Sifting through the opposing rulings on the legality of the subsidies on the federal health insurance exchange.
Nov. 17-- Gov. Mary Fallin has delayed a decision Friday on whether the state should take part in a health insurance exchange to accommodate the Affordable Care Act.
"Governor Fallin has decided to postpone an announcement on the future of health insurance exchanges in Oklahoma," spokesman Alex Weintz said in an email. "She will take advantage of the extension by continuing to study the issue and evaluate the state's options."
The governor's office doesn't have a timeline for the announcement, "but we do expect one sooner rather than later," Weintz said from San Diego, where Fallin is attending a meeting of the National Governors Association.
Friday was originally the deadline for states to notify the U.S. Department of Health and Human Services officials about their intentions concerning exchanges, but Thursday evening Secretary Kathleen Sebelius extended the time to Dec. 14.
Under the Affordable Care Act, a health insurance exchange is an electronic marketplace where consumers can shop for coverage. Eligible buyers can enroll in Medicaid through an exchange. Others can take advantage of federal subsidies if their total household income isn't above 400 percent of the federal poverty level, currently $92,200 a year for a family of four.
Sen. Gary Stanislawski, R-Tulsa, said he doesn't interpret Fallin's delay as an indication that she's leaning either way on the issue.
"I believe it's a good decision," said Stanislawski, who was a chairman of a joint legislative committee that studied the exchange issue and related issues last year.
Delaying a decision will give the governor an opportunity to discuss the issue with legislators and fully consider the state's options, he said.
While federal officials still hold out the option for states to establish their own exchange, that seems like a practical impossibility at this point for Oklahoma. The state has taken no advance steps toward beginning the complex issue of developing the computer network, phone banks and other systems needed to organize an exchange, which must be ready to begin enrolling clients Oct. 1, 2013. Also, there is no legal foundation for building an exchange, and the Legislature isn't scheduled to come into session in earnest for months.
The two most likely scenarios would be for the state to refuse to take part in an exchange -- leaving the job to federal officials -- or take part in a jointly administered exchange, a mechanism that isn't actually mentioned in the Affordable Care Act, but which is being pushed by federal officials as an option.
The Thursday announcement by Sebelius also clarified that states that opt not to operate their own exchanges initially can take over the process in the future.
Friday's delay came after a period of intense lobbying of Fallin by those on both sides of the politically hot issue.
Weintz said Fallin's office received more than 1,000 calls on the issue Thursday with a variety of opinions expressed, but the majority opposed an exchange.
"The establishment of a health insurance exchange is just a way for the federal government to force Obamacare onto the states, and Oklahomans have overwhelmingly opposed this government takeover of health care from the beginning," said Rep. Mike Ritze, R-Broken Arrow, prior to Fallin's announcement.
Ritze pointed out that State Question 756, which outlaws individual mandates in the state, passed with 65 percent support in 2010.
"Obamacare is deeply unpopular here," Ritze said. "Just because President Obama was re-elected doesn't mean the states should buckle to his unconstitutional law."
But Ginny Webster, regional organizer for moveon.org in Oklahoma, said she is puzzled by the governor's continued delay of a decision because the only effect of an exchange would be to help the poor people of Oklahoma get access to affordable health care.
"That would only serve to benefit the citizens of the state and for our public officials to even have to think about it is a real travesty in their duty as public officials," Webster said.
She said she suspected it had more to do with Republican Party politics than it did with health policy choice.
Fallin has had a rocky history on the exchange issue. Shortly after she took office, Fallin agreed to accept a $54 million federal grant to build an exchange for the state. The decision brought harsh criticism from the tea party wing of Fallin's Republican Party.
Ultimately, Fallin and Republican leaders were unable to get a legal structure for an exchange through the Legislature, and she was forced to notify federal officials that the state would not accept the $54 million grant.
When the Legislature again failed to deal with the exchange this year, it appeared the issue was dead, but Fallin raised the issue shortly after the presidential election.
Fallin's decision leaves the state's federal lawsuit challenging the constitutionality of the Affordable Care Act in limbo.
Attorney General Scott Pruitt's challenge to the federal law rides on the premise that Oklahoma has not taken part in a state exchange and won't.
Also unresolved by Fallin is the arguably larger question of whether the state should accept Medicaid expansion under the federal health care law.
If accepted by the state, the federal program would make everyone who lives in a household under 133 percent of the federal poverty level eligible for Medicaid coverage.
That would mean an estimated 200,000 uninsured Oklahomans would become eligible for Medicaid with the federal government picking up 100 percent of the cost for the first three years.
After that, the Affordable Care Act shifts a portion of the costs to states, capping at 10 percent in 2020, but some conservatives have pointed to evidence that more costs could be shifted to the states.
Wayne Greene 918-581-8308
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