Gov. Fallin and legislators ponder next steps on state Medicaid program

OKLAHOMA CITY – Gov. Mary Fallin was for Medicaid expansion before she was against it. 

Still, for nearly two years now, she has stuck to her more conservative inclinations – often restating her intention for Oklahoma to go its own way. Fallin says she wants to improve health outcomes for Oklahomans, without the explosive costs envisioned under the Affordable Care Act. 

Two legislators have developed a proposal to increase premium assistance under a homegrown program dating back to 2004. Known as Insure Oklahoma, it has notable bipartisan support, but is destined for the ash heap of history under provisions of the ACA.

Some foes of “ObamaCare” fear Sooner State leaders may be inclined to implement the president’s agenda in a round-about manner.

In a recent speech at the spring task force meeting for members of the American Legislative Exchange Council (ALEC), Fallin reiterated her opposition to “ObamaCare” Medicaid expansion, but said officials were working on a plan for Oklahoma that would involve waivers. 

In response to questions about possible evolution in her position, Fallin spokesman Alex Weintz told CapitolBeatOK, “The short answer is, nothing has changed about the governor’s decision not to expand Medicaid as outlined in Obamacare. Her thinking on the issue has not changed.”

In recent weeks, state Sen. Brian Crain, R-Tulsa, and Rep. Doug Cox, R-Grove, have fashioned Senate Bill 640, which Cox said would offer “premium assistance” for purchase of health insurance, along the lines of Insure Oklahoma — explicitly designed to assist the working poor with access to health insurance. Crain and Cox want to sustain Insure Oklahoma, while expanding its reach to children and mothers with children.

However, unless it grants a waiver, the Obama administration has slated programs like Insure Oklahoma for termination on Dec. 31. Crain and Cox say the state could seek a waiver, along the lines advanced in Arkansas legislation on April 23. Crain and Cox say their plan is targeted, and not a wholesale expansion of Medicaid as envisioned in the ACA.

In a statement sent to CapitolBeatOK, Sen. Crain said, “We are currently discussing a waiver request for Insure Oklahoma that would provide federal support for premium assistance to low income applicants who are working, looking for work, going to school or caring for a child at home.”

Under a voter-approved referendum in 2004, Insure Oklahoma helps low-income workers to purchase private insurance. It is financed by Medicaid dollars. Voters have also allowed use of tobacco settlement funds and taxes for health improvements. 

In an editorial, The Tulsa World characterized the Crain-Cox idea as “a decent compromise”. The state’s largest newspaper, The Oklahoman in Oklahoma City, said the state-based idea has some appeal, but that “ObamaCare” remains a bad idea

As for the activist community, Michael Carnuccio of the free market “think tank,” Oklahoma Council of Public Affairs (OCPA), says the Arkansas plan is still “fool’s gold.” 

“Oklahoma lawmakers should advance their own solutions to the problems dealt by the ACA.  However, with a $16 trillion federal deficit, it may be unwise to build any Oklahoma solution on a broken federal treasury.  And it is unclear that HHS in Washington will give states like Arkansas all of the free-market reforms they’re looking for,” said Christie Herrera, policy vice president at the Florida-based Foundation for Government Accountability.

She told CapitolBeatOK, “It’s important for Oklahoma to examine reforms like the one that passed the Florida House this year, which offered limited, targeted premium assistance to working young adults and low-income parents with state-only dollars.”

Supporters of Medicaid expansion, more broadly, include members of the Oklahoma Council of Churches. Nearly two dozen leaders of varied faith communities signed a joint letter in late April. At a Capitol press briefing, organized by OCC’s Dr. William Tabbernee, a diverse group of ministers made the case for Medicaid expansion. 

Even if the governor gravitated toward some new steps on Medicaid, she would need the support of legislators. Peter J. Rudy of Oklahoma Capitol Source, an independent online news organization, reported results of a survey of Oklahoma legislators.

Of the 41 responses Rudy garnered, 28 legislators opposed taking additional federal funds for Medicaid, nine supported Medicaid expansion as envisioned in “ObamaCare,” and four said they preferred using federal funds for an Oklahoma-developed plan. There are another 22 legislators on-record as supporting Medicaid expansion

While all this discussion continues, the Oklahoma Health Care Authority, which administers state Medicaid programs, is awaiting a report from the Leavitt Group, a private consulting firm that has undertaken a comprehensive study of low-income health care in Oklahoma. That report won’t be circulated until after this year’s legislative session ends late this month.

During the 2010 debate on the Affordable Care Act, HHS Secretary Kathleen Sebelius and President Barack Obama said Americans who liked their insurance plan could keep it – a commitment challenged by several developments in recent months. For thousands of Oklahoma’s working poor, their “current plan” is Insure Oklahoma.

One question could be whether, in light of the U.S. Supreme Court’s decision allowing the state’s flexibility in Medicaid management, a federal “waiver” could be as simple or elegant as approval current funding levels to sustain a program like Insure Oklahoma, allowing state legislators more time to consider a fresh cycle of homegrown approaches.

You may contact Patrick B. McGuigan at and follow us on Twitter: @capitolbeatok.