Nov. 15--Republican leaders at the state Capitol pushed health care reforms to the back burner earlier this year, hoping the U.S. Supreme Court would overturn the federal law or Americans would elect a president who would repeal it.
The governor and legislative leaders gambled -- and lost -- on both hands they played. With deadlines looming for decisions about setting up a state health insurance exchange and expanding Medicaid, the issue could trigger contention during the next legislative session.
Rep.-elect Arthur Hulbert, a Fort Gibson Republican who was sworn in Wednesday as House District 14 representative, could butt heads with party leaders on this issue. His stance on health care reform could prove to be the first test of his stated independence. Hulbert ran as a Republican, but his stance on many issues mirrored those held by Democrats.
Hulbert never favored the passage of the Patient Protection and Affordable Care Act, primarily due to his belief "it is an overstretch of the government's authority with the required individual mandate." But Hulbert said he would work within the framework of the law as a legislator "in the best interest of Oklahomans."
"I never was in favor of it, but it was upheld by the Supreme Court, we don't have a new president, and we don't have a Congress that will repeal it," Hulbert said of what has become known widely as ObamaCare. "We are going to have to work with what we have -- this would involve Oklahoma accepting the money from the federal government so Oklahoma can create its own state exchange."
Gov. Mary Fallin, who accepted $54 million in 2011 to help set up the exchange then rejected it after being pressured by Republican lawmakers. In July, she said she would wait for a Supreme Court ruling before making any decisions about the issue. When the court upheld the law, she pinned her hopes on the election of a new president.
After President Barack Obama won his bid for a second term, a Fallin spokesman said the governor "is continuing to explore the state's options as they relate to health insurance exchanges." She is meeting this week with other Republican governors before deciding whether to set up state insurance exchange, a decision due Friday.
Communications Director Alex Weintz said the governor's 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."
Top Republican lawmakers were urged by a conservative political action committee a week ago to fight federal health care reforms to the end. The state's attorney general continues to challenge the federal law in the courts.
Hulbert said regardless of the rigid resistance to health care reform that appears to be developing at the state Capitol, he will do what he thinks is best.
"I am sure I will be at odds with them on a lot of things, but you do what you think is best," Hulbert said about the likelihood of butting heads with GOP leaders who endorsed his candidacy. "We live in a nation of laws and need to work with the laws that are passed -- whether we like them or not -- and work to the best possible outcome."
Oklahoma must deal with issues soon regarding the Affordable Care Act. Weintz said Oklahoma "is not in a unique position; many other states are continuing to weigh what options best serve their citizens, as is responsible."
Some of the delay, Weintz said, is because of the federal government's "failure ... to provide further guidance regarding its own rules and regulations." Weintz said the governor "is extremely frustrated that states have been asked to make important decisions about the health outcomes of their citizens with little or no information."
"Basic questions, such as, 'How much will an insurance exchange cost the state of Oklahoma?' have still been left unanswered," Weintz said. "It is disappointing and frustrating that so little information has been provided to states."
Weintz said the governor's policy staff believes missing the deadline to submit a blueprint for a state insurance exchange -- the Obama administration extended the deadline until Dec. 14 -- would not subject the state to a federal exchange. On the issue of expanding Medicaid, Weintz said Fallin remains on track to make a "decision sometime after the election, when it was clearer what the future of the ACA would be."
Provisions dealing with Medicaid, which provides health care coverage for the nation's poor, were the only part of the Affordable Care Act struck down by the Supreme Court. The decision to opt in or out, the majority held, is within the purview of the states.
"The election ended a very short time ago, as you know," Weintz said. "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."
Hulbert, a physical therapist who has taught "an objective non-political course" about the impact of federal health-care reforms on providers, said one of his biggest concerns with Medicaid expansion is the anticipated costs once federal subsidies end after 2021.
Hulbert cites estimates provided by the Oklahoma Health Care Authority and the Urban Institute -- a nonpartisan Washington-based think tank -- showing the expanding Medicaid in Oklahoma could cost the state between $251 million and $789 million.
The Oklahoma Policy Institute cites benefits of what it estimates would be a modest increase in the costs of expanding Medicaid. The Tulsa-based nonpartisan think tank's summary states Oklahomans millions of dollars in uncompensated care for the uninsured who would be covered by expanding Medicaid, "created thousands of jobs in health care and related fields, and generated significant new tax revenue."
The full Senate will return for an organizational day Jan. 8, 2013, with the First Session of the 54th Legislature formally convening Feb. 4.
Reach D.E. Smoot at (918) 684-2901 or firstname.lastname@example.org.
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