Oklahoma's Republican leaders who delayed implementing provisions of the federal health care law in hopes it would be thrown out by the U.S. Supreme Court reacted Thursday with a lack of urgency after the high court upheld most of the legislation backed by President Barack Obama.
Now they are hoping the Patient Protection and Affordable Care Act will be thrown out by means of a Republican presidential victory in the Nov. 6 general election.
“This November we have an election coming up not only for the president of the United States but for Congress,” Gov. Mary Fallin said. “This summer and this fall the people of Oklahoma, the people of our nation will have the chance to voice their opinion about how they feel about the federal health care law once again when they go to the polls and vote. Certainly I am hoping that we'll elect a new president and we'll be able to change faces ... in the (Democratic-controlled) U.S. Senate that we can once and for all overturn the federal health care bill.”
GOP legislative leaders had the same attitude.
“Our best hope now is to elect those willing to repeal this law and work together to find better solutions to the significant health care challenges faced by our state and nation,” said House Speaker Kris Steele, R-Shawnee.
“We must turn our focus toward November and elect leaders who will repeal and replace Obamacare,” said Senate President Pro Tem Brian Bingman, R-Sapulpa.
Fallin and GOP legislative leaders last year turned down a $54.6 million grant to develop a health care exchange, or state-based marketplace, where residents would shop for private health insurance products. The exchange is a component of the federal health care law.
Fallin, Steele and Bingman at first accepted the money, but changed positions after hearing complaints from Republicans and conservatives. Voters in November 2010 approved a state question that prevents Oklahomans from being forced to buy health insurance, which is another part of the federal health care law.
“The people of Oklahoma spoke very clearly last November when they said that they didn't believe the federal health care bill was the right solution for the state of Oklahoma, so we listened to the people,” Fallin said Thursday.
It's uncertain what effect the ruling will have on the state constitutional change. Usually the supremacy clause in the U.S. Constitution states that federal law supersedes state law.
Fallin said she was extremely disappointed and frustrated with the Supreme Court's ruling and that she still considered the measure unconstitutional. She said she will be working with her legal staff and state agencies to determine what the implications are for Oklahoma.
“At this point in time, we really don't know what this means to the state of Oklahoma,” she said.
A legislative joint committee in February recommended lawmakers take steps to establish an exchange similar to the one in Utah, which was established before the national health care law was written. Legislative leaders a month later decided to take no action on the legislation until after the Supreme Court ruled on the constitutionality of the national health care law.
The federal health care law requires states to submit plans for health insurance exchanges if states don't want to use a federal system. The federal government will impose its version of an insurance exchange on states that don't set up their own.
The deadline to have a plan submitted to the federal government is Jan. 1. The system should be operational a year later.
Fallin said she didn't know if the state could have a plan by the Jan. 1 deadline.
The legislative committee recommended that the Oklahoma exchange be housed in the Insure Oklahoma program, which would be spun off from the Oklahoma Health Care Authority and turned into a public trust. Insure Oklahoma allows people whose employer does not offer health insurance to get coverage and pay premiums.
The task force didn't have a cost estimate or suggest where the money would come from.
No state agency is working on building a health care exchange at this point, said Alex Weintz, Fallin's communications director.
Oklahoma lawmakers don't meet again until February, and the governor said she has no intention of calling them back for a special session.
“It's always a possibility, but it's not something I'm going to do,” she said.
Democrats criticized the blase attitude of GOP leaders.
“For purely political purposes, Gov. Fallin flip-flopped on her decision to accept federal dollars for the state exchange, which at the time she said we were lucky to receive,” said Rep. Mike Brown, D-Tahlequah. “She refused these dollars and refrained from making any other effort to be in federal compliance. So here we are now — our state is short $54 million and Gov. Fallin has egg on her face.
“Gov. Fallin and Republican leadership gambled that the Supreme Court would overturn the Affordable Care Act, and did nothing in the meantime, which in my opinion amounts to a dereliction of duty to the people of Oklahoma,” Brown said.
Oklahoma Democratic Party Chairman Wallace Collins said, “It is immoral for the Republican leadership to gamble with the lives of our citizens and now they should start helping restore Oklahoma.”
Fallin said it wasn't a mistake for Oklahoma to turn down the $54.6 million federal grant.
The high court ruling also limited how the federal government could punish states that don't comply with its Medicaid regulations.
The federal health care law included expanding Medicaid eligibility up to 133 percent of the federal poverty level.
Mike Fogarty, chief executive officer of the Oklahoma Health Care Authority, which manages the state's Medicaid programs, said the Supreme Court ruled that states have a choice whether to cover additional people through their Medicaid programs.
“We expect the federal government will issue additional guidance as this ruling is reviewed,” he said. “The Oklahoma Health Care Authority will look toward Oklahoma's leadership for direction as to future action.”
Expanding Oklahoma's SoonerCare program under the federal guidance would make health care benefits available to an estimated 200,000 newly qualified adults, aged 19 to 64, with household incomes at or below 133 percent of the federal poverty level, Fogarty said. A single adult could make up to $15,414 a year, or a family of three would qualify with a household income at or below $26,344.
Medicaid benefits now are available to most Oklahomans with household incomes at or below 37 percent of the federal poverty level, said Jo Kilgore, a Health Care Authority spokeswoman. A family of four has to have an income of less than roughly $8,000 to qualify, she said.
The federal government currently pays for about 64 percent of the SoonerCare and Insure Oklahoma programs, or about $3.25 billion of the total $5.2 billion budget for this fiscal year, Fogarty said. In this fiscal year, SoonerCare and Insure Oklahoma has provided health care benefits to more than 990,000 Oklahomans.
The new eligibility rates are to take effect Jan. 1, 2014. If the state chooses to expand SoonerCare in 2014, the first three years of benefits for the new population would be paid completely by the federal government.
Beginning in 2017, the federal government's share would be 95 percent and would taper to 90 percent in 2020, Fogarty said.
About 17 percent of Oklahomans, or nearly 625,000, are uninsured, Kilgore said. Expanding the Medicaid eligibility up to 133 percent of the federal poverty level would have cut that number of uninsured nearly in half, or by about 250,000, according to Health Care Authority estimates.