The oral health of a state or community can serve as an interesting lens for examining economic health. That is the message that a series from newspapers in the Community Newspaper Holdings Inc. chain recently brought to its readers in Oklahoma.
Ron Jackson of Oklahoma Watch wrote one of the best stories I’ve seen laying out the policy dimensions and the human face of the decision by some states to forgo Medicaid expansion.
You’ll recall, of course, that when the Supreme Court upheld the Affordable Care Act it made the Medicaid expansion a state option, not a requirement.
That created an anomaly that the law’s authors did not intend: People with incomes at the poverty level and up to four times the poverty level (roughly $92,000 for a family of four) will be able to get subsidized insurance in the state-based health exchanges starting in 2014. But people who are poorer than that – who are below the poverty level and who are not now eligible for Medicaid in their state (which is way more restrictive than most people imagine) won’t get subsidies.
If their state doesn’t expand Medicaid, they get nothing.
Oklahoma is among the states rejecting the coverage expansion – saying it will leave them on the hook for untold millions of dollars, even though the federal government has promised to pick up the full cost for three years and 90 percent over the long haul.
Jackson described what that means to “tens of thousands of low-income parents.” Continue reading
The Tulsa World‘s Ziva Branstetter has, for months now, been doggedly investigating the billing practices of the Emergency Medical Services Authority, an agency that provides ambulance service to many residents in and around Tulsa and Oklahoma City. The service is largely funded by utility fees which, unless users specifically opt out, should cover the payers’ out-of-pocket costs.
Instead, Branstetter has found, EMSA has followed a number of apparently deceptive billing practices, including sending bills that list a “due from patient” balance of something like $1,100, even though that amount is actually covered by the utility fee. It also unilaterally implemented a policy making patients responsible for the balance if they don’t provide insurance information within 60 days, while providing lavish benefits to employees and executives.
Branstetter’s latest efforts have been directed toward innovative ways of proving EMSA’s sketchy billing practices, as well as uncovering the details of benefits given to the public utility’s CEO. For a full list of Branstetter’s stories on the subject, databases and documents, as well as a summary of the issues at hand, visit the World‘s excellent landing page for the investigation.
Writing for the local NPR StateImpact outlet, Logan Layden looks at how dental programs for the needy are coping in the absence of state funding. In the 2010 state budget crisis, Layden writes, “Funding for several programs, including Dentists for the Disabled and Elderly in Need of Treatment, was totally eliminated.”
Among those was Oklahoma’s D-Dent, which provides a sort of superstructure that takes care of logistics and tests in order to allow dentists to donate their work to the needy and elderly. Since the cuts, the statewide program has gone from supporting about 800 patients a year to about 600. They no longer get state funds, though they still rely on the health department for most of their referrals, as well as a little moral support.
“We here are entirely supportive of this program,” Jana Winfee, Chief of Dental Health Services the Department of Health, said. “They have our support, just no funds.”
For more on NPR’s StateImpact project and a list of current participants, check out their lab.
In February, the New England Journal of Medicine ranked Oklahoma as the worst when it came to access to medical care. With help from a California Endowment Health Journalism Fellowship, Tulsa World reporter Shannon Muchmore sifted through reams of data to emerge with a three-part series helping readers better understand the state’s unique health care delivery challenges.
Fans of data analysis and numbers will want to dive straight into the first installment. According to Muchmore, 66 of Oklahoma’s 77 counties contain “Health Professional Shortage Areas, which means “they don’t meet the national standard of one physician for every 3,500 people.” And those doctor-patient ratios aren’t improving.
The state is facing a severe shortage of doctors as the population ages. Adding to that, as many as 180,000 people are poised to receive insurance when provisions of federal health-care reform kick in 2 1/2 years from now.
What’s behind that shortage? Muchmore enumerates the key drivers.
Medical schools are not increasing their class sizes, residency slots are hard to come by, and doctors are choosing to locate in other states.
The last two factors go hand-in-hand, as doctors often practice where they have their residencies. Without a connection, they have little reason to locate in a rural area.
The state is not well-positioned to handle a further deterioration in its health-care system. Oklahoma consistently ranks among the worst states for obesity, diabetes, smoking, heart disease and overall health. It has the least improvement in the country in age-adjusted death rate since 1990.
In the second installment, she examines the link between disparities in access to medical care and disparities in life expectancy and other indicators throughout the state, with a special focus on Oklahoma’s most rural counties.
In the final piece, Muchmore looks at the future of health care provision in Oklahoma and the key role that physician extenders, such as nurse practitioners and physician assistants, are poised to play.
Keep an eye on the AHCJ website for an upcoming “How I did it” article from Muchmore in which she shares how she did the reporting on this project.