The repeal of Obamacare didn’t work, and it’s understandable to want to try a different sort of fix for a health insurance system marked by skyrocketing costs. However, state-authorized expansion of short-term insurance plans is most certainly not the right way to do it.

An Executive Order signed by President Donald Trump last October will let states grant greater use of what is known as short-term limited duration insurance (STLDI). While giving power over these types of policy decisions back to the states is to be applauded, state leaders should be very careful before they let more people sign up for longer stints on short-term plans.

Doing so could pull healthy people from the government Health Insurance Marketplace – where those so-called Obamacare plans are sold – which will, in turn, drive up premiums for those who are left. Once premiums get high enough and constituents get angry enough, the political will might be found to finally repeal and replace the Affordable Care Act, aka Obamacare, but in the meantime, we will all pay a steep price.

We will pay in higher health insurance premiums. States themselves will pay in higher health care costs. The federal government will pay in higher subsidies. And then we will pay (again) in higher taxes to cover growing government expenses.

Read the complete story on townhall.com

ONE service provided by Oklahoma’s multi-county grand jury and state auditor’s review of the Health Department’s finances is that it undermined a talking point too often blindly accepted as fact: That most, if not all, state agencies have been “cut to the bone.” The investigative audit report on the Health Department shows how that claim can rely on rhetorical sleight-of-hand.

The audit reveals, “Although the agency claimed that the current financial ‘crisis’ is due in part to decreasing revenues, that claim does not reflect the full picture.”

Auditors determined the money directly appropriated to the Health Department by the Legislature had been cut by $7 million between the 2011 and 2017 budget years, but those cuts were more than offset by $20 million in increased non-appropriated revenue during that same period.

“In summary, total agency revenues increased by $13 million and total overall expenditures increased by $15 million,” the audit revealed.

Read the complete story on NewsOK.com

Justin Forney worked for the state Department of Health for 12 years as a public information officer, stationed in several county health departments, including Logan County.

Then, in the wake of a financial crisis that shook the department, Forney lost his job in March – the result of cuts of nearly 200 health department positions.

Forney is still unemployed. And on Thursday, as the news rolled out statewide that a grand jury had found the agency’s reported cash shortfall never happened, he felt a sense of shock.

He got a text from a former co-worker: “This was all for nothing?”

Read the complete story on OklahomaWatch.org

OKLAHOMA CITY, Okla. – The Americans for Prosperity-Oklahoma (AFP-OK) and Oklahoma Senator Paul Rosino (R) are applauding Governor Fallin’s executive order she signed Tuesday which includes work requirements to Oklahoma’s Medicaid program.

“I applaud the Governor for directing the action on her work requirements for eligible state Medicaid recipients,” said Sen. Rosino. “In February, my weekly column stated that we should follow the lead of the Trump administration and implement in Oklahoma the stated work requirements that the Governor has just championed. Since I have been elected, personal responsibility and work requirements for able-bodied adults 19 to 64 has been one of my top priorities. I will continue my efforts to push and support any legislation that will make work requirements a reality in Oklahoma.”

“We applaud Governor Fallin for her forethought and leadership, which we believe will go a long way to help the state’s medically needy populations,” said AFP-OK State Director John Tidwell. “These efforts, along with necessary Medicaid audits will ensure that Oklahoma is a model for reducing dependency and fraud while expanding opportunities for everyone in our state.”

On Tuesday afternoon, Gov. Fallin issued Executive Order 2018-05, which instructs the OK Health Care Authority to file the necessary waivers and state plan amendments to incorporate a work requirement in the Medicaid program.

Read the complete story on kfor.com

STUDY TOUTS MODERN MEDICAID PROGRAM AS BEST CHOICE FOR OKLAHOMA
Report Highlights Best Practices And Budgetary Savings

OKLAHOMA CITY  (Feb. 20, 2018) –The Oklahoma Association of Health Plans has released a report that outlines how the state can achieve budget predictability by implementing a modern health care program for Medicaid recipients in Oklahoma.

The product of extensive research, the report provides a road map for improving health outcomes, providing tax dollar efficiency and accountability afforded by a modern, quality driven health care system for Oklahoma’s most vulnerable citizens.

“In this time of budget instability and a historic deficit, we as legislators must look at all ways possible to be fiscally responsible,” said Sen. Kim David, R- Porter. “Now is not the time for us to shy away from health care innovation. A proposal to modernize Oklahoma’s health care system will be presented during the 2018 regular session.”

The report will serve as a resource for legislators and Oklahoma Health Care Authority officials in understanding what the implementation of a modern health care will look like and how much money can be saved in Oklahoma.

“We have the opportunity to address inefficiencies, reduce redundant services and lowers costs, all while improving health care for Oklahomans,” said Rep. Glen Mulready, R- Tulsa. “This type of proposal must be seriously considered by our state legislature as we continue to examine policies that may have lasting savings in our state budget. Managed care does not cut corners in service. The healthier the overall program, the more savings are achieved.”

After the Oklahoma Health Care Authority halted the effort to design a risk-based managed care program for the age blind and disabled populations in 2017, the report highlights program infrastructure already in place in Oklahoma and lays out budgetary requirements and advantages as well as best practices that have been tested in other states.

The study was produced by Milliman, the world’s largest providers of actuarial and related services.  A full copy of the report is available at http://tiny.cc/OAHPMillimanStudy.

###

About Oklahoma Association of Health Plans

The Oklahoma Association of Health Plans is a not-for-profit organization, created in 1987, to promote quality and affordable health care through advocacy, communications and education. We are committed to cultivating a regulatory and marketplace environment that facilitates a robust health care financing market, product flexibility and innovation, and an abundance of consumer choice. As the voice of Oklahoma’s health plans and insurers, the Oklahoma Association of Health Plans represents the interests of our members on legislative and regulatory issues. We provide information and services, such as newsletters, bill summaries, legislative tracking, and on-line services. Our programs are designed to serve our member organizations and to inform Policymakers and the public about health care financing and delivery.

Preston Doerflinger resigned from the governor’s Cabinet and as interim director of the state Health Department on Tuesday after 2012 police reports surfaced alleging that he committed domestic violence against his then-wife.

The state Board of Health accepted Doerflinger’s immediate resignation Tuesday afternoon after an executive session. Gov. Mary Fallin put out a statement later Tuesday acknowledging that Doerflinger also had resigned as her as Cabinet secretary of finance, administration and information technology.

The Frontier, a Tulsa website, reported on Monday that Tulsa police responded to a 911 call hang up at Doerflinger’s house in 2012, where Doerflinger’s then-wife said he had choked her twice during an argument. She decided not to pursue charges.

“I was unaware of the personal situation involving Preston and his ex-wife almost six years ago,” Fallin said in a prepared statement on Doerflinger’s resignation. “Mrs. Doerflinger did not contact my office about this matter. I take domestic violence very seriously, but I will take Mrs. Doerflinger at her word that this matter was not a case of domestic violence. I respect Preston’s decision to move on from his government service, and wish him and his family the best.”

Read the complete story on tulsaworld.com

Governor Mary Fallin Response to House Speaker’s Statement on Recent Medicaid Provider Cuts

OKLAHOMA CITY – Governor Mary Fallin today responded to House Speaker Charles McCall’s statement that Medicaid provider cuts approved last week by the Oklahoma Health Care Authority would have been unnecessary if she had signed the budget measure passed by lawmakers during the recent special session:

“The budget bill that I vetoed was a short-time fix to a long-term problem. When we return to regular session next year to begin work on the 2019 fiscal year budget, we will be facing a budget gap of as much as $600 million and the reality that provider rates would be cut again. I believe we missed an opportunity to address our long-term structural budget problems in special session by continuing to kick the can down the road and failing to develop a predictable solution to fix our budget and fund our core services. We didn’t get our job done. Unfortunately, it took my veto pen to bring the proper focus and attention to this matter. I am committed to addressing the health care needs of Oklahoma as I always have, and I look forward to working further with legislators to find solutions.”

###

Many at our capitol talk about fraud, waste and abuse—I agree that those areas have played a role in our current budget situation. But we cannot continue to blame these factors without offering thoughtful and responsible solutions to ease the burden on our state budget.

Modernizing our health care delivery system for Medicaid recipients stands to save an estimated $400 million in state taxpayer dollars over the next decade. In the absence of a thoughtful solution, Medicaid will continue to eat into our state budget.

By modernizing our health care delivery system, we will save taxpayer dollars, and more importantly, Oklahoma’s most vulnerable citizens will receive better care. Coordinating care and providing the right care in the right setting is essential to avoiding costly emergency room visits. Managed care is a patient-centered model that will improve health care delivery and the overall health of Oklahoma’s most vulnerable.

Something else a modernized health care delivery system can bring is budgetary stability. By making payments on a capitated per member basis, the state will know exactly how money needs to be allocated. I cannot overstate the importance of budgetary stability in health care. It is the second-highest appropriated service in our state, only trailing education. With a stable health care delivery system in place, our state legislature will have a predictable funding scenario when it comes time to appropriate health care dollars.

We have the opportunity to address inefficiencies, reduce redundant services and lowers costs, all while improving health care for Oklahomans. This type of proposal must be seriously considered by our state legislature as we continue to examine policies that may have lasting savings in our state budget.

Managed care does not cut corners in service. The healthier the overall program, the more savings are achieved. One example of this is when Oklahomans use the emergency room for conditions that can be efficiently and effectively treated by a primary care physician. Modernized health care delivery holds managed care organizations to high quality standards, improves health care access through stable provider networks and helps remove social barriers to health by linking Oklahomans to critical services like shelter, clothing, food and transportation.

Sitting on our hands is no longer an option when it comes to dealing with the current financial situation in our state. It is negligent to ignore proposals that would consciously reduce costs while providing better services. Modernizing our safety net health care system is the fiscally responsible thing for our legislature to do.

Rep. Glen Mulready, a Republican, represents District 68 in the Oklahoma House of Representatives.

A cash crunch that emerged over the summer at the state Health Department goes beyond the state’s current budget shortfall and caused the department to reach out to public health agencies in Oklahoma and Tulsa counties for help in shoring up its finances.

The effort comes as the department has ordered furloughs of some employees, announced job cuts and called in State Auditor and Inspector Gary Jones for a special audit of its finances. Last week, the department announced cuts to several contracted services, including programs to prevent child abuse.

The shortfall is so severe that the department activated its incident command structure, a management response typically used for public health emergencies, such as outbreaks of the mosquito-borne Zika virus or food contamination cases.

At board meetings in June and July, department leaders provided financial updates that didn’t appear to raise alarm bells. The updates noted a 2.8 percent reduction in state appropriations for fiscal year 2018, along with targeted cuts to several programs totaling $229,000.

But at an August retreat in Stillwater, the board heard about a shortfall for fiscal 2018 that went far beyond the expected appropriations cut.

“This issue began in prior state fiscal years, also leaving the agency with prior year obligations that need to be made current,” according to the August presentation.

When it announced job furloughs in September, the department said it estimated a shortfall of more than $10 million. Leaders blamed the gap on the loss of federal funds, higher costs and cumulative cuts to state appropriations totaling 30 percent since 2009.

On Wednesday, the department went further than the furloughs, informing employees that it was cutting about 250 positions by early 2018. It plans to file specific information about the reduction in force in the next four to six weeks with the Office of Management and Enterprise Services. The cut represents about 12 percent of the agency’s workforce.

In a message to employees, the department said the job cuts would fall mostly on its community and family health services division. They would include both county offices and the central office in Oklahoma City.

“In considering which positions might be affected, service areas were evaluated where expenditures were over and beyond expected budgets,” the email to employees said. “Additionally, areas where there was overlapping responsibilities were included, and a determination was made of how to most efficiently provide those services while reducing staff.”

In a statement to Oklahoma Watch, the department said its financial updates to the board in mid-summer were a work in progress. The department declined to provide additional detail on the causes of the $10 million gap, which represents one-fifth of the agency’s state appropriations.

“The budget process is an ongoing evaluation of grants, programs and funding streams, and was not set in stone in July,” spokesman Tony Sellars said in an email. “Through continued research and monitoring, OSDH provided an update to the budget forecast.”

Leaders of the combined city-county health departments in Oklahoma and Tulsa counties were surprised when the state health department summoned them to a meeting in September about testing and medication costs for sexually transmitted diseases. They were told residents of their counties were seeking treatment in adjacent county health clinics that are state-funded.

Public health programs in Oklahoma and Tulsa counties are affiliated with the state but operate independently as combined city-county health agencies. The other 75 county health departments are under the state.

Gary Cox, executive director of the Oklahoma City-County Health Department, said the state’s request to reimburse costs for sexually transmitted disease testing was unprecedented. The state health department is seeking about $868,000 for STD testing done for Oklahoma County residents this fiscal year.

“Traditionally in Oklahoma, we’ve taken care of whoever shows up at the door,” Cox said in an interview. “In public health, that’s just the way we do it. That’s a big departure from 50 years of public health in Oklahoma, to change the way we do business.”

Cox took the information to his board, which unanimously voted to decline the state health department’s request. In a letter obtained by Oklahoma Watch, the city-county health department requested information about how state health department resources are distributed to all 77 counties.

“We think it important to not only look at STD funding but all public health funding to get an overall accurate financial and service delivery picture,” the Sept. 29 letter said. “Since there appears to be a financial crisis at OSDH, we recommend the immediate establishment of a joint commission with representatives from OSDH, County Health Departments, Tulsa Health Department and Oklahoma City-County Health Department, to look at public health delivery in Oklahoma, prioritization of core public health and shared services in both rural and metro regions.”

The board of directors at the Tulsa City-County Health department had a similar suggestion when the state proposed charging $700,000 for STD testing and medicine starting Nov. 1. The billing request was made by Julie Cox-Kain, senior deputy commissioner of the state health department.

“Julie mentioned that OSDH has been discussing these issues at meetings and off-site retreats for months,” said a Sept. 27 letter from Tulsa health department to the state. “Unfortunately, THD was not invited to be part of those discussions, and yet we have been given approximately 40 days to respond before we begin receiving bills from OSDH.”

Bruce Dart, executive director of the Tulsa City-County Health Department, said the billing request from the state came several months into the fiscal year and after its budget had been approved by the county’s excise board.

“It’s an impossible request for us to meet,” Dart said. “We feel like we don’t have the full story. Suddenly, there’s a budget crisis. Overall, Oklahoma has been dealing with budget shortfalls for a while, but we have been careful.”

Sellars said the state continues to have discussions with Oklahoma and Tulsa counties, contractors and other groups in order “to provide services in a fiscally responsible manner.

“In the current climate, it is imperative for all parties to work together on steps to make public health services stronger,” Sellars said in the statement. “Toward that goal, OSDH is analyzing all aspects of our financial operation. This is a long-term process and it would be premature to go into specific detail at this time about any future plans.”

Even with the layoff announcement, the department still plans to put furloughs into effect beginning Oct. 29. The furloughs – two days per month – will affect all employees at the agency making annual salaries above $35,000.

The department has 2,011 full-time employees, down from 2,287 in 2008. About 100 employees took a VOBO in 2010 and 86 employees took a VOBO last year, according to the state Office of Management and Enterprise Services.

Meanwhile, vendors whose state contracts were canceled said they are scrambling to fill the funding gaps. The department said it expected to save $3 million from cuts to federally qualified health centers and the Oklahoma Child Abuse Prevention program. The health center program reimburses medical expenses not covered by insurance or other funding sources. The child abuse prevention programs support in-home visits for new parents.

Parent Promise, which has contracted with the state health department for child abuse prevention programs since 1995, was notified in late August it would be awarded a new five-year contract for services. Less than two months later, the agency’s $276,000-per-year contract was canceled.

Employees at Parent Promise visit client homes to provide guidance to parents about child development and how to constructively deal with stress that could turn into neglect or abuse.

“The program really breaks a lot of generational poverty and the cycle of poor parenting skills,” said Sherry Fair, Parent Promise’s executive director. “We help them provide a safe and loving home for their children and offer better skills at coping with stress. These prevention dollars are better spent on the front end so the children can grow up to be productive adults who hopefully won’t need state services.”

Fair said her board is committed to finding a way to make up for the loss of the state contract. Parent Promise also uses private donations and some federal funds for child abuse prevention.

Fair and leaders at the Oklahoma City and Tulsa health departments questioned the sudden cuts at the state health department. The ongoing special legislative session to address a $215 million shortfall affected three main agencies: the Department of Mental Health and Substance Abuse Services, the Oklahoma Health Care Authority and the Department of Human Services.

“It’s confusing as to why the Health Department has to make these drastic cuts,” Fair said. “It wasn’t among the three departments that were affected by the cigarette fee that was struck down.”

In 1992, President George H.W. Bush worked in a bipartisan fashion to craft protections for rural hospitals, like the ones that dot the Oklahoma landscape. A very significant part of the 1992 law is section 340B.

The name “340B” tells nothing of the program’s advantages or even what this section of the law covers. Section 340B provides protection for rural and other safety net hospitals. In exchange for the ability to sell medication to the cash cow Medicare and Medicaid programs pharmaceutical companies would provide these hospitals with discounted medications, granting them the ability to stretch their limited resources. Patients with insurance or the ability to pay for medication do so at standard rates negotiated by their provider. The plan with the pharmaceutical companies was to trade a slight decline in profit margins for a huge gain in market share.

This program has been in effect for more than 25 years and many rural hospitals, running on razor-thin margins are able to keep their doors open because of 340B, providing services that might not otherwise be available to predominantly underserved communities, low-income seniors and Medicaid patients.

But now big Pharma is pushing Congress to revoke 340B, claiming losses on the program and unaccountable hospitals. Only one-third of U.S. hospitals participate in the 340B program, many in rural areas. While pharmaceutical companies are complaining about losses, in 2015 only $12 billion worth of drugs, or 3 percent of total pharmaceutical sales were purchased under the 340B program. Annual pharmaceutical sales overall for 2015 were $425 billion, of which Medicaid accounted for $57.3 billion and Medicare (Part D&B) spent $162 billion.

By revoking 340B these same pharmaceutical companies that have been fined billions of dollars for overcharging the government will yank the rug out from under the most vulnerable in the areas that need care the most. And yet these same pharmaceutical companies claiming big losses on discounted drugs charge $84,000 in the United States for hepatitis C treatment and provide the same treatment in India for a mere $900.

Rising healthcare and medical costs should be the key focus on why 340B should remain in place. 340B allows rural hospitals to stay open without government subsidies. Closing many of these rural hospitals would restrict access to care in these areas, potentially shifting the responsibility to cover the $25 billion in uncompensated care 340B safety-net hospitals provide to taxpayers’ expense.

The closure of our rural and safety-net hospitals isn’t the only possible cost of losing 340B. Some rural providers have used funds from the 340B program to create programs providing free transportation to receive care.  If these programs were to end due to budgetary restrictions, transporting low-income patients to these facilities would then likely fall to the government (ultimately the tax payer) Lowering medication costs through 340B for needy patients also reduces the burden on government-funded Medicaid programs. By having greater access to discounted preventative drugs it prevents more expensive catastrophic hospital visits from occurring.

A 2016 report by the Natural Rural Health Association reported that a third of rural hospitals – about 700 – are at risk of closing. Oklahoma cannot afford to lose its rural hospitals. In Markwayne Mullin’s Congressional district alone, two rural hospitals have been forced to close, now requiring travel of more than 30 miles for emergency treatment. If costs continue to rise another 41 rural Oklahoma hospitals could face closure. Our neighbors to the south of us, Texas, currently have 27 counties with zero licensed physicians. Combine the loss of patient care with the jobs impact that hospital closures would create – rural hospitals are often one of the largest employers of the communities they serve – and we are faced with a recipe for the decline of healthcare in rural Oklahoma.

No bill has been presented as yet, however Congress has held Committee hearings regarding 340B. Should big Pharma get their way and persuade Republican legislators to revoke 340B, it will be at their own peril. Rural voters were key to Donald Trump’s victory last November. Instead of revoking a program that keeps Oklahoma hospitals alive, perhaps Congress should fulfill their promise and repeal Obamacare, a big contributor to the rising cost of healthcare. Repealing 340B will only make rural access to healthcare a crisis of its own, and enrich fat cat pharmaceutical companies.

Ronda Vuillemont-Smith is President of the Tulsa 912 Project.

Fmr. Gov. Keating: Medicaid’s huge expansion under Obamacare ‘the 900 pound gorilla’ in the room from CNBC.

Rolling back ObamaCare’s Medicaid expansion has become the focal point of the health-care debate, and rightly so. Without fundamental change, Medicaid—expanded or not—will push state budgets to the brink even as it fails to help the most financially vulnerable Americans.

Consider Oklahoma, our home state. Despite intense lobbying by hospital corporations, the state Legislature stood strong and refused the Medicaid expansion. But the Medicaid rolls increased anyway, and at a dramatic cost to priorities like education, public safety and transportation.

Like most states, Oklahoma used to spend most of its funds on education. But a few years ago Medicaid’s rapidly rising costs pushed it to the top of the budget. Today, Oklahoma spends $5.1 billion a year on Medicaid, more than the $3.4 billion a year for K-12 schools and $942 million a year for higher education combined. Medicaid is now crowding out other state priorities, with real consequences in education and beyond: lower teacher pay, fewer textbooks, deferred road maintenance, fewer mental-health treatment options in the state justice system to prevent incarceration of nonviolent offenders, and—within the Medicaid program itself—lower reimbursement rates for doctors.

Something has to give. If policy makers want to preserve a functioning and reliable safety net for low-income citizens with serious health challenges, they must face the fact that Medicaid is failing.

Read the complete story on wsj.com

State Leaders Come Together to Call on Legislators to Approve New Budget Deal

Today at the state capitol, leaders of Oklahoma’s healthcare education, oil & natural gas, and business communities gathered to call on legislators to approve a revenue package that has been discussed.  The package, $1.50 per pack tax on cigarettes, a 6 cent per gallon increase in motor fuels taxes, and an increase to 3% in the Gross Production tax from the current 2% during the first 36 months of operation and eliminating 46.3 tax incentive million in oil & gas incentives has been widely discussed at the capital in recent days.

These Oklahomans, represent tax consumers and taxpayers, and agreed it was time to set politics aside and pass a budget.

“We cannot fail to have a budget,” stated Bruce Lawrence, President and CEO of Integris, who was speaking on behalf of the Oklahoma Hospital Association, “Without added revenue, the health care infrastructure of our state would be decimated.”

In regards to education funding, Tom Friedemann, Superintendent of Francis Tuttle Technology Center said, “Supplying Oklahoma companies with well-trained employees is a major point of emphasis at Francis Tuttle Technology Center.   Well-trained workers become productive citizens who contribute throughout their careers to the betterment of our state.  Investing in career education is an investment that will enable businesses of all sizes and types to have the people resources they need to keep growing for years to come.”

Tim Wigley, OIPA executive Vice President of governmental affairs stated, “Oklahoma’s oil and natural gas industry supports almost a quarter of the state’s economy by capitalizing on our unique geology and technological advances made right here in our state. The oil and natural gas industry understands its role as the state’s defining industry, and are willing to find legislative compromise to move our state forward. However, efforts to increase the gross production tax to levels that jeopardize investment in our state’s historic oilfields jeopardizes the state’s future and puts the jobs of working Oklahomans that work in the oilfield at risk.”

The Greater Oklahoma City Chamber of Commerce, President and CEO Roy Williams stated “This is far from a perfect deal, but we cannot risk cuts to core services.  Business leaders growing and bring jobs need to know this state will fund education, health care, roads, bridges, and core needs.”

Speaking on behalf of the Oklahoma Association of Health Care Providers, Nico Gomez said “Our industry is in a crisis. We’ve experienced over $93 million in budget cuts since 2010, which has led to the closure of about one quarter of our homes. Many of our facilities are in jeopardy of closing even without further cuts, because of the state’s extremely low Medicaid rate for nursing homes. We need help. We need a budget deal that adequately funds us. We need our legislators to work together and do their job.”

Fred Morgan CEO of The State Chamber of Oklahoma echoed that sentiment.  “As Oklahomans, we need government to work.  It is time to put politics aside and do the work of the people.  No doubt, this is a difficult process.  But those paying taxes have stepped forward. Those who provide services have shown where they can cut.  We cannot let emotions and personal relationship

Each speaker ended their discussion with the following statement:  We have all compromised.  It’s time to cut a deal. We cannot risk draconian cuts.

Participants included representatives from:

• Oklahoma Association of Health Care Providers,
• Oklahoma Hospital Association
• Oklahoma Academy of Family Physicians
• The State Chamber of Oklahoma
• Oklahoma Society of Oral and Maxillofacial Surgeons
• The Greater Oklahoma City of Commerce
• Oklahoma Oil and Gas Association
• Oklahoma Independent Petroleum Association
• Oklahoma State Medical Association
• Oklahoma Institute for Child Advocacy
• And individual Oklahomans present on their own accord.

###

Tribal treasuries could be collateral beneficiaries of a state cigarette tax increase, but it’s not clear Oklahoma’s Indian nations are all that eager for such a potential windfall.

Almost no one in state or tribal government is willing to talk about it on the record, but the proposed $1.50 cigarette tax increase wafting through the Capitol smells like trouble to at least some tribes as well as state officials and most non-tribal retailers.

The non-tribal retailers are afraid they are going to get squeezed out by the tribes; the tribes are concerned they will be squeezed out by the state, and looming over all is the threat of legal action nobody really wants.

At issue are the tobacco compacts more than 30 tribes have with the state, most of them signed or updated since 2013. Under the terms of those compacts, tribal smoke shops collect the equivalent of the applicable state tax on tobacco products, which is then divided with Oklahoma.

Read the complete story on tulsaworld.com

One thing upon which most Oklahomans agree is that former President Obama’s signature legislation, the Affordable Care Act, has been disastrous for most Oklahoma consumers. The regulatory framework of the ACA has led to higher prices and fewer choices for insurance consumers. While Congress works to craft an alternative, there is no doubt this law needs to be repealed.

Repealing the ACA, however, is not the panacea. It must be repealed and replaced in a way that provides stability for consumers and the industry, else Republicans and the Trump administration risk a failed response becoming their signature. I am pleased our Republicans in Washington have introduced legislation and are working through the process.

While “watching the sausage be made” is not always pleasant, this process is far superior to when Obamacare was originally passed, as now we have been given a chance to read it. Yes, there are hiccups along the way (such as pulling the vote in the U.S. House last week), but we must support a process that leads to an outcome that benefits consumers. Nobody ever thought the original bill would be the final piece of legislation, but we have to get the ball moving.

It’s time to act on at least some aspects of the ACA. For example, Congress needs to keep the Health Insurance Tax from going into effect. Congress delayed its implementation last year, and needs to make certain it doesn’t reach into the pockets of Oklahomans before a replacement for the ACA is enacted. We need Congress to act to make certain this issue does not get lost in the flurry of activity happening in Washington, D.C.

There is no one-size-fits-all insurance plan. Different families, individuals and even states have different needs. As Congress looks to create more stability in the insurance markets, I ask them to look at giving states more flexibility and let states be the innovators. While Congress needs to permit the sale of insurance across state lines, insurance needs to remain under state regulatory enforcement. States should be able to enact health reforms related to physical fitness and nutrition programs at the grade-school level and states should be able to innovate in health care delivery mechanisms such as telemedicine, and others, to benefit their state’s particular needs.

The best way to keep health care and health insurance costs from spiraling is to reject the creeping sentiment that health insurance is an entitlement rather than an insurance product. We must return to a free market, grounded in fair and limited regulatory oversight, which is predicated on constitutional freedoms and rights. This structure presents the best possibility of delivering sustainable access and affordability in the marketplace going forward.

I look forward to Oklahoma’s federal delegation helping replace the ACA by creating marketplace stabilization, allowing states to innovate, and ultimately allowing more Oklahomans to afford and tailor insurance coverage to fit their needs.

Mulready, R-Tulsa, represents District 68 in the Oklahoma House.

Read the complete story on NewsOK.com

When you call your doctor’s office, how long do you have to wait for an appointment? If you live in rural Oklahoma, how far do you drive for even basic health care? The truth is, too many Oklahomans wait too long and drive too far for the care that they need.

A lack of health care providers is about more than the inconvenience of long drives and wait times. Oklahoma faces a health care crisis. Our state is 49th in physician-to-patient ratio, and 64 of our 77 counties are designated as primary care “health professional shortage areas,” state Health Department statistics show. Many Oklahomans simply don’t have access to the health care they need.

This year, I’m pleased to author House Bill 1013, which takes a common-sense step toward addressing this problem. HB 1013 would allow nurse practitioners (NPs) to practice to the full extent of their education and training, increasing consumer choice and access to health care for all Oklahomans.

Read the complete story on NewsOK.com

Rep. McBride Plan Would Use Portion of TSET Funds for Health Education Compensation

OKLAHOMA CITY – State Rep. Mark McBride today filed a measure that would transfer funds from the Tobacco Settlement Endowment Trust (TSET) to use as a recurring revenue stream that school districts could use to compensate educators and staff that promote health and well-being for Oklahoma students.

House Bill 1245 would transfer 50 percent of “the moving ten-year average earnings amount” from the TSET fund, which would then be allocated to school districts to “promote the health and quality of life for students in pre-kindergarten through twelfth grade.”

“My goal is to find an ongoing revenue stream that we can use to compensate certain teachers involved in health and wellness, while freeing up funds to pay other teachers,” said McBride, R-Moore. “Not only would this provide those teachers and support staff a funding stream for compensation every year, but it would also indirectly help us reduce smoking among students. Studies show that better educated youth are much less likely to smoke. Increasing pay helps us attract and retain quality teachers, which helps improve our entire education system.”

McBride said the amount transferred could be anywhere from $15 to $25 million annually, depending on how well the TSET investment portfolio performs. In 2016, the investments produced a return of $26.3 million, but produced $46 million the prior year. TSET has a corpus endowment of more than $1 billion, and receives an additional amount annually from the tobacco settlement agreement with tobacco companies.

The funds could be used “for the purpose of compensating personnel involved in specialized mental health services, physical education exclusive of organized athletic programs, school nurse programs, special education services” and other programs that are consistent with promoting health and wellbeing of school children.

Robert Romines, superintendent of Moore Public Schools said the bill would allow school districts an additional revenue stream to compensate some teachers while freeing up funds from the districts general fund to compensate others.

“Mental health services is a growing and on-going expense for public schools,” said Romines. “For example, the Moore School District employs several individuals in the mental health profession. Salaries for these individuals are paid from our general fund and or special education funds. The proposed bill would offset part of these expenditures and would allow savings to the general fund.”

The 2017 legislative session begins on February 6.

-30-