Gov. Mary Fallin’s office released 100 pages of emails on Monday that it withheld last year regarding her decision to reject federal funds to create a state health-care exchange and expand Medicaid.

Fallin withheld the emails from among more than 50,000 it released to the Tulsa World and other media outlets last year. The governor cited “executive privilege” in withholding the documents, claiming the need to receive candid advice without concern for public reaction.

While Fallin said she needed to withhold some records to protect the “deliberative process” involving policy decisions, most of the emails revolve around the political cost of accepting federal funds for health care.

Many of them center on a feud between the governor and a conservative think tank, the Oklahoma Council on Public Affairs, over a blog post that was critical of Fallin’s leadership.

The emails related to health-care policy show the role former Secretary of State Glenn Coffee played in Fallin’s decision to reject Medicaid funding, listening in on a conference call among state governors.

“I think it stems as much of not more from the tone and tenor to the (governors’) conference call. There was no one making the argument for opting in. I will post my notes later tonight,” Coffee wrote in a July 3, 2012, email.

Chief of Staff Denise Northrup responded: “The govs only call? I would have been on if I knew there was staff allowed.”

Meanwhile, Policy Director Katie Altschuler argued that it was “unwise to make any rash decisions.”

“These are very complicated issues that will have a significant impact on the state whichever way we go,” she wrote.

Fallin’s decision to withhold the documents was challenged in a lawsuit by the American Civil Liberties Union of Oklahoma on behalf of The Lost Ogle, a media criticism and humor blog. In June, an Oklahoma County district judge ruled that the governor had a right to withhold documents that were part of the deliberative process.

On March 29, under pressure from the World and several other media outlets, Fallin released 51,029 pages of electronic public records concerning her policy considerations about the Affordable Care Act. The emails revolve around two related issues: whether to accept a $54 million federal grant to create a state health-care exchange and whether to accept federal funds to expand Medicaid funds in the state.

The grant would have allowed the state to create its own exchange through which residents could purchase insurance under the Affordable Care Act. Because Oklahoma did not accept the funds, it is among the states using the federal exchange.

In February 2011, then-Speaker of the House Kris Steele, R-Shawnee, offered House Bill 2130 to create the legal groundwork for a state exchange. Fallin’s office announced support for accepting the grant that month, but legislative opposition grew over the next several months.

A March 2011 email shows that Fallin’s office compiled a “whip count,” listing how various state GOP senators planned to vote on the exchange bill.

One senator was listed as opposing the bill because he “feels like he has to throw some kind of bone to his Tea Party crowd but understands the situation,” the email states.

Another said accepting the grant to create a state exchange would be “political suicide,” while several senators said the issue was “too hot politically.”

On April 13, a dozen freshman Republican legislators publicly called on Fallin to refuse the grant money. The next day, Fallin and legislative leaders announced that the state was refusing the $54 million.

In 2012, after the U.S. Supreme Court upheld the bulk of the federal health-care law, Fallin’s staff fretted about how to react, the newly released documents show.

The decision renewed the focus on whether Fallin would accept expansion of the federal Medicaid program. The expansion would have provided health care to more than 100,000 uninsured, low-income Oklahomans.

Fallin’s spokesman, Alex Weintz, said in an email to various staff members on July 3, 2012: “Here is an updated no-statement statement designed to get us through the next few days if no decision is reached.”

In the statement, Weintz noted that Fallin would “thoroughly and thoughtfully review the state of Oklahoma’s options regarding the future of both Medicaid and the creation of a health insurance exchange.”

Later that day, Weintz sent an email to Altshuler saying: “I believe we should proactively say No to both as soon as possible. … The longer we wait the more it looks like we are getting bullied by people like Patrick Anderson.”

The reference is apparently to Sen. Patrick Anderson, R-Enid, who has spoken publicly about the impact of uncompensated health care on the state’s hospitals.

Less than an hour after his July 3 email to Altshuler, Weintz sent another email stating: “Update — the governor has asked me to put together a statement saying we will not pursue Medicaid expansion.”

Northrup replied: “That’s fine, I just don’t know why we’d rush into a decision like that. I hardly think the political pressure of Patrick Anderson is worth jumping into a decision like that.”

Fallin did not announce her decision on whether to accept the Medicaid expansion for months after that.

A Nov. 14, 2012, email from Coffee spelled out talking points for Fallin: “Oklahoma does not want either a federal or a state exchange. … Should the (attorney general’s) lawsuit not be successful, however, Oklahoma will do everything it can to prevent a federal exchange from being imposed on Oklahoma’s citizens.”

“We sound like we agree with seceding from the union,” Altshuler wrote to Northrup that afternoon. “It is obstructionist. It is not constructive or productive – it is just sour grapes. It is not leading, it is taking the easy way out. And it does not acknowledge the facts. We may not have an option to build a state exchange when/if the lawsuit fails.”

Weintz responded to Coffee’s email, saying the Governor’s Office had two options:

“‘State exchanges can be good if done right so we are going to build one’ OR ‘Obamacare sucks, we aren’t going to help implement it and we aren’t creating an exchange. We are going to try to block the creation of any federal exchange with our lawsuit.’

“Since there is no way the legislature is going to allow us to do the former, I suggest we do the latter,” Weintz wrote.

Fallin rejected the Medicaid expansion November 19, 2012. Oklahoma was among 24 states to reject the expanded funding.

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Ziva Branstetter 918-581-8306

Cary Aspinwall 918-581-8477