First, Oklahoma's Republican lawmakers were hoping the U.S. Supreme Court would throw out the Affordable Care Act, also known as Obamacare.
When that didn't happen, they relied on a pledge by GOP presidential candidate Mitt Romney to kill it as soon as he got to the White House.
Now, with Romney's defeat, Oklahoma state officials are looking at a Nov. 16 deadline to submit a blueprint for creating a health care insurance exchange, an online insurance marketplace, required under the law.
Under the law, if Oklahoma refuses to create an exchange, the federal government will create one for it.
In 2010, Gov. Mary Fallin accepted a $54 million federal grant to set up such an exchange, but later rejected the money at the urging of fellow Republicans. Her spokesman said Tuesday she is now considering next steps.
“We are confident we've kept our options open at this point and are going to make a decision based on what's best for Oklahomans, not make a decision necessarily as quickly as possible,” Alex Weintz said. “During this process, the governor has continued to talk with health care experts in Oklahoma so that if we were to decide to do a state-based exchange … we would have the capability, we hope, of doing so.”
Oklahoma is one of eight states that have made no significant activity toward the development of a health care exchange, according to a report by the Henry J. Kaiser Family Foundation. Sixteen others have established a state-based exchange, three are planning for a state-federal partnership, seven have decided only that they do not want a state-based exchange and the rest are still studying their options, the report states.
Weintz said enough groundwork has been laid that Fallin might be able to present an exchange blueprint and application by the looming deadline. Though development and implementation of such an exchange will likely need approval from the state Legislature, which convenes again in February, a blueprint would not, he said.
Others, however, said it appears Oklahoma is destined for the federal exchange program.
“The wait and see is over,” said Senate Democratic leader Sean Burrage, D-Claremore. “The Affordable Health Care Act is the law, and it appears it will be the law for the next four years. I'm disappointed that we are now almost three years behind the curve in preparing for the changes in the law.”
“Ready or not, it's coming,” said David Blatt, director of the Oklahoma Policy Institute in Tulsa. “There seems to be absolutely no chance that Oklahoma will have enough time or the interest in submitting an application.”
But Weintz said there may be other options. The state is one of several that have requested either an extension or waiver from the exchange program, and Attorney General Scott Pruitt has requested a judgment as to whether the federal law unconstitutionally supersedes a state law passed by voters in 2010.
“Those are some of the questions that we don't think we've gotten really an answer for from the Obama administration,” Weintz said.
Fabien Levy, spokesman for the U.S. Department of Health and Human Services, said states have had more than two years to submit a plan but that the federal department will provide “significant flexibility” in assisting states through the process.
“(But) consumers in all 50 states will have access to an exchange come January of 2014,” he said.
Rep. Jason Nelson, R-Oklahoma City, said he thinks there will be time to figure out a way around the program. Nelson, a member of a joint-legislative committee that reviewed the law, said the state's Republican leaders are actively looking for ways to block the federal government from setting up an exchange.
“I think it's a risk that the Legislature was aware of when they decided not to act last session or the session before,” Nelson said. “And deadlines can be kind of sketchy things. I'm not sure if we don't meet that deadline that there's no turning back.”
The wait and see is over. ... I'm disappointed that we are now almost three years behind the curve in preparing for the changes in the law.”
Sean Burrage, D-Claremore