“Of all the forms of injustice, inequality in health care is the most shocking and inhumane.”
— Dr. Martin Luther King, Jr.
According to the American Community Survey’s 5-Year Estimates for 2008-2012, an estimated 18.7 percent of Tulsa County residents are without health insurance. While there are many arguments about the Affordable Care Act — philosophical, political, or otherwise — the cost of doing nothing regarding health care reform is too great. More so, the cost of repeatedly rehashing the political battles of the past does no good for both insured and uninsured community residents.
On March 24, nearly 700 individuals from northeastern Oklahoma attended “Marketplace Monday,” a health enrollment and education event held simultaneously at four locations in Tulsa County. Attendees received personal, one-on-one assistance to determine subsidy eligibility and complete enrollment on the health insurance marketplace. A total of 169 attendees enrolled in health insurance.
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The event was sponsored by a group of community partners with a vested interest in helping residents sign up for insurance without taking a position on the rightness or wrongness of the Affordable Care Act. The group was comprised of the Tulsa Health Department, Tulsa Regional Chamber, local insurance carriers, community health centers, and community agencies that initially met to discuss the ACA and its potential impact on Tulsa County after Congress passed the ACA, the President signed the legislation into law, and the Supreme Court upheld its constitutionality.
During Marketplace Monday, the community partners discovered that people in Oklahoma do want health insurance; unfortunately, many people fall into the “coverage crater,” which prevents them from obtaining affordable insurance. The so-called crater lies between being covered through current subsidy programs and being covered privately.
One of our greatest lessons learned is that now is the time to change the conversation around this issue and come together to do something in Oklahoma to help everyone, not divide the issue further. Lost in the debate over the cost of extending health insurance to eligible Oklahomans is the reality that doing so would actually save money in other ways and also have the very important benefits of improving overall health and saving lives.
One significant benefit would be a reduction in costly emergency room visits. People without insurance often turn to emergency rooms as their only option, leaving hospitals stuck with unpaid bills, which drives up the cost of care for everyone. Oklahoma hospitals provide more than $500 million in uncompensated care annually, including the cost of charity care and bad debt. These shortfalls must be “cost shifted” to self-insured businesses, insurance companies and others who pay for health care services.
People insured as a result of expanded coverage will be able to seek primary care in economical outpatient settings. Providing coverage in a care-coordinator model would help lower Oklahoma’s Medicaid costs and reduce unpaid hospital bills by emphasizing primary care and treatment of chronic conditions in lower cost settings.
The discussion around health insurance coverage is emotional and fraught with political land mines, but during the event we discovered that many Oklahomans struggle and live in fear and despair every day because of the lack of health care coverage.
The bottom line on expanded coverage: Does the cost to the state of expanding outweigh the cost of unpaid hospital bills shifted to those who pay for insurance? Is it worth the cost to expand coverage so that thousands of poor working families will not go without proper health care? Do we want to create a healthy Oklahoma, where the investment in prevention on the front end will likely reduce health care cost later in life? We have many policy decision makers, from the governor to our legislators, who care about their constituents and vulnerable Oklahomans. Can we come together for a discussion about how to close the gap and fund coverage for all Oklahomans?
Tulsa and Oklahoma City hospital executives have acknowledged that by developing an Oklahoma plan that uses expansion money, we can recapture federal tax dollars and use them to control the cost of health care and enhance access and the quality of care. The funding to cover the additional 17 million uninsured people nationwide and 180,000 in Oklahoma has already been allotted. The allotment is drawn from the federal taxes Oklahomans pay. In short, it is Oklahoma taxpayer money.
Oklahomans are resourceful and caring. Let’s not allow this opportunity to pass us by; instead, let’s devise a plan to help all Oklahomans improve their quality of life — and let’s do it now!
Bruce Dart is director of the Tulsa Health Department.
Bruce Dart is director of the Tulsa Health Department.
