The Enid News and Eagle, Enid, OK

August 10, 2012

Insurance commissioner shares info on health care exchanges

By James Neal, Staff Writer
Enid News & Eagle

ENID, Okla. — Oklahoma may be forced into a federal health care exchange if the November elections don’t change the political landscape in Washington.

However, the state still would have the option to create its own exchange and opt out of the federal system.

That was the central topic of discussion Friday when Oklahoma Insurance Commissioner John Doak spoke at the Garfield County Republican Women monthly meeting.

Oklahoma is one of 29 states that have not implemented, and are not making progress toward implementing, a health care exchange in accordance with requirements of the Affordable Care Act, according to the Center on Budget and Policy Priorities, a Washington-based think tank that favors the federal health care law.

Oklahoma lawmakers delayed implementing the Affordable Care Act while waiting for the results of a Supreme Court challenge, a decision that in June essentially declared the bulk of the law constitutional.

Still, Oklahoma and 28 other states are taking a “wait-and-see” approach on implementing a state health care exchange, or online market in which the uninsured can compare and purchase health insurance and apply for federal subsidies to cover the cost.

Alex Weintz, communications director for Gov. Mary Fallin, said the governor will wait until after the November elections before making any decisions on a health care exchange or increasing Medicaid coverage, the other major element of the ACA’s thrust to cover the uninsured.

“The governor wants to review all of the options available to the state, with the understanding that a lot can change in November depending on who the next president is and the makeup of the House and Senate,” Weintz said. “We’re going to take the next few months to review the courses of action available to the state and review what the governor thinks would be the best course for the state, again keeping in mind we might have very different leadership at the federal level at that point.”

Doak also is waiting to see what happens in November.

“We want to offer health care to all Oklahomans, we want the transparency to be there, and we need health care to be more affordable, but I don’t know if we need the federal government to be infused in our lives to make those decisions,” Doak said. “I think this is going to be one of the most critical elections we’re going to have in terms of how our government is going to be run.”

But, what if the ACA survives the outcome of November’s elections? A key provision of the law provides the federal government, through the Department of Health and Human Services, can establish a federal health care exchange for any state that has not met the requirement by January 2014.

Doak said Friday of a potential federal health care exchange “we don’t know what it will look like,” and the timing of its potential implementation is uncertain.

But, he added, Oklahoma likely would go into a federal exchange if a state exchange isn’t set up by the deadline, and if the law survives after the elections.

“I think we have to be under the assumption the federal exchange will be ready,” Doak said, “and then we will have to thoughtfully and carefully consider what’s best for Oklahoma, and then pull out of it and move into something that is more reflective of our values.”

Doak said even if Oklahoma is forced into a federal health care exchange, the state still could create its own exchange in accordance with the ACA requirements and opt out of the federal-level exchange.

The creation of any exchange in Oklahoma has become a politically charged issue, and likely would face popular opposition, whether created by state or federal legislators.

Doak said although he has his own political views on the matter, as commissioner, he will enforce whatever is passed down from the Legislature.

“As a regulator, I have to uphold the law, and sometimes you have to do things you don’t want to do,” Doak said. “We’re going to have to fulfill our requirements as a regulatory authority and do whatever the Legislature tells us to do.”

Doak remained optimistic a good solution will be found, regardless of the outcome of the November elections.

Borrowing from a popular British phrase, he urged Oklahomans to “keep calm and carry on.”

“I think it is the right thing to do to remain calm and see what the elections hold,” Doak said, “and then we’ll do things in a businesslike fashion that’s best for the state and in line with the will of the people.”