Oklahoma Health Exchange Profile
Establishing the Exchange
On November 19, 2012, Governor Mary Fallin (R) announced that Oklahoma would not pursue the creation of a state-based health insurance exchange.
Prior to the announcement, Oklahoma had established the Joint Committee on Federal Health Care Law to explore the state’s options regarding federal health reform, including exchange implementation in the state. The Joint Committee convened in 2011 and released final exchange recommendations to the Governor and the Legislature in late February 2012. Committee recommendations included establishing a state-based private marketplace network to avoid federal involvement in the state; this would resemble a Utah model for small-businesses but would not include an individual exchange. A bill based on these recommendations was introduced in the 2012 legislative session (SB 1629) but failed at the end of the legislative session.
The Oklahoma Health Insurance Exchange Project, led by the Secretary of Health as liaison to the Governor’s Office and State Legislature, the Oklahoma Department of Mental Health and Substance Abuse Services, the Insurance Department, and the Oklahoma Health Care Authority, began planning efforts in early 2011; however, the Project suspended activities in 2012 due to the exhaustion of federal grant funds.
On April 4, 2011, Governor Fallin signed into law a measure prohibiting any health insurance plans offered in the exchange from covering abortions except in cases of rape, incest, or life endangerment of the pregnant woman (SB 547). The bill allows health plan enrollees the option to purchase additional abortion coverage if desired.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Oklahoma has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Oklahoma- BlueOptions PPO.
Oklahoma’s Department of Mental Health and Substance Abuse Services received a $1 million federal Exchange Planning grant. In addition, the Oklahoma Health Care Authority received a $54.5 million Early Innovator grant to develop model technological infrastructure for a health insurance exchange. In April 2011, Governor Fallin announced that Oklahoma planned to return the Early Innovator grant funding.
The federal government will assume full responsibility for running a health insurance exchange in Oklahoma beginning in 2014.
For more information on Oklahoma’s health insurance exchange planning, visit: http://www.okhealthcare.info/