Let’s Hear It for Penalizing the Uninsured

The Daily Oklahoman passes along some suggestions

It would have been really, really nice had the Daily Oklahoman given a few more details about suggestions made by the state’s insurance commissioner, Kim Holland, who wants to stick it to uninsured Oklahomans. The paper told us that, according to a survey by the Centers for Disease Control and Prevention, about one-third of the state’s population is uninsured. Another survey done by Oklahoma’s Health Care Authority found that nearly 17 percent of residents, or close to 600,000 people, don’t have coverage. That’s a lot of folks any way you look at it. And most don’t have coverage because they can’t afford the high premiums in a state where the median family income is $40,709 and premiums for a good comprehensive family policy can run $12,000 or more.

Holland acknowledged it’s unlikely that the state will require everyone to buy health insurance, but held out the proposition of “inducements” to penalize those who fail to insure themselves. Those aren’t very pleasant solutions, she says, but “there needs to be a consequence.” Her consequences are a variation of “no ticki, no shirti,” or, in this case, no “shirti, no ticki.” If the uninsured have season tickets to the Oklahoma and Oklahoma State football games, she wants to take them away—no more Boomer Sooner OK U for them. But it’s unclear whether the loss of fifty-yard-line seats will get people to cough up several grand for health coverage. So Holland has other proposals—forfeiting lottery and gaming winnings, losing state tax deductions, and—get this—revoking licenses to hunt, fish, and drive a car. Maybe the uninsured can go without shooting pheasants, but driving a car? How are they supposed to get to work to earn money to pay insurance premiums? Then there are the penalties that eliminate in-state discounts for college tuition, which Holland has mentioned. Does she understand that penalty might make it harder for Oklahomans to go to college and perhaps improve their education, so they get higher-paying jobs to pay for the health insurance they will be required to buy?

“We have developed this culture over the years that some don’t feel like they have to pay their medical bills,” she said. Pretty strong stuff there—but the paper didn’t back it up. The paper did note, however, that state representative Kris Steele suggested Oklahoma to create a situation where people don’t have excuses for going without insurance. After that, he said, come the incentives.

All this suggests that the insurance commissioner and the state rep don’t understand family economics and budgets. But a good reporter at the The Daily Oklahoman should. It may be easier politically to penalize the poor and the near poor in the hope the country can eventually get to universal health coverage than to tell hospitals and insurance companies they can’t charge so much for care. The paper’s reporter should be pinning down the commissioner and reporting about this.

States are gearing up for new legislative sessions in January, and undoubtedly we will be treated to a new round of attempts to cover the uninsured. Last year’s efforts didn’t produce much, and the states, more strapped for cash than they were last year, probably won’t be able to do much now despite the rhetoric about personal responsibility and penalties and getting everyone a policy. Money problems bring desperation, and perhaps that’s why the insurance commissioner’s “no shirti, no ticki” plan deserves some careful media scrutiny.

The Daily Oklahoman’s coverage of the insurance commissioner and her pronouncements should be a how-to-not-do model for other news outlets tempted to report such “solutions” without context and critical evaluation. Context, context, context, please. And if the paper is worried that context veers too far from objective journalism, then the editorial page taking a look at the commissioner and her proposals.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.