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More than a week after the U.S. Supreme Court upheld the sweeping federal health care law, Oklahoma’s political leaders have offered few specifics about how the state will proceed in complying with its provisions.
Members of the Republican-controlled Legislature were quick to issue press releases condemning the high court’s decision, and some have vowed to continue fighting implementation of the law in Oklahoma — a position that legal experts say is futile.
Like many other states, Oklahoma took little action to comply with the Patient Protection and Affordable Care Act, gambling that the law would be ruled unconstitutional by the Supreme Court. The state now faces deadlines for implementing provisions of the act, such as whether to create a health insurance exchange, or online marketplace where people can shop for and purchase health insurance.
Gov. Mary Fallin, who opposed the bill while in Congress, has consistently voiced her opposition to the law. But Fallin has not suggested what steps the state should take to set up an exchange or whether Oklahoma should expand Medicaid eligibility to 133 percent of the federal poverty level, a move that health officials estimate would result in coverage for an estimated 200,000 of the state’s 624,000 uninsured citizens.
“In light of the Supreme Court’s decision to uphold most of the (act), Governor Fallin believes it is her responsibility to thoroughly and thoughtfully review the state of Oklahoma’s options regarding the future of both Medicaid and the creation of a health insurance exchange,” Fallin spokesman Alex Weintz said. “Her priority is not to make a decision soon; it is to make the right decision. The governor will continue to review how the state of Oklahoma can best meet the health care needs of its citizens.”
The Oklahoma Health Care Authority, the state agency that oversees the Medicaid program, has not been given any guidance from state officials on how to proceed, said spokesman Nico Gomez.
“It appears that everyone is still trying to gather information to better gauge options and requirements,” Gomez said. “We are managing the Medicaid program as it exists today and we will wait to see how the state plans to proceed in regard to the exchange or any expansion.”
Oklahoma is not alone among states that have taken little, if any, action to comply with the new law, said Dick Cauchi, program director in health for the National Conference of State Legislatures. Oklahoma is one of 20 states that passed some kind of statutory or constitutional provision opposing the new law, with nearly 65 percent of Oklahomans voting in 2010 for a constitutional amendment prohibiting the forced participation in a health care system.
“There are definitely states that have taken a broad, oppositional approach,” Cauchi said. “Because there was an anticipation that much of the law might be thrown out, quite a few states decided to wait and see.
“The fact is that this law presents complexities for all 50 states. It creates multiple sets of questions that all 50 states have to look at.”
Some members of the Legislature, like Rep. Mike Ritze, R-Broken Arrow, vowed to continue fighting the new law, arguing the state has the right under the Tenth Amendment to the U.S. Constitution.
“The states created the federal government, not the other way around,” said Ritze, an osteopathic physician. “The states have the ultimate say in issues like this that are completely unconstitutional.”
Ritze said he plans to revive a measure next session that would make it a crime to enforce the federal law in Oklahoma and authorize the attorney general to defend citizens who fail to purchase health insurance.
But such a law would be futile, said Joseph Thai, an expert on constitutional law at the University of Oklahoma’s College of Law.
“Like it or hate it, the health care law is the law of the land, and under the supremacy clause of the Constitution, it trumps conflicting state laws,” Thai said. “Hopefully those legislators who threaten further litigation by the state will pay for it out of their own pockets rather than taxpayer funds.”
The other doctor in the Oklahoma Legislature, state Rep. Doug Cox, R-Grove, said that while the opposition to the federal health care law has been fierce in Oklahoma, the state would be well-served to proceed as if the law will be implemented.
“If something happens after the next election, we can always change things at that time,” said Cox, an emergency room physician in Grove. “You have to be prepared.”
Cox said he sees firsthand the steady flow of uninsured Oklahomans seeking routine medical care at emergency rooms, which drives up the cost of health insurance and medical care.
While Cox questioned how the state could afford to dramatically expand its Medicaid eligibility, he said he sees the benefits of having everyone covered by health insurance.
“In the long run, it will hold down medical costs because you’re going to eliminate cost-shifting,” Cox said. “You spread the costs out over the entire population. That being said, I wear two hats in this thing, and sometimes they conflict.
“As a physician, I would like everyone to have insurance because it enables them to have access to care. But as a taxpayer, I don’t think it’s my job to have to buy it for other people.”