Oklahomans and Obamacare: Where We've Been, Where We're Going

November 14, 2013

The past is prologue and, contra Henry Ford, history is not bunk.

History does not seem to indicate that Oklahoma will soon join the ranks of states implementing unsustainable, unfinanced, and unwise variations of Medicaid expansion as envisioned in the president’s health law. Nevertheless, eternal vigilance is the price of liberty.

Let’s review Oklahoma’s history with the president’s unpopular health law.

Oklahoma voters did their part in 2010, passing State Question 756, the “opt out” amendment which simply amended the state constitution to prohibit any penalty for failure to purchase health insurance, and explicitly stated doctors may continue to accept direct payment for services rendered.

That amendment authorized state officials to challenge the federal law. The attorney general—who turned out to be Scott Pruitt, only the second Republican AG in state history (after the sainted OCPA trustee G.T. Blankenship)—has, in the course of events, become the “last man standing” with a “live round” that could put the president’s inaptly named Affordable Care Act (ACA) out of its misery.

It is actually difficult to overstate the significance of the path Pruitt and his staff have taken in Pruitt v. Sebelius. Step by steady step, they have advanced nuanced legal arguments focused on the Internal Revenue Service rules aiming to punish large employers (including state and local governments) who balk at the Obamacare mandates.

Briefs from Pruitt and his staff are complex, but with this succinct legal argument: In states which have not acted to create their own health insurance exchanges, the feds have “no authority under the law to use (exchanges) to offer subsidies and inflict the accompanying taxes.”

Commissioner of Insurance John Doak has frequently criticized the anti-market forces unleashed in the president’s health law. He was among the several state-level insurance officials who reiterated that state laws and rules concerning who is and is not authorized to act as insurance agents and brokers should and would be upheld. This shot across the bow of Obama’s good ship of “Navigators” (formerly known as community organizers) came at an opportune moment this summer.

Oklahoma’s heroic Green family continues to treat its employees like gold, while declining to join the bandwagon Obamacare tried to get rolling to erode religious liberty. Legal counsel for the Greens’ Hobby Lobby asserted that this summer’s legal ruling allowing the company to keep fighting the law’s abortion mandates meant “the tide has turned” against Obamacare.

Gov. Mary Fallin has done her part—rebuffing a $54 million federal grant to pay for creation of an Oklahoma insurance exchange. When she did so, Fallin said Oklahoma would not create a health exchange or authorize Medicaid expansion.

To be sure, two of the governor’s closest allies, consultant Pat McFerron and the State Chamber’s CEO Fred Morgan, have sent nuanced messages that the path might still be open to a warmed-over version of Medicaid expansion through Insure Oklahoma—a limited program of premium assistance that is not really a good policy fit with the “single payer” agenda laced throughout the president’s health law. And liberal journalist Arnold Hamilton has speculated that the governor might still flip-flop on Medicaid expansion after the April 2014 filing for reelection, or perhaps after the June 24 primary elections.

OCPA distinguished fellow Andrew Spiropoulos believes Oklahomans must remain vigilant. He wrote in the Journal Record, “A relieved Gov. Mary Fallin recently announced that the Obama administration has agreed to wait a year before euthanizing the Insure Oklahoma health insurance program.”

So why have the feds given us a reprieve? The administration perceives 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. …What’s the president’s plan? It’s very clever. He will offer to allow us to take all or part of the Medicaid expansion money and use it to expand Insure Oklahoma. The pitch is that we can keep our plan and get the money, too. However, here’s the truth—if we take the deal, it won’t be our plan any longer. … We need to remember that the president isn’t offering to negotiate because he has seen the light. It’s because he feels the heat.

Proponents of Medicaid expansion seem unwilling to accept the clear meaning of our now-frequent use of words like sequester, shutdown, and debt ceiling: federal government spending is on an unsustainable path, one that will become more rocky as the president’s health law is implemented.

On pages 6 and 7, U.S. Sen. Tom Coburn and OCPA’s Jonathan Small discuss the history of congressional inability to carry through with commitments for financing to the states.

When Obamacare advocates falsely claim we’re “leaving money on the table” in not accepting the federal money, they are also missing the meaning of the current, and permanent, war over the size and scope of government—a fight that will intensify if, somehow, Obamacare survives.

In the end, the president’s health law could still fall due to its fiscal unsustainability, or in one or more of the lawsuits outlined above—or perhaps due to some case or controversy not yet on the scene.

The ruling of Chief Justice John Roberts in National Federation of Independent Business v. Sebelius may eventually be seen as a stop-gap that put ACA on life support. Here’s hoping one day the plug will be pulled.