Wayne Greene: Is Fallin's Medicaid rejection the tea party's first win?
BY WAYNE GREENE World Senior Writer
Sunday, December 02, 2012
12/02/12 at 5:41 AM
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It's difficult not to wonder how much Speaker of the House T.W. Shannon - and the coalition responsible for his speakership - had to do with Gov. Mary Fallin's decision just before Thanksgiving to forgo federal Medicaid funding under the Affordable Care Act.
If my suspicions are right, you can chalk up the governor's decision - after months of playing with the issue publicly - as the first victory of a new tea party-tinged GOP leadership in the state House, maybe the first of many.
On June 28, the U.S. Supreme Court raised the issue for Fallin. The high court ruled that while most of the so-called "Obamacare" is constitutional, the federal health-care law's mandated state expansion of Medicaid programs to serve people up to 133 percent of the federal poverty level was not.
So, the court said, each state would get to make its own decision on that part of the program.
Medicaid expansion is, of course, essential to the Obamacare scheme. Without it, the plan has no means of extending health care coverage to the poorest people, meaning the plan for nearly universal coverage would have a giant hole for the group most likely to be in need of help.
To lure the states into that scheme, the federal government went to its best weapon - money. The feds would pay for 100 percent of the benefit costs of the newly eligible clients for three years and the lion's share forever, the law promises. At the top end, in 2020, Washington would pick up 90 percent of the cost. In other Medicaid programs that the state is part of, Oklahoma's share is closer to one-third.
Some GOP governors - Rick Perry in Texas and Bobby Jindal in Louisiana - were quick to reject the Medicaid money on philosophical grounds. They didn't want anything to do with Obamacare.
But Fallin didn't.
She made no secret of her disdain for Obamacare in general. It was unaffordable and unsustainable, she said. It was a violation of the Constitution and bad government ... but still she didn't say no to that Medicaid money.
Nearly a month after the Supreme Court ruling, Fallin announced she wasn't going to make a decision until after the November presidential election. She wanted Mitt Romney to get elected on a repeal-Obamacare platform that would resolve the issue for her.
Things didn't work out that way, and on Nov. 7, she still had a decision to make, and she still didn't make it. She wanted to make the right decision, her staff said, not a fast one.
Actually, the option of a fast decision was long-since gone at the point, but the implication is obvious: She was at least toying with the idea of taking the Medicaid money.
Advocates of such a move - including state hospitals - were telling her that the money would help thousands of uninsured Oklahomans get health coverage and help ebb the passing of uninsured costs to insured patients. The state would end up healthier overall and without a great deal of state tax money involved.
Of course opponents were in the governor's ear, too: Don't tie your political star to President Barack Obama and his signature legislative product, they would have told her. The tea party-wing of the Republican Party was especially adamant on not taking the Medicaid money, using their own statistics to suggest that the state couldn't afford the program and that the federal deficit really couldn't afford it.
Nov. 16 seemed like a likely day for the governor to make a decision. It was a Friday, always a good day for politicians to clear off their desks, and it was the federal government's original deadline for states to announce if they were going to form Obamacare-compliant health insurance exchanges.
Exchanges are a separate but related issue, but if Fallin wanted to reject the Medicaid money, and appease the tea party voice, the national media attention on the exchange deadline would give her the opportunity to kill two Obamacare birds with one stone.
But Fallin signaled from the National Republican Governors Association meeting in San Diego, Calif., that no birds would be killed that day, Fallin's stone apparently being kept clean and dry in a safe place.
For the third time, Fallin had an opportunity to tell Obama to take his Medicaid money and, well, keep it. And for the third time, she kept quiet.
The series of delays is hard to ignore. Why would Fallin keep waiting to turn down the money, if that was what she was going to do?
Which we know now is what she did.
On Nov. 19, Fallin rejected both the Medicaid money and the state option of participating in a health insurance exchange. No Obamacare Medicaid funding for Oklahoma, Fallin announced - 143 days after the Supreme Court raised the issue.
So why the wait?
Here's how I figure Shannon, the new speaker of the House, played into that decision.
Shannon got elected by building a coalition of Republican House members who weren't in power under Speaker Kris Steele and those who were in open conflict with Steele. In other words, to get to the speaker's chair, Shannon needed the support of the tea party-faction of the Republican caucus, and he got it.
Having come to the party with the tea partiers, Shannon now must dance with them.
If Fallin had decided that the state needed the Medicaid funding (even if it came with the taint of Obamacare), it would only work with the active support of the speaker.
With his support, efforts to overturn her decision and reject the money legislatively could be bottled up in committee or pinched off without ever getting a vote on the House floor.
Without his support, a decision to accept the Medicaid money would go down in flames in short order, leaving the governor with the political stain of Obamacare and no Medicaid funding to show for it.
I've shopped that idea around among some GOP lawmakers who know what's going on at the Capitol, and it's gotten mixed reviews, especially the idea that Fallin and Shannon ever actually talked about the politics of accepting the Medicaid money.
But there isn't much disagreement about this: The coalition that lifted Shannon to the top post in the House wasn't going to live with a decision to accept Obamacare money.
In a sense, the decision to reject Medicaid funding got made in October 2011, when the GOP House caucus decided Shannon would follow Steele in the speaker's office.
So, just before Thanksgiving, Fallin rejected the Medicaid money with a lot of fiery rhetoric about the failures of Obamacare.
Almost immediately Shannon issued a press release saying he was "proud to stand with Gov. Fallin and our citizens to continue leading the fight against a federal government that increasingly overreaches and tramples the rights of individuals and the states."
He didn't say anything about her waiting nearly five months to lead that fight.
Original Print Headline: Is Fallin's Medicaid rebuff tea party's first win?
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