OKLAHOMA CITY -- Republican leaders in Oklahoma were quick to criticize the U.S. Supreme Court's decision Thursday to uphold the federal health care law but offered no specifics on how they intend to proceed with implementing its provisions.
Gov. Mary Fallin said she was working with her legal team and state agencies to determine what the implications are for Oklahoma, but that she has no plans to call a special session to address some of the law's requirements that lawmakers decided not to enact.
After the nation's highest court upheld most of President Barack Obama's historic health care overhaul in a 5-4 decision, Fallin told reporters she was still trying to digest the ruling.
"We want to make sure we get it right ... and take the appropriate amount of time to do our legal research, certainly listen to the experts in the industry to help us be able to determine what are the options to the state of Oklahoma," Fallin said.
Like many other GOP-controlled legislatures, Oklahoma resisted setting up new online insurance marketplaces _ or exchanges _ where people can shop for and buy health insurance, a linchpin of the federal legislation. Instead, those states have opted to gamble that the law would be struck down.
Opposition to the health care law was so fierce in Oklahoma that the Legislature rejected $54 million in federal money to help set up the exchange, mostly because of resistance from tea party activists and other conservatives who maintained the plan would inextricably link the state to new federal requirements.
Because Oklahoma, like many other states, took no action to create an exchange, experts say it's unlikely the state has time to develop one that would meet federal deadlines.
"One of the things (Thursday's ruling) means is that the health insurance or health benefit exchange, we will probably have the federal model forced on us, because the Legislature is out of session and can't implement the Oklahoma version of the exchange," said Kevin Gordon, president of Crowe & Dunlevy and the head of the Oklahoma City law firm's health care litigation practice group.
Gordon called it unlikely that Oklahoma could establish an exchange by January.
Fallin defended the state's decision not to implement some of the federal law's requirements, saying Oklahoma voters sent a clear message to state leaders in November 2010 when they voted by a nearly 65 percent margin for a constitutional amendment prohibiting the forced participation in a health care system.
"I think the people of Oklahoma spoke very clearly in November when they said they didn't believe the federal health care bill was the right solution for the state of Oklahoma, so we listened to the people," Fallin said.
Gordon said Thursday's ruling essentially makes that constitutional change null and void because of the supremacy clause in the U.S. Constitution that says federal law supersedes state law.
About 17 percent of Oklahomans, or nearly 625,000 people, are currently uninsured, according to the latest figures from the Oklahoma Health Care Authority. About 81 percent of those are adults over the age of 18.
The expansion of Medicaid eligibility to up to 133 percent of the federal poverty level that was included in the federal law was estimated to cut that number of uninsured nearly in half, by about 250,000, according to OHCA estimates. But the court in its ruling determined that Congress' ability to punish states that don't comply with the Medicaid expansion was limited.
"The way we've read it, it looks like the court is giving states the choice," said Jo Kilgore, a spokeswoman for the Health Care Authority.
Oklahoma currently provides Medicaid coverage for children, pregnant women and women with breast and cervical cancer with a household income of up to 185 percent of the poverty level. But for adults, the current eligibility is 37 percent of the federal poverty level.
Fallin spokesman Alex Weintz said the governor was not prepared to discuss her position on the expansion of Medicaid eligibility.