LIKE other Republican-led states, Oklahoma is in no hurry to comply with President Barack Obama's health care law by starting the work of creating a health insurance exchange. And they're getting plenty of support from conservative circles.
The day after the Supreme Court upheld Obamacare, U.S. Sen. Jim DeMint of South Carolina and U.S. Rep. Michele Bachmann of Minnesota fired off a letter to the National Governors Association encouraging governors not to create an exchange. Among the many co-signers to the letter was Sen. Tom Coburn, R-Muskogee.
Last November, the co-chairmen of a legislative committee studying how Oklahoma could comply with Obamacare met with Coburn about it. They said he advised them to develop a state plan, and look to Utah's plan as a possible model. By March, Coburn had changed course, saying that failure of the state to establish an exchange wasn't cause for concern.
The letter to the NGA said the exchanges “pose a threat to the financial stability of our already-fragile state economies with no certainty of a limit to total enrollment numbers. Resisting the implementation of exchanges is good for hiring and investment.” It also says state-run exchanges are subject to the same coverage mandates and rules as a federally run exchange. “Clearing the hurdles of crafting an exchange that complies with the 600-plus pages of federal exchange regulations will only result in wasted state resources and higher premiums for your constituents.”
Gov. Mary Fallin hasn't decided whether Oklahoma should agree to an expansion of federal Medicaid funding made possible by the Supreme Court's ruling. She's been more clear about the exchange — she's not a fan, although for a time in 2011, the state was on its way to creating one.
She and leaders in the House and Senate agreed to an exchange plan, and the state accepted a $54 million federal grant to get it going. Conservative blowback produced an about-face and a return of the grant. The legislative committee studied possible state responses to the law last fall, but no action was taken during the legislative session that wrapped up in May.
We're among the voices that have encouraged Oklahoma to get busy creating a state insurance exchange, in part because the alternative is one run by the federal government. States are supposed to submit their plans to the government by the end of this year, and have their systems running by Jan. 1, 2014. Oklahoma isn't close to having a plan drafted, but is hardly alone — about three dozen states haven't taken action.
They'll be emboldened by stories such as that by Michael Cannon of National Review Online, who found that one provision of the law makes federal subsidies for insurance available only through exchanges that states create themselves. “So, while the federal government does have the power to create exchanges in states that refuse to do so, it can't offer subsidies through those federally run exchanges,” wrote Cannon's colleague, Michael Tanner.
Tanner said governors who don't expand Medicaid and don't implement state-run changes are saving taxpayers money and “potentially reducing federal spending by as much as $1.5 trillion over the next 10 years.”
Those kinds of numbers, along with a nudge from the likes of Coburn, are sure to keep Fallin and state leaders from acting any time soon.