OKLAHOMA HEALTH & HEALTH SYSTEMS Peter Budetti, MD, JD Bartlett Foundation Professor of Public Health College of Public Health, University of Oklahoma June 15, 2007

Grateful acknowledgment to my colleague Michael Lapolla, Director, Center for Health Policy Research College of Public Health, University of Oklahoma OKLAHOMA HEALTH & HEALTH SYSTEMS

It took a while but … we eventually received the message

OKLAHOMA OUR HEALTH CARE “DUST BOWL” PROBLEMS ARE NOT NEW

10 YEARS OF WARNINGS Oklahoma State Board of Health Annual “State of the State’s Health” INTERNATIONAL HURRICANE WARNING

Oklahoma A State of Health? “We are the ONLY state where our age-adjusted death rates became WORSE through the 1990s and into this century.” “If we had the same adjusted death rate as the nation, we would have about 3,700 fewer people dying each year.” Oklahoma State Board of Health “2006 State of the State’s Health” Graphic: University of Oklahoma College of Public Health. Data Source: U.S. Centers for Disease Control and Prevention AGE ADJUSTED DEATH RATE U.S OK

OKLAHOMA United Health Foundation America’s Health Rankings – 2006

AHRQ’s STATE SNAPSHOTS OKLAHOMA

National Average 1,029 1, AGE ADJUSTED DEATH RATES THE TEN STATES WITH THE HIGHEST RATES Source: Centers for Disease Control. Graphic: OU College of Public Health

National Average AGE ADJUSTED DEATH RATES THE TEN STATES WITH THE HIGHEST RATES Source: Centers for Disease Control. Graphic: OU College of Public Health

OKLAHOMA HEALTH REPORT CARD SOURCE: OKLAHOMA STATE BOARD OF HEALTH: “2006 STATE OF THE STATE’S HEALTH”

$5k$10k$15k$20k$25k$30k$35k$40k$45k$50k$55k MN CT KS VT TX OK NM AR SELECTED MEDIAN INCOMES Data Source: U.S. Census Bureau, CPS, 2001, 2002 and 2003 Annual Social and Economic Supplements Graphic: Oklahoma State Board of Health: “2006 State of the State’s Health

HEALTH INDEX AGE-ADJUSTED DEATH RATES U.S. ÷ OK RATE WEALTH INDEX PER CAPITA PERSONAL INCOME OK RATE ÷ U.S. RATE 1980 OKLAHOMA COMPARED TO U.S. THE 25 YEAR DELAYED “WEALTH - HEALTH” FUSE % 80% 100% 95% 90% 85% Personal Income Per Capita (PCPI) 1980–2004. Bureau of Economic Analysis, U.S. Commerce Dept ( Age-Adjusted Death Rates (AADR) U.S. Centers for Disease Control (CDC Wonder at wonder.cdc.gov/mortSQL.html). Graphic: University of Oklahoma College of Public Health

OKLAHOMA INITIATIVES ACCESS O-EPIC subsidized insurance program “All Kids” Medicaid waiver/private insurance subsidy Task Force on Health Insurance CHAT statewide outreach HEALTH PROMOTION Cigarette tax increase “Strong and Healthy Oklahoma”

Oklahoma Employer/Employee Partnership for Insurance Coverage

BUSINESSES ENROLLEES O-EPIC 2007 Employee/Spouse and Employer Monthly Enrollment (Enrollees are 59% female)

WHO PAYS? Federal/State - 60% Employer - 25% Employee - 15% EXPANDED ELIGIBILITY Governor Brad Henry (D) recently signed bipartisan legislative initiative that authorized expansion of cap from 50 to 250 employees and from 185% of FPL to 250%. Authors: Rep. Chris Benge (R- Tulsa) and Sen. Johnnie Crutchfield (D-Ardmore) OTHER Available to individuals on a sliding scale. Waiver amendment to be submitted to CMS. O-EPIC Oklahoma Employer/Employee Partnership for Insurance Coverage

“ALL-KIDS” INSURANCE EXPANSION Increased eligibility level for children from Medicaid level of 185% FPL to 300%. SoonerCare (Medicaid) already added some 100,000 children between 2003 and 2007 Creates eligibility for an estimated 40,000+ children to buy private insurance. Parents pay 26% of premium and state/federal governments pay the balance. State funds provided by the OK Tobacco Tax. A bipartisan initiative recently signed by Governor. Authors were State Senator Tom Adelson (D-Tulsa) and State Representative Doug Cox, MD (R-Grove).

KIM HOLLAND OKLAHOMA INSURANCE COMMISSIONER INITIATIVES FOR OKLAHOMA

INITIATIVES OKLAHOMA INSURANCE COMMISIONER TASK FORCE ON HEALTH INSURANCE Two-year process to bring together public and private sector to address problems of insurance coverage in Oklahoma Developed 10 recommendations on: Access - Quality and Performance - Consumer Education and Information - and Finance CHAT STATEWIDE OUTREACH Citizen Views on Health Plans 41 Town Halls in 31 communities – plus 5 Town Halls chaired by the Insurance Commissioner – in 2007

AN OKLAHOMA CHAT CHOOSING HEALTHPLAN ALL TOGETHER © University of Michigan; courtesy of Sacramento Healthcare Decisions (SHD)

OKLAHOMA TOBACCO TAX INCREASE In 2004, voters approved Governor Brad Henry’s proposal to increase tobacco excise taxes to $1.03/pack – an increase of $.80 (net increase was $.55/pack because sales taxes were eliminated) Separate legislation restricted smoking in restaurants

DATA FROM KFF.ORG FOR except as noted MASSACHUSETTSOKLAHOMA Population6,344,5403,442,720 Low Income1,866,8201,388,520 Household Income$54,617$38,895 Gross State Product $328,535 million$120,549 million Tax Collections$2,815 per capita$1,933 per capita 2004 Medicaid Expenditures State $2.9 billion Total $5.8 billion State $596 million Total $2.6 billion 2007 DSH$287 million$29 million Uninsured number681,500659,370 Uninsured percent11%19%

THE BAD NEWS? We have a long way to go. THE GOOD NEWS? We’ve already started and know we have a long way to go.