NORMAN, Okla. —
Last summer, the U.S. Supreme Court upheld the Affordable Care Act as constitutional, but also decided that states cannot be forced to expand Medicaid, leaving the decision up to each state.
Fallin has rejected two key portions of the law. She decided not to set up a state-operated health-care exchange, thus letting the federal government run Oklahoma’s exchange. She also refused federal funds to expand SoonerCare, the state’s Medicaid program.
In February, Fallin announced the state would pursue its own plan, focusing on improving health outcomes, reducing the cost of care and expanding access to care. Fourteen other states have also declined to participate; three others are leaning against, according to The Advisory Board Company, a research firm.
In February, Arkansas Gov. Mike Beebe, a Democrat, announced he had received verbal approval from U.S. Health and Human Services Secretary Kathleen Sebelius to use federal money intended for Medicaid expansion to subsidize private insurance for low-income people. The insurance would be purchased through a health-care exchange. Arkansas is still working on a formal written plan.
Ohio Gov. John Kasich has proposed a similar approach, but it’s unclear if the legislature will approve the plan.
Texas Republicans have shown interest in such a plan as well, but no formal proposal has been put forth.
A key issue with such plans is the conflict between the Obama administration’s wanting to limit costs and protect benefits for the poor and the probability that using private insurers will cause pressure to raise costs and reduce benefits.
In Tennessee, for example, Gov. Bill Haslam proposed using Medicaid funds to subsidize the purchase of private insurance, but his plan would require a higher co-pay than Medicaid’s. The Department of Health and Human Services took issue. Haslam decided not to present his plan to the state’s General Assembly this year.