Oklahoma is an ornery cuss. I do not mean just their legendary football teams. I mean their attitudes: non-cooperative with whatever is going on in Washington. I believe I can pick on them with some authority, having been born and raised in that iconic Okie town ... Muskogee.
Oklahoma has a history of thumbing its nose at anything federal. It is not a sentiment that is exclusive to their state; they take it to the extreme. One of the last states to remain dry, I recall that the boot-leggers' stills of the night were held in esteem and federal "revenuers" were the enemy. Anti-federal sentiment is just part of their DNA.
That is why I was also not surprised to read in the New York Times on July 29 that Oklahoma planned to thumb its nose at the mandate to require all states to participate in Obamacare. It did so by turning down a $54 million dollar grant to administer the program. Oklahoma was also the first state taking advantage of the ability provided by the Supreme Court decision to opt out of federally paid extension of Medicaid. The Times held Oklahoma up as the pioneer of the rejectionist position. Since then some other states, mostly those with Republican governors, followed Oklahoma's lead.
There is a provision in Obamacare that does not let such states off the hook. If they do not set up their own systems statewide per federal guidelines, the feds can step in and do it for them. Some states hoped the Supreme Court would overturn Obamacare. That did not happen. Then many states besides Oklahoma also gambled the GOP would win in November so that Obamacare would be repealed. They lost that bet. Elections do have consequences, and keeping Obamacare is a big one.
States with Republican-dominated governments are faced with a dilemma: Either let the federal government take over their health care system or partner with them. It is a particularly uncomfortable position for GOP governors in swing states that voted Democratic.
Wisconsin this week opted to let the feds take over; Ohio will take the partner route; Florida is mulling over the partnering. States have until Dec. 14 to announce their intentions, but not providing Obamacare to their citizens is no longer an option.
Fortunately, 15 state legislatures, such as Colorado's, had the foresight to set up their own state-based structure to administer Obamacare, to determine the private sector participants, and to keep health care control local and tailor made for specific state needs. Beginning October 2013, currently uninsured Colorado citizens will have the ability to choose among a large number of private insurance plans that meet certain standards and to be charged according to their income level. Actual coverage begins January 2014.
A colleague of mine from Texas loudly proclaimed at a social gathering post-election that Obamacare would bring down our economy and destroy jobs. She must not have gotten the message: The Congressional Budget Office on July 25 scored repealing Obamacare as adding more to the federal deficit than keeping it would. The Simpson Bowles Commission concluded that Obamacare was a contributor to reducing the deficit because Obamacare provides some very important cost savings that impact federal Medicare and Medicaid costs. A major reason is that continuing to dump uninsured into emergency rooms is a very expensive way to provide health care.
The GOP's "Obamascare" tactics of wrongly implying the savings to the Medicare system would reduce benefits or their touting vouchers to save Medicare had less of an effect than Republicans had hoped.
Those who already have insurance can also be thankful to Obamacare this Thanksgiving that their 18-25 year olds can remain on parents' insurance and pre-existing conditions will no longer be an excuse to deny coverage.
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