Groups Oppose Oklahoma’s Efforts To Offer Stripped-Down Health Plans

Health providers and advocacy groups strongly oppose efforts in the state Legislature to reduce the number of mandates that the state requires for health insurance policies sold in Oklahoma.

They say allowing stripped-down plans, even along with more comprehensive options, will leave consumers vulnerable when they need help the most.

Jane Nelson, executive director of the Oklahoma Nurses Association, said cheaper plans could appear more attractive at first glance, but consumers might not be aware of the protections they will lose.

"With one stroke of a pen, these families can be left paying thousands of dollars for policies that don't cover them when they become ill," she said. "If we are buying insurance, it is to protect us in the event of a serious illness."

Coverage of treatment of autism is an example.

Less than a year ago, Emily Scott, her son, Jimi, and other autism advocates stood behind Gov. Mary Fallin as she signed House Bill 2962.

After years of attempts, the law made Oklahoma the 44th state to require insurers to cover applied behavioral therapy for children with autism.

But allowing insurers to offer plans without state-mandated benefits could make the requirement less available and affordable.

Scott said she fears insurers will offer some plans without autism coverage, which means plans that include the coverage could be far more expensive because the risk is spread among fewer people.

That could be devastating to parents who buy plans excluding autism and then discover a child has the disorder, Scott said.

"This is very specialized therapy, so they are a lot of money per hour," she said. "Before last year's law, parents were going without or parents were cashing in college funds or 401ks, and we lost a lot of really good families who just moved out of state."

Jason Nelson, who retired as a Republican House member last year, was the lead sponsor of HB 2962. He said he is dismayed that fellow conservatives are pushing a plan that could negate the work that overwhelmingly passed with bipartisan support in 2016.

"Oklahoma already has a relatively small and unhealthy population with limited competition for consumers," he said. "This could potentially have a devastating effect for a lot of families."

Possible easing of mandates

Regardless of what Congress does with the federal health-care law, coverage mandates could be loosened.

The Republicans' original version of a replacement plan, the American Health Care Act, kept Obamacare's 10 essential health benefits for small-group and individual plans.

Those include outpatient care and emergency services, hospitalization, pregnancy, maternity and newborn care, mental health and substance abuse, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and pediatric services.

An amendment to the ACA replacement legislation would have removed the federal requirements and allowed states to determine essential health benefits. In that case, if HB 1712 and SB 643 were to pass, insurers could potentially offer plans without having to meet federal or state mandates.

But the U.S. health and human services secretary, now Tom Price, would retain broad authority to determine how those categories are implemented or give states more flexibility in how to apply them.

Republicans could also try again to pass legislation eliminating the 10 essential benefits.

In 2013, when he was in Congress, Price authored an ACA replacement bill that would have done away with the essential benefits.

Eliminating them would effectively return the health-care system to pre-ACA standards in which insurers only had to provide each state's mandated benefits. If HB 1712 or SB 643 passes, insurers could potentially offer plans without having to meet federal or state mandates.

State may seek waiver

The mandates could even be relaxed if the Affordable Care Act survives intact.

That's because starting this year, states may seek a special "innovation waiver" that allows them to ignore certain parts of the law.

Gov. Mary Fallin and legislators have expressed support for seeking a waiver. A state task force published a report earlier this month with recommendations on the type of waiver the state should seek. The group suggested the state should "re-evaluate and reduce the essential health benefits package" required by Obamacare.

The report doesn't go into specifics, but among its recommendations are retaining preventive and behavioral health services.

Oklahoma Hospital Association Vice President Rick Snyder, who was involved with the task force, said he sees some opportunities to adjust the list slightly.

"I think having certain benefits that are universally covered by health insurance is important," he said. "But I think there are dangers in having too much flexibility in that."

Snyder suggested that lawmakers don't rush into anything.

"There is a lot of uncertainty at the federal level, other than we are certain some things will change. We are just not sure about the which and the what," he said. "So it doesn't seem like the best time to legislate a lot of changes on the state level."

Oklahoma Watch is a nonprofit, nonpartisan media organization that produces indepth and investigative content on publicpolicy issues facing the state. For more Oklahoma Watch content, go to oklahomawatch.org.