For the some 300,000 Oklahomans getting health insurance through the Affordable Care Act Marketplace, there’s a small user fee built into your premium going straight to Washington, D.C. Oklahoma is making a move to claim that money and the power to lower such fees later on.
The state is transitioning to running the Affordable Care Act Marketplace for Oklahomans instead of it being run by the federal government, as reported by KOSU. This new state-based exchange will be housed in the Oklahoma Insurance Department and is set for the 2028 open enrollment period.
“As far as the agent broker community and the public, I don’t think they’ll notice much of a difference at all from an enrollment standpoint or ease of enrollment. It’ll be going to a different site,” said Oklahoma Insurance Commissioner Glen Mulready.
There’s a tax paid on all insurance premium policies in Oklahoma, with 45% of those funds going to the legislature, Mulready said. Under a state-based exchange, the small 1.8-2.5% user fee on ACA premiums will start going to the state too.
Mulready says the state will start receiving some of those funds as early as mid-2026, bringing in $4.5 million in 2026 and $8.5 million in 2027. The full retention of fees will begin Jan. 1, 2028.
The state could make changes to those user fee rates in the future, even potentially lowering them down the road, but they will stay the same for now. Mulready says the state wants to invest them into a waiver to help lower premium costs and stabilize the market.
Moving to a state-based exchange could also add more control over fraud complaints, special enrollment periods and data collection. With better data, Mulready says they can respond better to the market too.
“Under the federal exchange, we send (complaints) into CMS (Centers for Medicare & Medicaid Services), and that kind of would go into a black hole of the federal government,” Mulready said. “We will be able to react in a substantially expedited manner.”
A team of about 25 to 30 people will be hired to handle the call center and customer service once ACA falls under Oklahoma’s responsibility.
Other states like Georgia and Illinois have also recently moved to state-run marketplaces. In talking with the Georgia commissioner, Mulready says the state saw “phenomenal success.”
On average, ACA premium costs jumped 29% this year. While expired enhanced premium tax credits were part of it, Mulready mainly blames the rising overall cost of health care. He says the Oklahoma Insurance Department can’t do much to lower those costs. They aren’t able to regulate things like hospital systems, costs of new equipment or prescription drugs.
“We can educate folks and encourage folks to be more healthy, right?” Mulready said. “But we can’t really impact health care costs.”
The One Big Beautiful Bill Act adds changes to state-based exchanges, but Mulready says he’s not worried about them.
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