As allies send nuanced messages, will OK Gov. Mary Fallin stick to her guns on Medicaid expansion?

OKLAHOMA CITY – Oklahoma Gov. Fallin has consistently expressed opposition to Medicaid expansion as envisioned in the Affordable Care Act.

However, a close ally said she has “not closed the door” on an expansion along lines envisioned by state advisors in the Leavitt Group, a consulting firm that has examined the state’s options under the legislation known as “ObamaCare.” And, she is under constant pressure to shift her stance by key supporters in the health care industry.

The ally who hinted at Fallin flexibility was Pat McFerron of the consulting firm CMA Strategies. While Fallin has not said she would favor expansion through the state’s program of support for the working poor, he said, “she hasn’t slammed the door either. If it were dead on arrival we wouldn’t be taking our time and energy to do this.”

McFerron’s comments, reported in The Lawton Constitution, came in the context of a late August event where members of the state Hospital Association were encouraging business leaders to support Medicaid expansion

More recently, former state Rep. Fred Morgan, now CEO of the State Chamber of Oklahoma, applauded the Insure Oklahoma program developed almost a decade ago that assists the working poor, indicating it could become a means to expand coverage to Oklahomans presently ininsured. 

Alex Weintz, communications director for Gov. Mary Fallin, said the comments from McFerron and Morgan do not signal weakening in her administration’s often-stated opposition to Medicaid expansion.  

Oklahoma Watchdog asked if Gov. Fallin would stick to her guns on Medicaid expansion under the ACA. Weintz replied, simply, “Yes.”

In an interview, he also commented on changes made in Insure Oklahoma, the home-grown system of premium support for the working poor unveiled in 2006. That system is funded by employers and employees, and also uses tobacco taxes, giving beneficiaries “skin in the game.” 

After negotiations with the Obama administration, 8,000 working Oklahomans now in the program whose annual income falls between 100 percent and 200 percent of the poverty rate will, in 2014, shift into the federal marketplace — and become eligible for federal subsidies

Under a waiver from the Obama administration, some 20,000 more Oklahomans will remain in the system as presently structured – at least for the next year, before the waiver is revisited.

Weintz told Oklahoma Watchdog, “Obviously, the governor’s preference was for Insure Oklahoma to remain unchanged. However, even after negotiating with the Obama Administration, the program will remain almost unchanged for the majority of users.

“Businesses using Insure Oklahoma will see no changes at all. The majority of individuals using the program will be allowed to remain on Insure Oklahoma, seeing small adjustments in their co-pays.  Given that the program was set to disappear at the beginning of 2014, Gov. Fallin’s ability to negotiate an extension with so few concessions is a major victory.”

In a follow-up email, Oklahoma Watchdog asked Weintz if Fallin “is opposed to any effort to use ObamaCare funds or any additional federal revenues to operate Insure Oklahoma in partnership with the federal government after 2014?”

Weintz replied, “I’m not really sure I understand the question. Insure Oklahoma is already using federal funds and always has been. The governor has not proposed expanding Insure Oklahoma, but she is not necessarily opposed to it.

“If it was expanded, it wouldn’t have anything to do with ObamaCare. The ACA does not propose expanding Insure Oklahoma. In fact, Insure Oklahoma was nearly eliminated completely because of the ACA. “

Oklahoma City University Prof. Andrew Spiropoulos interprets the impact of the Insure Oklahoma extension differently. 

The law professor – also the Friedman Fellow for the state’s largest free-market think tank, the Oklahoma Council of Public Affairs – supports what he describes as an “innovative, successful program that relies on a partnership between government and the private sector to provide coverage for the uninsured.”

But in a recent commentary (, and in comments to Oklahoma Watchdog, Spiropoulos contends the Obama Administration gave Oklahoma a reprieve in the one-year extension because the feds perceive “an opportunity to use our state’s leaders’ support of Insure Oklahoma as a wedge to break Oklahoma’s resistance to the expansion of Medicaid.” 

Pointing to changes in co-pays and the shift of thousands of Oklahomans out of the Insure Oklahoma system at the start of next year — and that one-year limit on the program’s lifeline — Spiropoulos contends the federal administration’s “intent couldn’t be clearer. We’ll be happy to support your program, so long as you change it to work like ours.” 

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