By Constitution Staff

Conservatives were pleased by the November 19 announcement by Gov. Mary Fallin that Oklahoma will not pursue the creation of a state-based health insurance exchange or participate in the Medicaid expansion called for in the Patient Protection and Affordable Care Act (PPACA), also known as ObamaCare. It was just two years ago that the governor and Republican legislative leaders initially supported, and then reversed their position on accepting a $54.6 million "Early Innovator Grant" from the Obama administration to develop a state health insurance exchange. This time, conservatives were cautiously optimistic that the governor would make the right decision.

"After careful consideration, I have today informed U.S. Secretary of Health Kathleen Sebelius that Oklahoma will not pursue the creation of its own health insurance exchange. Any exchange that is PPACA compliant will necessarily be "state-run' in name only and would require Oklahoma resources, staff and tax dollars to implement. It does not benefit Oklahoma taxpayers to actively support and fund a new government program that will ultimately be under the control of the federal government, that is opposed by a clear majority of Oklahomans, and that will further the implementation of a law that threatens to erode both the quality of American health care and the fiscal stability of the nation," said Gov. Fallin. "Furthermore, I have also decided that Oklahoma will not be participating in the Obama Administration's proposed expansion of Medicaid. Such an expansion would be unaffordable, costing the state of Oklahoma up to $475 million between now and 2020, with escalating annual expenses in subsequent years."

Fallin said the state of Oklahoma will pursue two actions simultaneously. The first will be to continue support for Oklahoma Attorney General Scott Pruitt's ongoing legal challenge of PPACA. Pruitt's lawsuit raises different constitutional questions than previous legal challenges, and Fallin said that she and the AG remain optimistic that Oklahoma's challenge can succeed.

Fallin said the second and equally important task will be to pursue state-based solutions that improve health outcomes and contain costs for Oklahoma families. Serious reform should be pursued in the area of Medicaid and public health, where effective chronic disease prevention and management programs could address the trend of skyrocketing medical bills linked to avoidable hospital and emergency room visits. The governor pledged to work with legislative leaders and lawmakers in both parties to pursue Oklahoma health care solutions for Oklahoma families.

Oklahoma is one of 19 states to announce they will not create the federally mandated state insurance exchange. States had until December12 to declare if they would set up the insurance exchanges mandated by the PPACA. The exchanges will be the marketplace where health insurance is to be sold under the ObamaCare law. ObamaCare will require individuals and families to buy federally approved health insurance plans, starting in 2014. Those with incomes at 100% to 400% of the federal poverty level will be eligible for taxpayer funded subsidies -- tax credits -- to help pay for the insurance premium.

The law allows the federal government to establish an exchange if the state fails to do so. However, due to a fluke in the way the law was written, the tax credit is apparently available only to people who are enrolled in "an exchange established by the state under (Section) 1311." There is no mention of people enrolled in federal exchanges being eligible for the tax credit. Also, there is no funding mechanism for the federal exchanges, so the Obama administration may have to go back to Congress to request funding, which is unlikely to be approved by the U.S. House of Representatives. Therefore, it is believed that a state may be able to block implementation of ObamaCare in their state by not setting up an exchange.

U.S. Senator Tom Coburn, M.D. applauded the governor's decision. "I applaud Governor Fallin's decision. ObamaCare's Medicaid expansion and exchange would have, in the long run, hurt Oklahoma patients by increasing their costs, reducing their choices and placing an unsustainable fiscal burden on our state," said Dr. Coburn.

Michael Carnuccio, president of the Oklahoma Council of Public Affairs (OCPA), also expressed support of the governor's decision: "Gov. Mary Fallin faced a critical decision today -- and she chose wisely. Her courageous rejection of fleeting federal dollars to expand Medicaid in Oklahoma improves the odds that the state government will have the means to adequately fund important core services -- including transportation infrastructure, education and public safety -- for years to come. The appeal of federal funds for an expansion of Medicaid is obvious. What is less obvious is that, under the Affordable Care Act, the federal government will gradually reduce Medicaid funding -- and the states will be left to pick up the tab for any well-intended, but short-sighted expansion of the program. With the expansion, the cost of the program to Oklahoma taxpayers by 2023 would have been roughly $6.5 billion -- almost the exact amount of the entire current state-appropriated budget. Thanks to the governor's vision, we can now pursue Medicaid-reform solutions at the state level that will be fair for taxpayers and program beneficiaries alike. The way to save our country is through strong states -- and those start with a strong governor. Therefore, today, we applaud Gov. Fallin's bold leadership."

Oklahoma Insurance Commissioner John Doak endorsed the decision. "I fully support the Governor's choice to forego a state-based exchange," said Doak. "Oklahomans have been very clear about ObamaCare. They don't want it. An overwhelming majority, 65 percent, voted to outlaw individual mandates in 2010. That opposition is just as strong today."

Oklahoma House Speaker-elect T.W. Shannon praised the decision: "It is increasingly evident that reform will come from the state level. Oklahoma has drawn a line in the sand, and I am proud to stand with Gov. Fallin and our citizens to continue leading the fight against a federal government that increasingly overreaches and tramples the rights of individuals and the states."

Senate President Pro Tempore Brian Bingman (R-Sapulpa) weighed in on the decision. "Senate Republicans have welcomed conservative solutions, but a state-run exchange, one that is "compliant' with Obamacare's mandates and supervised by Washington bureaucrats, would be "state-run' in name only. On behalf of the Senate Republican caucus, I want to commend Governor Fallin for recognizing that the hard-earned tax dollars of Oklahomans should not go toward another new government program in the form of a vehicle for implementing a law our citizens have soundly, firmly, and unquestionably rejected."

Bingman also addressed Medicaid. "Moreover, Senate Republicans stand with Governor Fallin in rejecting President Obama's expansion of Medicaid under the Affordable Care Act. We can't afford it -- plain and simple -- and it will do more harm than good in the long run by shifting unsustainable, massive costs to the states. If you believe, as most Oklahomans do, that the federal government simply can't help itself from driving the car at full speed off a fiscal cliff, you must treat any Obama Administration promise to keep up their end of a bargain with a healthy dose of Reaganesque skepticism."

State Reps. Mike Ritze (R-Broken Arrow), and Mike Reynolds (R-Oklahoma City) gave their comments concerning the announcement. "I was very concerned that Governor Fallin might be swayed by the false assertion that we would be delegating the federal government more power if we didn't set up the exchange ourselves," said Dr. Ritze. "As she rightly stated in her announcement, this could not be farther from the truth." Ritze continued, "I am proud to see her and Speaker-Elect T.W. Shannon reverse their support for the ObamaCare Health Insurance Exchange so that we can present a unified front against the federal health care law, which so many Oklahomans rightly reject."

Rep. Reynolds noted that we are already suffering under runaway health care costs. "If we were to go along with this Medicaid expansion, we would quickly see things get worse. Our federal government is already wrecking the nation's fiscal health. We're just choosing to not to tie the state's needs to this sinking ship," said Reynolds.

Ritze and Reynolds both strongly debated against House Bill 2130, legislation supported by Gov. Fallin and Speaker-Elect Shannon two years ago, which would have established the health insurance exchange. The measure only passed by one vote in the Oklahoma House of Representatives before the Senate refused to hear the bill, effectively killing it.

Dr. Ritze believes the "common sense" approach to ObamaCare is nullification, which he said 12 other states have proposed or passed into law. Ritze said nullification would block any implementation of ObamaCare. He has included the nullification option in a bill that he filed for the upcoming legislative session.

Gov. Fallin did not receive universal support for her opposition to ObamaCare. Some Democrat legislators were disappointed in the decision. State Rep. Joe Dorman (D-Rush Spring) said, "I believe that by failing to act on the implementation of a state-run health care exchange, we are removing ourselves from a process that is going to affect Oklahomans. I am disappointed in Governor Fallin's decision to take no action at all to maintain local control over certain aspects of this federally-mandated law. I also believe that while many Oklahomans rejected the federal health care law, including myself when we were called to vote on fighting it for the original court battle, we cannot legally block it or nullify it because the United States Supreme Court has already ruled it constitutional."

Oklahoma House Democratic Leader Scott Inman (D-Del City) stated: "On behalf of the hundreds of thousands of uninsured Oklahomans; the businesses, doctors and hospitals who are drowning in the costs of their uncompensated care; and the Oklahoma taxpayer who ultimately foots the bill for those uninsured through higher taxes and increased medical costs, House Democratic leaders are deeply disappointed and frustrated that Governor Fallin and Republican Leaders have today decided to play politics with the lives, health care and pocket books of thousands of Oklahoma citizens."