HAVING dragged their feet and looked for reasons not to comply with federal law, Gov. Mary Fallin and Oklahoma policymakers now have no choice — they need to decide whether to expand the state's Medicaid program and create an insurance exchange.
The direction taken will be a test of Fallin's leadership, because if she pushes for either one, she will be criticized by the most conservative members of her party. They (and the state's dislike of most everything related to the Obama administration) are who have kept officials from moving forward.
Indeed Fallin and Republican legislative leaders agreed in early 2011 to accept a $54 million federal grant to establish an exchange — an online clearinghouse for consumers to use to choose health care coverage options — that would comply with Obamacare. Only after receiving complaints from the far right did the governor do an about-face and send the money back.
She and others became concerned that accepting the federal grant would make them susceptible to being portrayed by those in their own party as Republicans who endorsed Obamacare — traitors, more or less. The poison attached to the health care bill, which was passed by Congress without a single Republican vote, became such that after the grant was returned, GOP legislators who were tasked with simply exploring ways for the state to comply with the law were branded as pro-Obamacare by Republican challengers.
And so the GOP-controlled Legislature did nothing, opting instead to hope that President Barack Obama would be defeated and Obamacare would be repealed — disregarding the fact that Obamacare was the law of the land all the while. They also pointed to Attorney General Scott Pruitt's challenge of the health law. Pruitt says it doesn't provide for subsidies to be provided through federally established exchanges, only state exchanges — so not establishing our own exchange effectively negates some of the law's impact on Oklahoma.
Obama's re-election dashed any hopes for a repeal and left the state staring at a Friday deadline to submit its plan for a state exchange. States that don't create their own exchanges face the prospect of having the federal government construct one instead.
Fallin's spokesman says the governor will make her decision that's “best for Oklahoma” and not necessarily make one “as quickly as possible.” But this issue has been in play for nearly two years!
As approved by Congress, Obamacare also called for states to expand their Medicaid rolls as a way to insure more Americans. A U.S. Supreme Court ruling this summer said forced expansion was unconstitutional, but it gave the states the option to expand.
Those who favor expansion say it's the morally correct thing to do because it would mean more medical coverage for the state's poorest citizens, and that not expanding would only leave Oklahoma taxpayers funding expansions for other states. Meanwhile opponents, including U.S. Sen. Tom Coburn, say among other things that expansion would result in higher taxes, strain the state budget and shrink the private insurance market.
A Tulsa health care provider said he's encouraged that Fallin continues to mull the Medicaid question. “She can take all the time that she needs to make an informed decision,” he told the Tulsa World.
But really, she can't. The governor needs to act on these two important and lingering issues.