Ironically, the need for state development and control was Oklahomas rationale for turning down a $54 million Early Innovator Grant in 2011 the highest federal grant awarded to only seven states viewed as leading the way on building a better health insurance marketplace.
Yet action on a state-created exchange came to an abrupt halt before the end of the last legislative session. Now Gov. Mary Fallin and legislative leaders are in wait-and-see mode until after the November elections.
The states chance of meeting the federal governments Jan. 1, 2013, readiness requirement for the exchange is nearly nil, said David Blatt, director of the Oklahoma Policy Institute, a Tulsa-based think tank.
You cant put just any old thing together and call it the exchange, he said, noting that while the concept of the exchange may be simple, its development is not. The many factors involved including information technology and governance will take time and money.
Essentially, the exchange will be an online marketplace for individuals without health insurance to choose from an array of insurance-provider plans. The U.S. Department of Health and Human Services touts the exchanges as a competitive private health insurance market where Americans and small businesses will be provided one-stop shopping for affordable coverage.
State vs. federal
The ACA requires state exchanges to begin enrolling individuals by fall 2013 and to be operational by Jan. 1, 2014. Still, the law does require states to demonstrate that they have taken the steps necessary to create an exchange and that they will be able to meet the timeline. States that cant do this in the next few months will be subject to a federally devised exchange.
Blatt said it is uncertain what the impact will be if the online shopping place is created by the federal government rather than by Oklahoma leaders.
The important thing is the exchange offer consumers real choice, real competition between various qualified health plans, he said. To us, it is of secondary importance whether it is run by the federal government or the state. If we had done this
properly, yes, we could have tailored it to be state-specific. But its
not clear to us that it will make a big difference.
At the end of the day, the exchange is a place where you can go to get information, figure out your eligibility and get enrolled or get assistance if you need it.
However, having a state health care exchange devised and run by Oklahoma is of chief importance to the State Chamber, whose members include insurance companies. While some may think the chances of that happening are slim, chamber officials said they believe there are still avenues to be pursued.
An asset in Oklahomas hip pocket, said Matt Robison, chamber vice president of government affairs, is Insure Oklahoma, a program created under former Gov. Brad Henry to help small businesses provide coverage for their employees.
It is already a web-based program, Robison said. It is not in full compliance [with the ACA exchange requirements], but it is at least a foundation.
We simply would like a submission [of Insure Oklahoma] to be made in order to keep the feds from imposing their one-size-fits-all exchange.
When asked if Fallin would support and make such a submission to meet the Jan. 1, 2013, deadline, her communications director, Alex Weintz, would not say.
In a written statement, he said, Because of the uncertainty surrounding the future of the Affordable Care Act, Gov. Fallin will not make any announcements or endorse any course of action regarding a health insurance exchange until after the November election. In the meantime, she and her staff will thoroughly and thoughtfully review the state of Oklahomas options regarding a potential exchange.
Even if Obama wins re-election, some state leaders have not given up hope of derailing the ACA. State Attorney General Scott Pruitt last week revived Oklahomas lawsuit challenging the laws constitutionality.