With Gov. Mary Fallin's refusal to expand Medicaid, the fate of health care for about 200,000 uninsured people is in question.
But who are these Oklahomans?
All are of working age, but otherwise they are a diverse group, according to a study by the Urban Institute, a nonpartisan research organization.
More than half are between ages 19 and 35, and more than three-fourths live below the federal poverty level, which is $11,170 for an individual and $23,050 for a family of four. About 60 percent are white, and more than half are men.
A relatively high share in Oklahoma, 24 percent, are parents. That compares to 18 percent nationally, the study found.
These people don't now qualify for health care under the government program but stood to gain coverage next year through expanded Medicaid as envisioned under the Affordable Care Act, also known as Obamacare.
Most also fall into a “crater,” meaning not only will they not qualify for Medicaid when the Affordable Care Act more fully takes effect in 2014, but they won't be eligible to buy subsidized coverage on a new health exchange, where people can shop for insurance online.
Fallin has said the state can't afford the Medicaid expansion and won't participate, even though most of the expansion costs would be covered by the federal government. She has promised the state will continue to look for ways to provide more health care options to the uninsured.
On Thursday, the Oklahoma Health Care Authority authorized a $500,000 contract for a consultant to figure out how much it will cost for Oklahoma to come up with a state-based solution to improve health care coverage in the state.
Fallin's decision not to expand Medicaid leaves people such as Greg Rogers disappointed.
“It just doesn't make sense,” said Rogers, 40, of Del City. “Why would someone turn down federal money that was going to help with the health of thousands upon thousands of people?”
He said the lack of insurance causes him to avoid going to the doctor. His wife, Keta Rogers, 38, lost her medical coverage last year when she was laid off.
“There have been days when I felt too sick to get out of bed,” Greg Rogers said. He works for a small insulation company that doesn't provide health insurance. “But I can't afford to miss work. My family is counting on me. So I drag myself out of bed and do what I have to do to take care of my family.
“One day I was so sick, I finally broke down and went to the emergency room. … It cost me $1,000 for a $30 prescription.”
The couple have three children, ages 14 years, 12 years and 10 months, who are covered under Medicaid. Greg and Keta Rogers are among as many as 50,000 Oklahoma parents who don't now qualify for Medicaid but would have qualified under the expansion plan, according to the study by the Urban Institute, a nonprofit group based in Washington, D.C.
The couple's best hope for getting medical insurance may be to qualify to buy heavily subsidized coverage through the health care exchange the federal government will set up under Obamacare.
The problem is: In order to qualify for subsidized health insurance through the exchange, people must have an income level that is at least at the poverty level. Greg Rogers' income is slightly below that level.
He is trying to boost his pay. He wakes up at 5 a.m. and works at his full-time job until about 3:45 p.m. He then attends classes as part of a three-year apprenticeship that will ultimately earn him a certification that can lead to higher pay.
“I remember one day a man (from an outside insurer) came to talk to us at work about signing us up for health insurance,” Greg Rogers said. “I knew I couldn't afford it before he even began to talk. Right now, I have money taken out of each check to pay for the apprenticeship. We need every penny I make just to get by.
“I'll be honest, I worry a lot about my health,” he said. “I pray nothing happens to me. If something did happen, it would be devastating to my wife and kids.”
Greg and Keta Rogers fall into what's being called a crater: They make too much to get Medicaid but too little to buy the subsidized coverage on the exchange.
Work with lawmakers
When Fallin announced her decision in November, she said the state cannot afford Medicaid expansion and would become more dependent on federal money that might not be available in the future.
Alex Weintz, a spokesman for Fallin, said recently that the governor wants to work with lawmakers, businesses and the health community to find other ways to provide affordable access to care, but it is too early to provide specifics.
“We know that we need to improve our health as a state,” Weintz said. Insuring more families is part of the answer, but sustaining economic growth and reducing preventable illnesses also are important.
If the state had agreed to expand Medicaid, the federal government would have paid $3.6 billion over seven years, including 100 percent of costs for the first three years.
Fallin said accepting the money would put the state at risk of costs of up to $475 million between now and 2020, with escalating annual expenses in subsequent years. For context, the state now spends more than $1 billion a year on Medicaid.
William Noel, pastor of Grace and Glory Baptist Church in northeast Oklahoma City, which sponsors a free clinic, said many people would be surprised at the variety of uninsured Oklahomans.
“These aren't homeless people who don't have jobs. In our free clinic, we see people all the time from various professions — teachers, small-business owners, and a lot of truck drivers.
“In fact, I don't have insurance,” added Noel, saying his church can't afford the coverage.
I'll be honest, I worry a lot about my health. I pray nothing happens to me. If something did happen, it would be devastating to my wife and kids.”