Having rejected Medicaid expansion, exchanges, Gov. Mary Fallin must push real state-run health reforms

The Oklahoman Editorial Published: November 21, 2012

GOV. Mary Fallin's rejection of two components of Obamacare — establishing a state-run health exchange and expansion of Medicaid — is significant but hardly unexpected.

We've generally supported the concept of a state-run exchange, believing local control is better than federal control. The concept for the exchanges originated with a conservative think tank. The idea has merit.

However, Fallin and many other governors argue federal guidelines are so restrictive that only the appearance of state control is provided. President Barack Obama has shown little willingness to compromise in the past, so it's understandable that some governors would be skeptical of sudden new promises of “flexibility” on his signature initiative.

The danger for governors is that their implementation of state exchanges could ultimately put them, rather than the federal government, on the hook for Obamacare's failures. It's no surprise many aren't rushing to accept that offer.

We've been wary of the Medicaid expansion because the existing program's costs have steadily increased over the past decade and some officials think its trajectory is already unsustainable. The Kaiser Commission on Medicaid and the Uninsured has estimated Oklahoma's Medicaid enrollment could increase as much as 67 percent under Obamacare, which would likely make a bad fiscal situation worse.

The federal government has promised to cover the full cost of expansion for three years and cover no less than 90 percent thereafter. But it would be naive to put faith in Washington's financial commitment, given the nation's already precarious fiscal standing.

Fallin's critics should also keep in mind that every state dollar directed to Medicaid expansion is money that won't support schools, roads or public safety.

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