Oklahoma GOP leaders gambling on health care decision

The move is calculated — albeit risky — for Oklahoma's GOP leaders, who cited fears of a federal takeover of health care in declining to set up a state-run health insurance exchange. Should the law be upheld and the state doesn't create its own exchange by November, the state would automatically be absorbed into the federal system — the very thing they're fiercely trying to avoid.

“Like many states, Oklahoma has opted to see whether or not the federal health care law survives a challenge in the U.S. Supreme Court before acting on an exchange,” said Alex Weintz, a spokesman for Republican Gov. Mary Fallin. “The governor's hope is that the law is overturned, allowing states to pursue their own health care solutions that emphasize choice and free-market competition rather than being saddled with ineffective and costly mandates from the federal government.”

But Weintz acknowledged Fallin has not decided how to proceed if the law is upheld, saying she plans to discuss those options after the ruling.

In a state that filed a federal lawsuit claiming the law is unconstitutional and where nearly 65 percent of the voters in 2010 favored a constitutional amendment that prohibits forced participation in a health care system, Republican lawmakers are clearly in no hurry to comply with the law.

The resistance to the new health care law was so fierce in Oklahoma that the Legislature rejected $54 million in federal money to set up the exchange, mostly because of fierce opposition from tea party activists and other conservatives who maintain the plan would inextricably link the state to new federal requirements. When lawmakers decided to study how the state could set up and fund its own health insurance exchange, conservative activists were so relentless in their opposition that the Legislature ultimately decided to do nothing.

“If the court rules for the individual mandate, we're going to be a little behind the curve and we'll have to be playing catch up,” acknowledged Republican state Rep. Doug Cox, an emergency room physician from Grove who served on the legislative study committee. “I think what we're really betting on is the presidential election this fall.”

But even if Republicans were to take back the White House and the Senate, states still face a November deadline for having an exchange plan in place.