Note To Oklahoma GOP: Obamacare Will NOT Be Repealed

We can only hope local Republican leaders will soon get over any smug celebration of Oklahoma’s election results, recognize how they and others in their party seriously miscalculated the election’s national outcome and finally come to terms with the Affordable Care Act.

Conservative pundit after conservative pundit predicted a Mitt Romney landslide in the election as they isolated themselves in a Fox News/Rush Limbaugh bubble that is as laughable as it is tragic. Romney’s huge landslide was then supposed to lead to the immediate repeal of the ACA. Oklahoma, of course, did give Romney a landslide and extended state Republican gains in the House and Senate, but we’re out of step with a majority of the electorate.

President Barack Obama’s signature legislation, known derisively as “Obamacare,” wasn’t the election bugaboo Oklahoma Republicans wanted it to be. GOP leaders here have wasted valuable time and money by filing a lawsuit against it and declining money to implement it.

Just as Democrats must accept that Republicans have super majorities in both chambers of the Oklahoma Legislature so do Republicans here need to accept the idea that Obamacare is here to stay. It’s the law. American voters had a chance to get rid of Obamacare, and they chose not to do so.

This means two things need to happen right now. Oklahoma should accept an expansion of the Medicaid program and either create a health insurance exchange as mandated by the ACA or work amicably with the federal government as it does so.

So far, post-election, Fallin has again delayed a decision on these matters. She has no excuse. Obama’s Electoral College rout, 332 to 206, has clearly given him a mandate to implement his health care legislation. What politics are there left to play?

It’s true the U.S. Supreme Court recently ruled that states don’t have to accept the expansion of the Medicaid program to people at or below 133 percent of the poverty rate, but the federal government will pay all the costs for three years and then gradually make states pay only 10 percent of the cost.

Republicans, such as U.S. Sen. Tom Coburn, argue the expansion will cost too much, but this ignores the long-term savings of expanding basic medical care and providing preventative care to a broad swath of American people.

The exchange will allow people to purchase health insurance at competitive prices and thus increase the number of people who are insured. This drives down medical costs for everyone, too. Unfortunately, Fallin, under pressure from extremists in her own party, rejected $54 million in federal funding to help set up the exchange and now she has until Nov. 16 to decide whether the state will do it on its own or simply let the federal government will do it.

Of all Republican leaders here, state Attorney General Scott Pruitt perhaps miscalculated the most when he filed suit on behalf of Oklahoma against the ACA. The Supreme Court, with a majority of conservative justices, has upheld the individual mandate provision in the ACA and now voters have reelected Obama to a second term. The energy and state money Pruitt has expended on this political nonsense should be controversial, but it’s highly unlikely Republicans, who control the state government, will hold him accountable.

At issue here is, again, math. Obama consistently led in most polls conducted in battleground states throughout the election. Most prominent Democrats never publicly gloated and recognized the capricious nature of “odds,” but mathematicians, such as Nate Silver of The New York Times, were consistent in predicting Obama’s victory. Meanwhile, Republicans—from U.S. Sen. Jim Inhofe to conservative pundit Dick Morris—predicted a Romney landslide. They simply didn’t do or couldn’t do the math.

Republicans here are not doing the math on the ACA either. The math is to expand the number of people who are insured to drive down health care costs for everyone. The math is to catch medical problems earlier before they develop into major, expensive illness. The math is to pool resources to benefit everyone. There is an algorithm for each of these items.

Oklahoma Republicans can isolate the state further through smug, petulant ideology and false arrogance, but it’s clear Obamacare is the law of the land and will remain so.

Fallin, GOP Should Accept Medicaid Expansion

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Will Gov. Mary Fallin refuse federal money to expand the state’s Medicaid program under the Affordable Care Act?

Fallin has said through a spokesperson that she is currently weighing the matter, but the decision should be a no-brainer when it comes to human decency. The expansion will make approximately 200,000, low-income Oklahomans eligible for health insurance. That’s a significant number in a state with a population of 3.7 million people, and that’s why Fallin should brush aside calls in the Republican Party here for her to reject the money.

As we all know, the U.S. Supreme Court recently upheld the ACA, known as Obamacare, but its decision also allowed states to opt out of the Medicaid expansion program contained in the new law. Under the program, states could use Medicaid to cover adults who have incomes up to 133 percent of the poverty level. The federal government would provide the bulk of the money, but states would eventually have to cover some of the expansion costs with matching funds.

Florida Gov. Rick Scott, a Republican, has already said he will refuse the federal money because it would eventually cost his state too much money, and it’s been reported the Republican governors in other states are considering rejecting the money as well.

The question, though, is whether the threat of rejecting federal money is more of a political act, an anti-Obamacare gesture, than it is a fiscal decision.

Oklahoma, in particular, with its poor medical care rankings and relatively modest budget, is a place where a Medicaid program expansion could go a long way in improving health care. Obviously, the state could definitely use the extra federal money.

If she accepts the money, Fallin undoubtedly will find herself under fire from conservative extremists in her party, and it could be used against her in a reelection bid. But that’s two years away, and the overall view of Obamacare might be much different than it is now. The political risk seems minimal given Fallin’s popularity ratings as well.

If Fallin adopts a do-nothing posture and just hopes for repeal, as she did by rejecting federal money to create a health insurance exchange in the state, then Oklahomans could actually end up paying for Medicaid expansion in other states with their federal tax dollars. Meanwhile, our medical rankings here will remain low, and thousands of low-income adults will go without adequate health care.

The new health care law is not perfect, but it’s what we have, and it’s a start to repairing an unsustainable medical system that has many problems. Fallin should do the right thing by putting politics aside and accepting the new federal money.

Judicial Restraint

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The U.S. Supreme Court will begin hearing arguments Monday on the constitutionality of the Patient Protection and Affordable Care Act, heralded as one of its most important cases in decades.

If the court issues a wide sweeping ruling striking down PPACA completely, it would then be seen by many as an activist political body inserting itself into a controversial issue during a presidential election year. The reputation of the court would most likely suffer for years, and it could then become even further politicized.

If it decides in favor of PPACA, it would strengthen and further modernize the federal government’s role in regulating commerce—one of the main issues will be the interpretation of the constitution’s commerce clause—but would be widely viewed, especially in the South, and in places like Oklahoma, as a blow against state rights. Twenty-six states have sued the federal government over the law.

The core issue is the individual mandate, which requires that most everyone purchase health insurance or pay a penalty. The mandate has yet to go into effect, making the court’s decision even more philosophical, political and polemic. The commerce clause holds that the federal government can regulate . . . “Commerce with foreign Nations, and among the several States, and with the Indian Tribes.” Does the commerce clause, then, support the constitutionality of the PPACA?

The generality and fluidity of the commerce clause and other parts of the constitution granting states rights makes the question an interpretative and plural argument. The court could also issue a limited decision delaying full consideration until after the mandate goes into effect or strike down the individual mandate but leave other aspects of the law intact.

Of course, there’s also the issue of how the decision would affect the presidential election, which is probably a win for President Barack Obama in either case. If PPACA is struck down completely, the Republicans win a tactical battle on a huge scale, but they also lose one of their main rhetorical complaints against the Obama administration, and this might inhibit GOP political motivation in November.

If PPACA is upheld, Obama will simply argue that the highest court in the land has legally sanctioned a health program similar to the one supported by his probable, Republican opponent, Mitt Romney. Romney endorsed such a program as governor of Massachusetts, and the program has been proven successful.

Many legal experts predict the court will either uphold the law or issue a limited ruling if only for the sake of the court’s reputation. If it strikes down the law, it would be widely seen as an intrusive, politically explosive gesture proclaiming a superiority of the judicial over the legislative and executive branches of government.

Judicial restraint, however, might not hold as much significance in a country that remains this deeply divided politically.

All of this matters little, of course, to the actual pragmatics of PPACA, which has proven popular for many people because, among other reasons, it allows children up to 26 to remain on their parents’ health insurance policies and allows people to obtain insurance with preexisting conditions. It also surely matters little to the uninsured person dying of cancer or the parents of an uninsured sick child.

Oklahoma is one of the states that has sued the federal government over the law and has rejected federal money to help establish health insurance exchanges that would make it easier for some people to get insured.

Obviously, the current Oklahoma political power structure overwhelmingly opposes the law and, one might assume, will hope the court rules it invalid. This is historically wrong in the legacy of American legal issues, but, more importantly, it’s a step backwards in a state that has some of the worst medical outcomes in the country, faces rising insurance costs and has a decided lack of insurance choices.

Here are facts, provided by the U.S. Department of Health and Human Services, I’ve previously published:

The overall quality of care in Oklahoma is rated as “Weak.”

16 percent of children in Oklahoma are obese.

28 percent of women over the age of 50 in Oklahoma have not received a mammogram in the past two years.

45 percent of men over the age of 50 in Oklahoma have never had a colorectal cancer screening.

76 percent of adults over the age of 65 in Oklahoma have received a flu vaccine in the past year.

Roughly 1.9 million people in Oklahoma get health insurance on the job, where family premiums average $12,256, about the annual earning of a full-time minimum wage job.

Since 2000 alone, average family premiums have increased by 77 percent in Oklahoma.

Household budgets are strained by high costs: 29 percent of middle-income Oklahoma families spend more than 10 percent of their income on health care.

High costs block access to care: 17 percent of people in Oklahoma report not visiting a doctor due to high costs.

Oklahoma businesses and families shoulder a hidden health tax of roughly $1,900 per year on premiums as a direct result of subsidizing the costs of the uninsured.

19 percent of people in Oklahoma are uninsured, and 70 percent of them are in families with at least one full-time worker.

The percent of Oklahomans with employer coverage is declining: 54 percent were covered in 2007.

While small businesses make up 78 percent of Oklahoma businesses, only 39 percent of them offered health coverage benefits in 2006.

Choice of health insurance is limited in Oklahoma. BCBS OK alone constitutes 45 percent of the health insurance market share in Oklahoma, with the top two insurance providers accounting for 71 percent.

Choice is even more limited for people with pre-existing conditions. In Oklahoma, premiums can vary based on demographic factors and health status, and coverage can exclude pre-existing conditions or even be denied completely.

Perhaps, the most telling fact is Oklahoma’s infant mortality rate, which is one of the highest in the country. That’s a statistic that tells the state’s story as much as the number of oil pumpers that dot the landscape here. Given the high infant mortality rate and other poor health outcomes, the complaints here against the law seem hollow and mean.

I supported PPACA even though it lacked a public option, which remains the key component to solve medical access and exorbitant health care costs. I still believe the new law is a step forward and will be redeemed by history, though the court could, but absolutely should not, make that a problematic premise.

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