Action: Take a comprehensive approach to improve the health of Oklahomans by coordinating prevention and care. The Legislature should increase the tobacco tax by at least 50 cents per pack and use the money to help pay for a comprehensive cancer center and expand availability to health insurance.
The Legislature should design programs and provide tax incentives to businesses for establishing or continuing wellness programs that reduce health costs and boost employee productivity.
Personal health — from wellness, to access, to care — is integral to the economic well-being of a community. Oklahoma has a number of significant challenges including alarming rates of obesity, tobacco usage, type II diabetes and high numbers of medically uninsured. If our state is to be economically successful, we must make better health a top priority for all Oklahomans — whether they live in urban or rural areas. To achieve this goal, the state must take a comprehensive and coordinated approach toward preventing poor health and providing health care when it is needed, ranging from preventative effort such as wellness programs to an adequately funded trauma system to treat those who need urgent care.
The Need to Reduce Smoking
As the state's leading preventable cause of death, smoking kills more people than alcohol, illegal drugs, car accidents, suicide, homicide and AIDS combined. Oklahoma has the third highest tobacco consumption rate per capita in the nation. According to the Oklahoma Department of Health, 42 percent of adults and 21 percent of children use tobacco during a single year. These percentages are 5 to 6 percentage points higher than the national average. Oklahoma has the 11th-highest smoking-related death rate in the nation, and the life expectancy of the state's smokers is 14 years less than that of non-smokers.
Demand can be decreased by increasing the cigarette tax and increasing fines for underage tobacco sales and underage tobacco users. Oklahoma's tax on a pack of cigarettes is currently 23 cents, which is significantly less than the regional and national average, and should be raised by at least 50 cents.
Increasing the tobacco tax would decrease the demand and raise revenue for both treatment and prevention.
Moreover, as discussed below, a significant share of the tobacco tax revenue could be matched and enhanced through the federal Medicaid formula so that the under-insured in Oklahoma could get better access to high quality health care.
Expanding Health Insurance Coverage in Oklahoma
Oklahoma's percentage of uninsured citizens is among the highest in the country, and its percentage of reimbursement rates for health care providers is among the lowest. About one-third of all Oklahomans who receive health care are uninsured or Medicaid recipients. The care they receive is well below cost from the state's health care providers, and some of the financial burden is translated into higher premium costs and smaller numbers of insured citizens.
Oklahoma could potentially leverage additional federal Medicaid matching funds and other funding sources by using a portion of the new state tobacco tax revenue and utilizing a health care provider assessment agreed to by the state's health care providers. Once matched under the federal Medicaid program, these additional dollars – which could add up to several hundred million per year – could fund (1) premium assistance for qualified working families to enable them and their employers to purchase basic health care coverage and (2) a rate adjustment to serve as an incentive to doctors to provide care to qualified persons.
To encourage responsibility on the part of qualified families seeking basic health care coverage, the state should require all such families to pay a premium based on a sliding scale determined by the ability to pay. Coverage should be optional to these families in the event they are eligible for Medicaid coverage.
Emphasizing Wellness
Oklahoma offers many incentives for employers and is considered by many professionals to be one of the top “pro-business” states in the nation. In numerous instances, employer-sponsored wellness programs have been shown to decrease disability days, disability per capita costs, annual medical costs and workers' compensation costs. During the 2004 session, the Legislature should design programs and provide tax incentives to businesses for establishing or continuing wellness programs that reduce health costs and boost employee productivity. Reducing health care costs will help Oklahoma because existing and prospective employers closely examine health care costs when considering expansion and relocation.