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Okla. Gov Weighs Medicaid Expansion, Health Insurance Exchange

By Wayne Greene, Tulsa World, Okla.
McClatchy-Tribune Information Services

Nov. 08-- A spokesman for Gov. Mary Fallin says she isn't rushing into a decision about accepting federal funding for a state Medicaid expansion under the provisions of the federal Affordable Care Act -- although her own milestone for that decision has now come and gone.

Meanwhile, her administration seems to be opening the door to the possibility that the state will establish a state-based health insurance exchange, an issue that had seemed to be resolved.

The federal law -- "Obamacare" to its critics -- would provide Medicaid services to all families at or below 133 percent of the federal poverty level as one of its primary means of reducing the number of uninsured Americans.

The federal government would pay for 100 percent of the cost of newly eligible Medicaid patients for three years and then gradually shifts costs to the state until a 10 percent cap was reached in 2020.

But when the U.S. Supreme Court ruled that that part of the federal law was unconstitutional, it made state participation in the Medicaid expansion essentially optional. Several Republican governors quickly announced that they would not accept the money, but Fallin has put off a decision, repeatedly saying she didn't want to make a call until after the presidential election.

The re-election of President Barack Obama removes the possibility that the decision would be a moot issue, but the Fallin administration declined to say Wednesday whether she was ready to accept or reject the funding.

"The governor did say she would make a decision sometime after the election, when it was more clear what the future of the ACA would be," said Alex Weintz, spokesman for Fallin. "The election ended a very short time ago, as you know. Her priority is not to make this decision as quickly as possible; it is to make the right decision.

"Gov. Fallin is still conferring with other lawmakers, her Cabinet, and health-care experts in Oklahoma and around the country as to what course of action best serves the people of Oklahoma," Weintz said.

Fallin is being lobbied heavily on the issue.

Hospital and business leaders, including the Tulsa Metro Chamber, are pushing her to accept the funding, arguing that otherwise Oklahoma taxpayers would be paying for other states' poor people to get medical treatment while its own indigent residents went unfunded. That would mean hospitals would continue to shift unpaid medical bills to the costs of insured patients and still suffer the financial consequences of a population with more than 693,000 uninsured citizens.

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But others -- most prominently U.S. Sen. Tom Coburn, R-Okla. -- have urged Fallin to reject the Medicaid funding.

The Medicaid expansion would increase taxes, put future state budgets at risk, narrow the private insurance market, strengthen the federal bureaucracy and put the poor people of Oklahoma at the mercy of an unreliable system of health care, Coburn argued in a recent letter to Fallin that he made public.

Advocates for accepting the federal funding say Fallin's continued consideration of the issue is encouraging.

"We're fervently hoping that she will accept the expansion so we can accommodate additional folks," said John Silva, CEO of Morton Comprehensive Health Services in Tulsa. "For us it's a slam dunk."

About 55 percent of Morton's patients are uninsured. While the federal government provides about a quarter of the facility's funding, that federal funding hasn't risen in about 15 years.

Additional Medicaid coverage for indigent Oklahomans would allow Morton to catch a financial breath, potentially expand important services and think about ways to treat patients in a more comprehensive fashion, Silva said.

"I find the fact that she's still deliberating on it is very encouraging in that she's interested in making an informed decision," Silva said. "She can take all the time that she needs to make an informed decision."

Weintz said Fallin also is still considering the possibility of the state's establishing a health insurance exchange, a separate controversial issue of the Affordable Care Act.

"Gov. Fallin is continuing to explore the state's options as they relate to health insurance exchanges," Weintz said. "Her priority is to ensure the people of Oklahoma are best served by a system that increases access to health care, controls health-care costs and does so in a way that is fiscally responsible.

"Oklahoma is not in a unique position; many other states are continuing to weigh what options best serve their citizens, as is responsible."

When she first came into office, Fallin accepted a $54 million federal grant to establish an exchange that would comply with the Affordable Care Act, but later -- under heavy pressure from tea party members of her own party -- Fallin told federal officials not to send the funding.

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Subsequently, legislative leaders tried multiple times to establish exchanges -- including one exchange that explicitly would not comply with Obamacare standards -- but had to back down under renewed tea party pressure.

When the Legislature failed to address the issue before it adjourned earlier this year, the question seemed to be resolved. States must advise the federal government by Nov. 16 if they intend to establish an exchange. If they don't, the Affordable Care Act provides for the federal government to impose one on states, an option Fallin has made clear should be avoided at all costs.

Weintz said the statement that the governor is still considering exchange options doesn't represent any change in policy.

"She has never ruled out the possibility of creating a state-based exchange and has kept Oklahoma's options open on that front," Weintz said.

Wayne Greene 918-581-8308

wayne.greene@tulsaworld.com

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(c)2012 Tulsa World (Tulsa, Okla.)

Visit Tulsa World (Tulsa, Okla.) at www.tulsaworld.com

Distributed by MCT Information Services

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