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.

Another Meeting about the Health Insurance Exchanges – 12/8/11 at the Capitol in OKC

We just received noticed that there will be an additional legislative meeting dealing with the subject of health insurance exchanges in Oklahoma.

This meeting will take place on Thursday, December 8, 2011 at 10:00 am in room 419C at the Oklahoma Capitol.  (Details below).

It is important that all those with concerns about the establishment of an insurance exchange – state-based or federal – in Oklahoma should attend.

 

 

 

 

 

 

 

 

 

 

 

Announcement (received 11/29/11):

There will be a presentation at 10:00 a.m. on Thursday, December 8^th in Room 419C of the Oklahoma Capitol to cover Health Insurance Exchanges under the Affordable Care Act:  State-run vs. federally facilitated.  This overview will include federal requirements for a compliant state-run health insurance exchange; Oklahoma ‘s readiness to enact such an insurance exchange; recent developments/predictions about legislative/executive action at the state-level on exchanges; and updates on other federal/state health policy partnerships.

The presenter, Kate Richey of the Oklahoma Policy Institute, has a degree in International Business from the University of Texas at San Antonio and a Masters degree in Political Science from the University of Central Oklahoma .  She is currently a PhD Candidate in Political Science from the University of Oklahoma and works as a Policy Analyst for the Oklahoma Policy Institute specializing in health care, immigration, and anti-poverty issues.

This program can also be accessed remotely.

Ashley Olmstead

Legislative Assistant to

Speaker Pro Tempore Jeffrey W. Hickman

Oklahoma House of Representatives

Phone: 405.557.7339

Fax: 405.962.7620

Stop Obama Care in Kansas Responds to OK-SAFE Comments on Health Care Reform Committee

The following letter of support from our friends in Kansas, who are also engaged in a fight against the implementation of PPACA (the Patient Protection and Affordable Care Act, aka “Obama Care”).  Like Oklahoma, Kansas citizens applied political pressure to their legislators and governor and rejected the Obama Care enabler “Early Innovator” federal grant money.

OK-SAFE thanks them for their support and will continue to offer our support to their efforts against the liberty and privacy killing provisions of PPACA and the ARRA, (the stimulus bill was the real health care reform bill, providing the funding mechanism for electronic health records adoption, the backbone of the inhuman health IT monster called “reform”.)

(See earlier OK-SAFE post entitled OK-SAFE Response to Federal Health Care Reform Committee.)

______________________________________________________________________________________________________

Sunday, November 20, 2011

RE: OK-SAFE comments on the recent Joint Legislative Committee on Health Care Reform Law in Oklahoma.

Dear Amanda,

On behalf of the Stop Obama Care in Kansas (the Republic) (SOCK) tour we are 100% in solidarity with you, OK-SAFE and the citizens of Oklahoma.

In addition I would note that under Article VI cl. 3, of the U.S. Constitution every state and federal legislative, judicial and executive officer must take an oath to “support” the Constitution.  Although the founders left the actual words of this oath of support to the individual states they did write the oath for the President of the United States.  No other officers can have any more or less responsibility that that of the President, although the means to carry one’s oath out will change based on the office held. That oath is as follows:

“I do solemnly swear (or affirm) that I will faithfully execute the Office of President of the United States, and will to the best of my Ability, preserve, protect and defend the Constitution of the United States.”

-U.S. Constitution, Article II §1.

All of the descriptors of this duty to the U.S. Constitution are action words which clearly indicate that his duty is an active duty not a passive duty. One may not, consistent with their oath to the Constitution, sit quietly by as the Constitution is violated or otherwise attacked.

Also note this duty is by no means limited to military or other physical attacks but includes all attacks including philosophical attacks and legislative, judicial and executive usurpations.  Also those who are not fulfilling their duty in this regard are also failing to support the Constitution and are passively attacking the Constitution.

Under the Kentucky and Virginia Resolves, Thomas Jefferson and James Madison espoused the principle that any time the central government  exceeded its authority under the Constitution then the central government’s actions in such regard was a nullity and of no force and effect upon the sovereign States. They also noted the only way for the states to preserve the Union was to protect the Constitution from such usurpations by the federal government and in fact the States not only had a right but indeed a duty (were required)  to intervene and “interpose” themselves between the central government and their citizens to stop an infringement of the rights of their citizens.

In 1803, Chief Justice John Marshall, speaking on behalf of the U.S. Supreme Court,   affirmed the principle espoused by Jefferson and Madison, holding that any federal law which was not “in pursuance” of the Constitution  was a total nullity upon its inception and never comes into force and effect. Murbarry v. Madison. (See U.S. Constitution Art. VI cl.2.) As such no one is required to enforce, obey or otherwise support such law. In fact to support such an unconstitutional law would be a breach of one’s duty to the Constitution.

Note the Court said the law was a nullity upon its very inception not from the time the Court declared it to be so.

What this means is that all those who are under an oath to the Constitution must in the first instance determine for themselves if a law or regulation is Constitutional.  Once they have made that determination their further conduct is sealed.

It is no excuse for those under oath to say they are “not an attorney” or are not a “Constitutional scholar”. Once they raise their hand and swear their oath to the Constitution they are required to have a working knowledge of the Constitution otherwise they are incompetent to hold office. In other words such oath established a substantive requirement for them to be qualified to hold office, the oath is not a mere formality as most public officials now treat it.

As Justice Scalia said in District of Columbia v. Heller, 554 U. S. ___, and was repeated in M c DONALD et al. v. CITY OF CHICAGO:

“In interpreting this language, it is important to recall that constitutional provisions are “‘written to be understood by the voters.’ ” Heller, 554 U. S., at ___. The objective of this inquiry is to discern what “ordinary citizens” at the time of the Fourteenth Amendment ’s ratification would have understood that Amendment’s Privileges or Immunities Clause to mean. Ibid.”

For those of us who know the law, our public servants have no excuse for their ignorance except for laziness and incompetence.

In Kansas the Governor has declared Obama Care to be “unconstitutional”. He has thereby limited the actions he may take as to Obama Care. Also Kansas has sued the federal government based on Obama Care being unconstitutional. Therefore, the official policy of Kansas is that Obama Care is unconstitutional. Further the Federal District Court and the 11^th Circuit Court of Appeals have found it to be unconstitutional at some level. Therefore, any official in Kansas that moves ahead with Obama Care is violating their oath to support the U.S. Constitution by supporting and or implementing an unconstitutional law.

I am sure you will find that Oklahoma politicians are in the same position.

Thank you for all your effort to return our Republic to Constitutional Governance.

For the sake of Liberty,

Richard D. Fry

Founder / Co-Coordinator

Stop Obama Care in Kansas

General Counsel

Patriot Coalition

816 853 8718

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.

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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.

Appeals Court Rules Individual Mandate is Unconstitutional

The 11th Circuit Court of Appeals has ruled against the individual mandate called for in the controversial Patient Protection and Affordable Care Act, aka “Obama Care”, passed in March 2010.  (Read full opinion here.)

OK Attorney General Scott Pruitt’s reaction to this decision is noted below the AP announcement.

From the Associated Press,  8/12/11:

“Appeals court strikes health insurance requirement

Legality of the individual mandate is expected to go to the Supreme Court

By Greg Bluestein, AP 8/12/11

Washington – A federal appeals court panel on Friday struck down the requirement in President Barack Obama’s health care overhaul package that virtually all Americans must carry health insurance or face penalties.

The divided three-judge panel of the 11th Circuit Court of Appeals struck down the so-called individual mandate, siding with 26 states that had sued to block the law. But the panel didn’t go as far as a lower court that had invalidated the entire overhaul as unconstitutional.

The states and other critics argued the law violates people’s rights, while the Justice Department countered that the legislative branch was exercising a “quintessential” power.

The decision, penned by Chief Judge Joel Dubina and Circuit Judge Frank Hull, found that “the individual mandate contained in the Act exceeds Congress’s enumerated commerce power.”

“What Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die,” the opinion said.

Circuit Judge Stanley Marcus disagreed in a dissent.”

The AP article continues:

“The states urged the 11th Circuit to uphold Vinson’s ruling, saying in a court filing that letting the law stand would set a troubling precedent that “would imperil individual liberty, render Congress’s other enumerated powers superfluous, and allow Congress to usurp the general police power reserved to the states.” ”

Rest of AP article is here.

Oklahoma A.G. Scott Pruitt’s Reaction:

Pruitt Applauds Ruling on Federal Health Care Law 08/12/2011

OKLAHOMA CITY – Attorney General Scott Pruitt released a statement in support of the ruling by the U.S. appeals court: “I am pleased the 11th circuit ruled today that the federal government cannot force Americans to buy health insurance. “Indeed, the ruling affirms and strengthens Oklahoma’s… more

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So Where Does That Leave Oklahoma’s Health Insurance Exchange?

A joint legislative committee created by the Oklahoma legislature in May 2011 is to examine the impact of PPACA on Oklahoma. The committee will begin its’ series of 5 meetings in September 2011, with the first one scheduled for Wednesday, September 14, 2011 in Oklahoma City, OK. (Time and location to be determined.)

The subject likely to take center stage is the terrible, horrible, no-good, very bad Health Insurance Exchanges.  These exchanges, or so-called clearinghouses, are a cornerstone of the  ObamaCare nightmare and most people can see the problems with their establishment.

The ones to be convinced, of course, are the legislators, who have to make a decision on how to move forward – follow the will of the people and common sense, or establish a state-based exchange.

The 8/2/11 House press release on this committee is below, including a list of the committee members.

Health care law committee to begin work
8/2/2011 11:09:00 PM

Jarred Brejcha
(405) 521-5605 desk
brejcha@oksenate.gov

John Estus
(405) 962-7674 desk
john.estus@okhouse.gov

OKLAHOMA CITY (August 2, 2011) – Legislative leaders today announced membership and meetings of the Joint Committee on Federal Health Care Law, a special legislative committee that will study how the new federal health care law affects Oklahoma.

Senate Pro Tem Brian Bingman and House Speaker Kris Steele ordered the formation of the joint committee this past legislative session to ensure Oklahoma properly addresses the Federal Patient Protection and Affordable Care Act.

At the direction of co-chairmen Sen. Gary Stanislawski, R-Tulsa, and Rep. Glen Mulready, R-Tulsa, the Joint Committee on Federal Health Care Law will do its work through a series of public meetings in Oklahoma City and Tulsa.

The committee’s first meeting will be Sept. 14 in Oklahoma City. The committee is expected to meet at least five times through November.

“Having suitable health care options in Oklahoma is an issue the Legislature takes very seriously and intends to proactively protect and address through this committee,” said Stanislawski, a Certified Financial Planner. “Oklahoma patients, taxpayers, businesses, health practitioners, insurers and others all have wide-ranging questions and concerns about this largely unwanted new federal law. The law will affect all Oklahomans, some in significant ways, so this committee will seek to address all relevant questions and concerns for the benefit of all Oklahomans.”

Among the topics to be studied are the state of health care in Oklahoma, logistics and ramifications of implementing the federal health care law, implementation timelines, responses to the law and the costs local governments and businesses may face as a result of the law.

The committee will also explore the implications Oklahoma’s lawsuit challenging the law’s constitutionality may have on the law’s implementation here.

“Clearly, most Oklahomans oppose this law. While we have taken steps to guard against harmful portions of the law, we would be remiss if we did not continue reviewing it so we can do our best to protect a choice-based, free-market health care system for Oklahomans,” said Mulready, a 28-year insurance industry veteran. “Simply put, the committee will show Oklahoma what to expect from this law, how we can continue to protect Oklahoma’s interests and how we can make sure we are best prepared as a state.”

The committee will solicit testimony and recommendations from a wide range of public and private sector experts. It is expected to hear from state and federal policymakers, business officials, insurance agents and brokers, legal experts, health care industry officials and more.

“All parties will be at the table working to make sure Oklahomans have health care choices, not mandates,” said Bingman, R-Sapulpa. “This is an opportunity for Oklahoma to assert our state’s rights and I’m confident all stakeholders will rise to the challenge so we can avoid dangerous federal mandates wherever possible.”

Ultimately, the committee will make recommendations on how the state should address components of the federal health care law.

“The committee will explore all possibilities for putting forth Oklahoma solutions that support a free market health care system,” said Steele, R-Shawnee. “Not everything is clear about this law, and most of us don’t like it, but what we do know is Oklahoma cannot afford to be caught flat-footed, unprepared and unprotected if it takes effect. As much as anything else, this committee ensures Oklahoma is prepared.”

Committee members are:
Sen. Gary Stanislawski, R-Tulsa, co-chair
Rep. Glen Mulready, R-Tulsa, co-chair
Sen. Cliff Aldridge, R-Oklahoma City
Sen. Bill Brown, R-Broken Arrow
Sen. Brian Crain, R-Tulsa
Sen. Sean Burrage, D-Claremore
Sen. John Sparks, D-Norman
Rep. Doug Cox, R-Grove
Rep. Randy Grau, R-Edmond
Rep. Jason Nelson, R-Oklahoma City
Rep. Jeannie McDaniel, D-Tulsa
Rep. Danny Morgan, D-Prague

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

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
Contact: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.”

OK Exchange Language Found! SB 971 Establishes an Insurance “Network”

Dropping the term “exchange” in favor of “network” and adding “private enterprise” to the title is apparently aimed at providing assurance to Oklahomans that this OK Republican administration is serious about not implementing a Health Insurance Exchange in Oklahoma.

Here is the language found in the newly introduced SB 971, the replacement for the controversial HB 2130, which narrowly passed the OK House on 3/17/11 and which the Senate refused to hear.

See if you can see much assurance that a framework for an exchange is not being built if this bill passes…bill language below:

SB 971, by Myers/Jolley of the Senate and Sears/Martin,(Scott) of the House.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:

SECTION .     AMENDATORY     Section 2, Chapter 128, O.S.L. 2009 (36 O.S. Supp. 2010, Section 4602), is amended to read as follows:

Section 4602.  A.  The Insurance Commissioner in collaboration with the Oklahoma Health Care Authority shall advise and aid the Health Care for the Uninsured Board (HUB) in its duties.  The Insurance Commissioner is hereby authorized to promulgate such reasonable rules as are necessary to implement the purposes of this act.

B.  The State Board of Health shall direct the implementation and duties of the HUB to assist the Insurance Commissioner.  The duties of the HUB shall be to:

1.  Advise, consult with, and make recommendations to the Commissioner as to the matters addressed in subsection C of this section; and

2.  Assist and advise the Commissioner on such other matters as the Commissioner may submit for recommendations to the State Board of Health

The purpose of this act is to allow Oklahoma to establish and operate its own Health Insurance Private Enterprise Network to facilitate access to health insurance and enhance competition in the individual and small employer health insurance markets.

B.  As used in this act:

1.  “Aggregate premiums” means a mechanism to pay insurance premiums with contributions from multiple sources;

2.  “Defined contribution” means pretax dollars contributed by the employer;

3.  “Insurance producer” has the same meaning as defined in Section 1435.2 of Title 36 of the Oklahoma Statutes;

4.  “Network” means the Health Insurance Private Enterprise Network; and

5.  “Network Board” means the Health Insurance Private Enterprise Network Board.

C.  The Health Insurance Private Enterprise Network shall be established as a state-beneficiary public trust.

D.  The Network shall be governed by a board of directors.  The Network Board shall consist of seven (7) members as follows:

1.  One member appointed by the Governor representing health insurance carriers granted a certificate of authority by the Oklahoma Department of Insurance;

2.  One member appointed by the Speaker of the House of Representatives representing consumers and who has purchased policies through the Network or is reasonably expected to purchase policies through the Network;

3.  One member appointed by the Governor who shall be a health care provider;

4.  One member appointed by the Governor who shall be a representative of employer groups;

5.  One member appointed by the President Pro Tempore of the Senate who shall be an insurance agent or broker;

6.  The Insurance Commissioner; and

7.  The Secretary of Health and Human Services.

E.  The Insurance Commissioner shall serve as chair of the Network Board.  The Network Board shall appoint an Executive Director.

F.  In order to avoid the establishment of a federal exchange, the Network shall have the minimum authority under state law that is necessary to implement its purposes.  Funding for the Network shall come from state and private sources.

G.  The purpose of the Network shall be to:

1.  Increase choice and competition in the health insurance market of Oklahoma;

2.  Provide more choices and options in the health insurance market for employees in the state;

3.  Promote and encourage portability of coverage;

4.  Promote a competitive, patient-centered, market based health insurance system that includes a defined-contribution health insurance alternative for employer-sponsored coverage which includes an aggregate premium system;

5.  Encourage health insurance carriers to collaborate with medical providers to offer health insurance coverage that provides consumers quality care delivered in the most cost-effective manner; and

6.  Establish a fair and impartial health insurance producer referral network for the purpose of assisting individual and qualified small employers in obtaining health insurance coverage through the Network.

H.  The Network shall not:

1.  Exercise regulatory authority over any entity;

2.  Discriminate against any qualified health insurance carrier willing to participate in the Network; or

3.  Supplant any marketplace outside the Network.

I.  The Commissioner Network Board shall:

1.  Establish a system of certification for insurance programs offered in this state to be recommended offered by the HUB the Network; and

2.  Establish a system for the credentialing of licensed insurance producers who intend to market insurance programs certified by the state in accordance with this section.

3.  Establish a system of counseling, including a website, for those individuals who are without health insurance and are not covered by Medicaid, that includes but is not limited to:

a.            educating consumers about insurance programs certified by the state in accordance with this section,

b.            aiding consumers in choosing policies that cover medically necessary services for that consumer, and

c.             educating consumers on how to utilize primary and preventative care in order to reduce the unnecessary utilization of services by the consumer; and

4.  Establish a system whereby if an individual qualifies for a subsidy under the premium assistance program, established in Section 1010.1 of Title 56 of the Oklahoma Statutes, that person is able to become enrolled through the HUB in conjunction with local, qualified insurance producers.

J.  All personal information generated through the purchase of any policy purchased through the Network shall remain confidential between the insurer and the insured.

K.  The Network Board shall promulgate rules as necessary to implement the purposes of this act and to help individuals facilitate the selection of health insurance coverage and to allow health insurance carriers to provide market based health insurance products without unnecessary regulation and burdens.

SECTION .     AMENDATORY     Section 3, Chapter 128, O.S.L. 2009 (36 O.S. Supp. 2010, Section 4603), is amended to read as follows:

Section 4603.  A.  The Insurance Commissioner in collaboration with the Oklahoma Health Care Authority shall initiate a program to encourage enrollment of individuals, not covered by insurance or enrolled in Medicaid in health insurance programs.

B.  Upon treatment of an uninsured individual or an individual not covered by enrolled in Medicaid, a health care provider shall refer the individual to the HUB Network established in Section 2 4602 of this act title to begin the enrollment process in a certified insurance plan or the premium assistance program established in Section 1010.1 of Title 56 of the Oklahoma Statutes, if eligible.

SECTION .  The provisions of this act shall be subject to legislative review and renewal no later than May 25, 2014.

SECTION .  This act shall become effective November 1, 2011.

53-1-1708            ARE        4/27/2011 4:10:04 PM

OK Republicans Implementing “Obama Care”

On Friday, Feburary 25, 2011 OK Governor Mary Fallin issued a press release announcing “Oklahoma Will Accept $54 M “Early Innovator Grant” to Support Oklahoma-Based Health Insurance Exchange.” 

Noticably missing from the announcement is the fact that the “Early Innovators” grants are to fund implementation of the Information Technology (IT) infrastructure needed to operate Health Insurance Exchanges, a cornerstone of the Patient Protection and Affordable Care Act, aka “ObamaCare.”

The grant application, officially called the Cooperative Agreements to Support Innovative Exchange Information Technology Systems, is a 41-page document outlining the purpose, authority, and background of the funding “opportunity”, as well as eligibility requirements states must meet in order to qualify. 

The application also notes the specific sections of the Patient Protection and Affordable Care Act (and the Health Care and Education Reconciliation Act, together referred to as the Affordable Care Act) authorizing the funding of the grant.

Oklahoma was one of seven initial grant awardees, with our state getting the largest dollar amount – $54,582,269.  The grantee in Oklahoma is the Oklahoma Health Care Authority.

According to Grants.gov, the expected number of awards is 51 – all 50 states, plus the District of Columbia.

All of the exchanges are to be interoperable and usable by other states.

Exchanges – Cornerstone of the PPACA

The creation of Health Insurance Exchanges is a cornerstone of  PPACA (ObamaCare), without which there would be no socialized health care plan.  The plan requires an IT infrastructure to be in place in order to function.  No Exchanges, no ObamaCare.

These insurance Exchanges are mentioned 278 times in the Act.

The specific section of PPACA (ObamaCare) noted in the grant application are:

Page 5 of the grant application cites Section 1311 of the PPACA.
 
“C. Background
On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act. On March 30, 2010, the Health Care and Education Reconciliation Act of 2010 was signed into law. The two laws are collectively referred to as the Affordable Care Act. The Affordable Care Act includes a wide variety of provisions designed to expand coverage, provide more health care choices, enhance the quality of health care for all Americans, hold insurance companies more accountable, and lower health care costs. Among its provisions, the law provides grant funding to assist States in implementing parts of the Affordable Care Act.

Section 1311 of the Affordable Care Act provides funding assistance to the States for the planning and establishment of Health Insurance Exchanges (“Exchanges”). The Affordable Care Act provides that each State may elect to establish an Exchange that would: 1) facilitate the purchase of qualified health plans (QHPs); 2) provide for the establishment of a Small Business Health Options Program (“SHOP Exchange”) designed to assist qualified employers in facilitating the enrollment of their employees in QHPs offered in the SHOP Exchange; and 3) meet other requirements specified in the Act.”

Pages 6 & 7 of the application cite Section 1323 of the PPACA:

“The products of this Cooperative Agreement will be available to all States and the District of Columbia for evaluation and adaptability throughout the process so that non-grantee-States will not have to wait until a complete product is finished to test for adaptability for its existing systems. As IT systems are developed, attention should be paid to assuring that information gathered will be accessible for evaluation purposes. U.S. Territories that establish Exchanges under Section 1323 will be eligible to participate in the evaluation and adaptability process and the products developed under this Cooperative Agreement will be available to them.”

Pages 7, 17, 21, 28, and 29  of the application cite Section 1561 of PPACA:

Key Principles of Exchange IT capabilities for Early Innovators
• The organization governing the design, development, and implementation of the core capabilities must follow standard industry Systems Development Life Cycle (SDLC) frameworks including the use of iterative and incremental development methodologies. The governing body must also be able to produce requirement specifications, analysis, design, code, and testing that can be easily shared with other interested and authorized stakeholders (i.e., other States, consortia of States, or any entity that is responsible for establishing an Exchange).
• The design must take advantage of a Web Services Architecture (using XML, SOAP and WSDL or REST) and Service Oriented Architecture approach for design and development leveraging the concepts of a shared pool of configurable computing resources (e.g., Cloud Computing).
• The services description/definition, services interfaces, policies and business rules, must be published in a web services registry to support both internal and external service requests that are public and private, and be able to manage role-based access to underlying data.
• Per Section 1561 of the Affordable Care Act, all designs must follow the standards thatare currently outlined in the recommendations published by the Office of the National Coordinator (ONC). For details on Section 1561 Standards, see: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3161.
• Per National Institute of Standards and Technology (NIST) publications, the design and implementation must take into account security standards and controls. (For details on NIST publications, see: http://csrc.nist.gov/publications/PubsSPs.html)

Health Insurance Exchange Legislation

Currently there are several live bills implementing the Health Insurance Exchange but two worth noting are SB 960 by Sen. Bill Brown, and HB 2130 by Rep. Kris Steele.

Health Insurance Exchange Impact on Independent Brokers

Several independent insurance brokers in Oklahoma are concerned about the impact the exchanges will have on their businesses.  The exchanges operate contrary to the free enterprise system and most likely will put the independent insurance broker out of business.  Click here to hear the 2/27/11 interview with Mark Croucher of WHY-Insurance. 

To contact Governor Fallin about this issue:
Phone: 405-521-2342

To call Senate Pro-Temp Brian Bingman:
Phone: 405-521-5528
Email: bingman@oksenate.gov

To call House Speaker Kris Steele:
Phone: 1-405-557-7345
Email: krissteele@okhouse.gov

More on this subject in the weeks ahead.