A 2011 decision by Oklahoma's insurance commissioner to return a federal health care grant came just days after a prominent conservative encouraged state officials to reconsider their approach to Obamacare.
Insurance Commissioner John Doak announced he would return $1 million in federal funds barely a week after Barry Goldwater Jr., board member at the Goldwater Institute, proposed in an email that the state return all money associated with the new law. The money was intended to pay for health insurance premium rate reviews as required under Obamacare, or the Affordable Care Act.
Emails — which show how Doak and Gov. Mary Fallin progressed from supporters of a state-based exchange to critics — were made available on Thursday in response to an open records request filed by The Oklahoman in November with the insurance commission, the governor's office and the attorney general's office.
The email from Goldwater — addressed to Katie Altshuler, a senior policy adviser to Fallin — criticized Oklahoma state officials for moving ahead with plans to comply with the new health care law while simultaneously suing the federal government to strike down the mandate.
“I am hard pressed on how to fight this battle,” Goldwater wrote in an email to Altshuler on April 4, 2011. “What would happen if the Governor just gave the money back?”
On April 11, 2011, Doak, a Republican, told his staffers to prepare a news release announcing he would return the grant, which was accepted by his Democratic predecessor.
An attachment in an email two days later indicates Fallin had also decided by then that she would return $54 million in federal funding that would have helped develop a health care exchange, a primary component of Obamacare.
Doak and Fallin made their decisions public shortly thereafter.
Health care exchanges
Health insurance exchanges are one of the most debated elements of the Affordable Care Act. Exchanges are organizations set up to create an organized and competitive market for buying health insurance, according to the Henry J. Kaiser Family Foundation, a health policy analysis group.
Beginning in 2014, exchanges will serve primarily individuals buying insurance on their own and small businesses with up to 100 employees, though states can choose to include larger employers in the future, according to the foundation.
States that decline to develop a health care exchange will be rolled into a federal exchange instead, according to the law.
Emails demonstrate that just a few weeks before, both Doak and Fallin were intent on using the funds to develop an Oklahoma-based, pro-growth health care exchange.
In a written statement issued Friday, Doak said his decision against participating in the new federal health care law was not influenced by conservative organizations.
Doak, who took office in January 2011, said he was opposed to Obamacare since its inception but that he instructed his staff to gather information anyway about creating a “private market solution” without influence by the federal government.
“As we became more familiar with Obamacare, we realized that wouldn't be possible,” he wrote.
The Insurance Department's spokeswoman, Kelly Collins, said in a separate written statement that the reversal was the natural progression after Doak began studying the federal program.
“After taking office, Commissioner Doak interacted with many conservative think tanks and ultimately made the decision that an Oklahoma exchange without federal strings could not be accomplished,” she wrote.