On paper, House Bill 2130 deals “merely” with membership and appointments to the Health Care for the Uninsured Board (HUB) to oversee implementation of a health care exchange. Governor Mary Fallin has now endorsed the idea, yet debate seems likely to continue.

On February 16, Oklahoma received news the state had received a $54,582,269 grant from the federal government. 

When he informed two key members of the state House about the grant reward, Nico Gomez of the Oklahoma Health Care authority wrote, “Oklahoma via the Oklahoma Health Care Authority applied for the federal early innovator grant to build the IT [information technology] infrastructure necessary for a state-based health insurance exchange. …[O]ur application was successful. The official announcement is being made this afternoon in Washington D.C. There will be a lot of work ahead of everyone but this allows the state to make our own plan. I also wanted to note that 97 percent of these funds are planned to be spent through private vendor contracts.”

The “early innovator” grants came from the federal Department of Health and Human Services. Governor Fallin, in her State of the State address, had said creation of a health insurance exchange was one of her top priorities.

Soon after news of the grant award became public, Gov. Fallin and other top state officials – House Speaker Kris Steele, Senate President Pro Tem Brian Bingman, Insurance Commissioner John Doak, Secretary of Health and Human Services Terry Cline and Mike Fogarty of the Health Care Authority – said the state would accept the insurance exchange grant.

When the measure came to the House floor on St. Patrick’s Day (March 17), however, there was no unanimity. While supporters contend the state should take practical steps to be ready in case the federal health care law passes constitutional muster, opponents say the state is hypocritical to try to kill the 2010 law through a federal lawsuit while taking federal money to prepare implementation of its provisions. Some foes note, as well, that the idea of exchanges pre-dates the federal law, and that the controversial federal mandates undermine the market-orientation of health care exchanges.

On March 17, five roll call votes and debate that ran for more than an hour were required to keep the proposal alive. It turned out that the concept of private health care exchanges has a lot of support, but establishment of this particular mechanism – with its roots in federal policy — barely mustered a majority in the Oklahoma House. The measure prevailed 51-34, with four Democrats joining about 60 percent of the Republican caucus in support. The 34 votes against came from a mix of Republicans and Democrats, while 16 members avoided the final roll call.

There are two physicians in the House – Dr. Doug Cox of Grove and Dr. Mike Ritze of Broken Arrow. Ritze opposed H.B. 2130. Cox was not present for any of the roll calls last week.

After the vote, Rep. Rep. Mark McCullough of Sapulpa said:

“It is very exciting for me to see Oklahoma’s Insurance Exchange actually taking shape. It has been over three years since Ed Haislmaier of the Heritage Foundation first came to the Capitol to discuss this groundbreaking innovation in health insurance delivery. Oklahoma is on its way to leading the nation away from top-down, government run health care and toward individual choice and the free market.”

In debate, state Rep. Mike Reynolds said, “This is a clever method to deceive the voters; a way to disguise what you stand for.” Paul Wesselhoft – like Reynolds, an Oklahoma City Republican — opposed the bill. He asked colleague George Faught of Muskogee what members should do, and the latter replied, “I think we should throw it [the grant money] back in their face.”

Opponents say that other states have taken a cleaner and simpler approach to the health care exchange idea, and that needed mechanisms can be established without taking millions of dollars in federal money. U.S. Sen. Tom Coburn and Jason Sutton, a policy analyst at the Oklahoma Council Public Affairs, contend along those lines.

The website MuskogeePolitico said passage put Oklahoma in line with “ObamaCare.” The website’s commentary expressed hopes that Senate Republicans will oppose H.B. 2130.

A conservative taking a contrary view after the measure passed the House was Speaker Kris Steele, who said in a statement sent to CapitolBeatOK, “Oklahoma ranks fifth highest in the nation in the percentage of citizens without health insurance. We now have the opportunity to construct a system that will provide meaningful access to quality, affordable health care coverage. The health care Exchange will empower Oklahomans to make good choices for their families. It will also enable small business owners to purchase health plans that best meet their needs.”

Rep. Glen Mulready of Tulsa, a freshman Republican who handled the bill on the House floor, reflected, “This is an important step towards ensuring that any Exchange established in Oklahoma is a free enterprise and focused solution for private markets. It incorporates the continued role of professional insurance brokers and agents in helping Oklahoma families make the best long term healthcare decisions for their families. The last thing we want to do is leave this role to the federal government.  This establishes our governing board and confirms we have state control that best suits the state of Oklahoma.”

Today (Tuesday, March 22), in what might (or might not) have been a “game-changer,” Governor Mary Fallin reiterated her opposition to “ObamaCare” while giving a strong endorsement to H.B. 2130.

Falllin wrote a letter to every member of the House and Senate. CapitolBeatOK prints every word of her argument in the balance of this story:

“Dear Lawmaker,

“As you may know, this Wednesday, March 23, will represent the one year anniversary of the enactment of President Obama’s Patient Protection and Affordable Care Act (PPACA). I believe, as I know many of our legislators and the majority of our citizens do, that the PPACA is unconstitutional, fatally flawed and ultimately harmful to our economy and the health of our citizens. That is exactly what I told both the Obama administration and our federal lawmakers, in no uncertain terms, when I voted against the law as a United States Congresswoman.

“As governor of Oklahoma and as a citizen, it is my great hope that the PPACA is either repealed by federal legislators or else is struck down by the United States Supreme Court. Our Oklahoma Congressional delegation has my full support as they work towards the former option, and Attorney General Scott Pruitt has my support and encouragement as he leads Oklahoma’s legal challenge.  As governor, I have sent multiple letters to the White House explaining the unreasonable economic burdens the PPACA places on Oklahoma and have requested that the White House fast track the lawsuits against President Obama’s health care law to the Supreme Court. In short, I have been proud to be part of a united conservative front in Oklahoma opposing what I believe to be one of the most dangerous and counterproductive pieces of legislation to come out of Washington in decades.

“I remain deeply concerned, however, that the PPACA will remain the law of the land for some time to come. As long as that is the case, the president’s law will continue to actively assault both the rights of our citizens and the tenth amendment rights of our states. For that reason, I believe Oklahoma’s lawmakers must continue to find new ways to prevent a federal takeover of our health care system in Oklahoma.

“One of the most important ways we can fight that federal takeover is to implement an Oklahoma-based, free-market health insurance exchange so that Washington does not force its own model on the state. While we have already begun to create that exchange, the next step in the process is the passage of HB 2130, which creates a governing board for the program. I am writing now to ask you to support that legislation.

“Under current law as outlined by the PPACA, the federal government will begin establishing a federally designed and run health insurance exchange in 2013 in all 50 states except those that have begun implementing their own state-based exchanges. If we do not develop our own exchange, if we instead do nothing, then we will be powerless to oppose the creation of a federally run program in Oklahoma.

“As you may know, health insurance exchanges, when done right, have long been a conservative idea. In 2009, our Legislature authorized the creation of such an exchange based on model legislation introduced by the conservative Heritage Foundation.

“Using that model, the Oklahoma Health Insurance Exchange we are seeking to create will be an online health insurance market that empowers consumers by providing vastly improved access to information on private insurance products and expanding the purchasing power of individuals and small businesses. Private insurance products will be sold to meet individual needs, insurers will compete to promote real choices for consumers and the free-market will work to lower costs. Unlike the federal exchange Washington may try to force on us, the exchange we are trying to build offers a positive, free-market alternative to the big government, tax-and-spend plan that is the PPACA.

“If we do not pass HB 2130 and implement an Oklahoma-based exchange, the results will be devastating for those of us who oppose ObamaCare and the federal intrusion it represents. Without an Oklahoma exchange, the state is virtually guaranteed to be subject to a federally run, Washington D.C. substitute. And unlike the one we develop here in Oklahoma, that federal exchange will rely on public health care plans and be funded by public debt for many years to come.

“For that reason, a vote against an Oklahoma Health Insurance Exchange and HB 2130 is a vote to leave Oklahoma defenseless against a federal takeover, as mandated by ObamaCare, beginning in the year 2013.

“As a conservative, I hope the PPACA is long gone by then. I join the majority of our lawmakers, as well as the majority of our citizens, in being passionately opposed to the federal health care law. It is my great hope to see it overturned or repealed. But I believe we have an obligation to plan for a future where that may not happen. And in the event the federal health care law is not overturned by 2013, I am not willing to allow the federal government to seize what has been a conservative idea and turn it into something unrecognizable and harmful to the state of Oklahoma and its citizens.

“For all these reasons, I hope you will join me in supporting a free-market, conservative exchange and defend Oklahoma against the federalization of our health insurance by voting for HB 2130.

“Sincerely,

“Governor Mary Fallin”