Issue Brief: Insure Oklahoma

October 22, 2018

Issue Brief: Insure Oklahoma

What Is Insure Oklahoma?

Insure Oklahoma is a public-private partnership between the State of Oklahoma and small businesses that aims to make health coverage more affordable for low- to middle-income working families. The program has two types of health insurance plans: employee sponsored plans, in which the state, eligible employers, and eligible employees split the cost of health insurance premiums, and individual plans, in which eligible individuals are able to purchase health insurance directly from the state at a subsidized rate.

As of September 2018, Insure Oklahoma provides health insurance to more than 19,000 Oklahomans. Of these plans, 75% are employee sponsored plans and the remaining 25% are individual plans.

Why Insure Oklahoma?

Oklahoma has the second highest uninsured rate in the nation. Having such a high rate of uninsured Oklahomans causes both public health and economic concerns for the state.

Oklahoma has an average life expectancy of 75.7 years, which is three years less than the United States’ average. Oklahoma’s high rate of uninsured individuals could contribute to this statistic. According to the U.S. Centers for Disease Control, individuals without insurance are less likely to receive preventative health care, are more likely to be hospitalized for a condition that could have been prevented, and are more likely to die in a hospital than individuals who have health insurance.

Additionally, Oklahoma’s low rate of health insurance coverage hurts the pocketbooks of all Oklahomans, insured and uninsured. The 14.2% of adults in Oklahoma who do not have health insurance are at risk of severe financial harm, including bankruptcy, if an unexpected medical emergency requires expensive medical care and prevents the individual from working. Additionally, Oklahoma hospitals provide over $550 million in uncompensated care per year. Uncompensated care is a term that describes what occurs when uninsured individuals require health care and are unable to pay the bill; hospitals are forced to shift these costs to their insured customers through higher service prices.

How Does Insure Oklahoma Work?

Insure Oklahoma launched in 2005 following the passage of Senate Bill 1546 and State Question 713. The state’s portion of the program is funded by cigarette taxes that were raised for this purpose by SQ 713 as well as matching Federal Medicaid funds.

The employer sponsored plans program splits costs between employers (25 percent), employees (15 percent), and the Oklahoma Health Care Authority (60 percent). In order to qualify for this program, an Oklahoma small business must employ less than 250 people, and this option is only available for those employees between ages 19 and 64 who earn less than 200% of the federal poverty level. The plan may also be used to provide health insurance to the employee’s spouse and dependents.  

The individual plans provided by Insure Oklahoma allow low-income individuals to purchase a plan directly from the state for a subsidized rate for themselves, their spouse, and any dependents. In order to qualify for an individual Insure Oklahoma plan, someone must earn less than 100% of the federal poverty line, be between the ages of 19 and 64, and not qualify for an employer sponsored plan because they are self-employed, temporarily unemployed, or a full-time enrolled student.

What could be done to expand Insure Oklahoma? What have other states done with similar programs?

Insure Oklahoma was an innovative, public-private partnership designed to reduce Oklahoma’s uninsured rate when it first launched in 2005. Currently, nearly 20,000 people receive health insurance through Insure Oklahoma programs. However, more than 500,000 Oklahomans still do not have health insurance.

Following the passage of the Affordable Care Act (ACA) in 2010, states were given the option of expanding Medicaid eligibility to all residents earning less than 138% of the federal poverty level. If a state chooses to expand Medicaid, 90% of the cost of this expansion will be covered by the federal government, and the remaining 10% will be covered by the state. Currently, Oklahoma is one of 14 states that have chosen not to expand Medicaid eligibility.

The State of Indiana provides one possible model of what Oklahoma could do to expand health coverage to more individuals within the framework of the state’s existing programs. Under the leadership of then-Governor Mike Pence, Indiana expanded the eligibility for the Healthy Indiana Plan, a cost-sharing program similar to Insure Oklahoma individual plans, to match with ACA requirements. This expansion allowed the state to access federal funding and reach a larger segment of their population.

A study conducted for the State Chamber Research Foundation in 2017 found that expanding Insure Oklahoma in a similar manner as Vice President Pence’s Healthy Indiana Plan would reduce the number of uninsured Oklahomans by 114,000, create 4,700 jobs, and increase Oklahoma’s gross state product by $400 million.


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Issue Brief: Insure Oklahoma | Issues