick, Oklahoma Solicitor General

3. 10:45 – 11:30 – Comparison of Federal vs. State based Exchanges – David Blatt, Director of Oklahoma Policy Institute

4. 1:00 – 1:45 – Constitutional issues – Andy Spiropoulos, Professor of Law and Director of the Center for the Study of State Constitutional Law and Government, OCU School of Law

5. 1:45 – 3:00 – What other States are doing – Laura Tobler, Health Programs Director, Martha Salazar, Policy Associate, NCSL

6. Other Business

Committee Members:
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
_________________________________________________________

To call these legislators, see their contact information here. Click on Legislators link, then Senate of House members pages.

There OK legislature has created a website detailing these meetings: http://www.okhealthcare.info – check for meeting details, including presentations.

NOTE: The second meeting took place on October 5, 2011 at the Tulsa Technology Center, Riverside Campus, and featured speakers from the OK Insurance Dept., providers, and insurance underwriters. One presenter, Janet Trautwein, of NAHU, hinted at the development of the federal data hub. Video of this event is here.

Psalm 118: 8,9 – “It is better to take refuge in the LORD, than to trust in man. It is better to take refuge in the LORD, than to trust in princes.”

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%) 48^th 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.

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

OK Health Insurance Exchange Update – Public Meetings this Fall

OK-SAFE, 6/6/11 – The substitute language for the failed HB 2130 (HUB board bill, establishing governance of the health insurance exchange) finally appeared in SB 971, introduced on 4/27/11.

Due to all the calls, emails and legislative visits by the Oklahoma grassroots, OK leadership decided not to hear SB 971, choosing instead to form a special joint legislative committee to study the issue this fall.

From a 5/23/11 Tulsa World article by Wayne Greene:

“OKLAHOMA CITY – Two Tulsa lawmakers have been chosen to deal with one of the hottest of political hot potatoes next fall.

Sen. Gary Stanislawski, R-Tulsa, and Rep. Glen Mulready, R-Tulsa, are the leaders of a special joint legislative committee that will study how the state should respond to the federal mandate to create a state health insurance exchange.” Rest here.

These public meetings should be attended by everyone with concerns about the controversial health care reform act.

Contact Information:
Sen. Gary Stanislawski – stanislawski@oksenate.gov
Rep. Glen Mulready – glen.mulready@okhouse.gov

OK-SAFE Meetings Re: Implementing ObamaCare in Oklahoma

Most Oklahomans (and most Americans) objected to the idea of socialized medicine as specified in the Patient Protection and Affordable Care Act, (PPACA), aka ObamaCare.  It’s companion law was the Health Care and Education Reconciliation Act of 2010.  Collectively these two laws are referred to as the Affordable Care Act.

It appears that the Henry/Fallin administrations, as well as the Oklahoma legislature, have been, and currently are, engaged in implementing the provisions of ObamaCare, as evidenced by the federal grant applications and legislation, while appearing to oppose ObamaCare via SQ 756 and the national lawsuit.

There will be an open discussion/review of both the grants and the legislation paving the way for the implementation of ‘ObamaCare’ in Oklahoma at two meetings this week.
See details below.

OKC – Wednesday, March 16, 2011 – The Village Library, 10307 N. Penn Ave, The Village (OKC), Oklahoma.  Time 6:30 – 8:00 pm.

Tulsa/Broken Arrow – Saturday, March 19, 2011 – Heartland HQ Building, 1008-B N. Hickory, Broken Arrow, OK.  Time: 10:00 am to 11:30 am.

Currently, HB 2130 by Steele, is a key piece of enabling legislation dealing with the HUB board and the development of the Health Insurance Exchanges.  HB 2130 removes the Insurance Commissioner from oversight of the exchange and puts in his place Dr. Terry Cline, OK Sec. of Health and Human Services, appointed by Gov. Fallin.

This bill is being presented by freshman legislator Rep. Glen Mulready, (HD-68) who apparently agreed to carry this bill for leadership.  Leadership has not done him any favors here – HB 2130 is not a bill one would wish to be associated with in the future.

We are recommending a NO vote on HB 2130.  We also suggest to Rep. Mulready that if he is anxious for approval that he might want to get dog – politicians make lousy friends.

Psalm 118: 8,9 – “It is better to take refuge in the LORD than to trust in man; It is better to take refuge in the LORD than to trust in princes.”