Mary Fallin, Oklahoma Governor, Rejects Medicaid Expansion, Health Insurance Exchanges

TAMPA, FL - AUGUST 28:  Oklahoma Gov. Mary Fallin waves as she walks on stage during the Republican National Convention at th
TAMPA, FL - AUGUST 28: Oklahoma Gov. Mary Fallin waves as she walks on stage during the Republican National Convention at the Tampa Bay Times Forum on August 28, 2012 in Tampa, Florida. Today is the first full session of the RNC after the start was delayed due to Tropical Storm Isaac. (Photo by Mark Wilson/Getty Images)

Oklahoma is the latest state to reject two key elements of President Barack Obama's health care reform plan to extend health coverage to poor and middle-class Americans, Gov. Mary Fallin (R) announced Monday.

Oklahoma won't participate in Obamacare's expansion of Medicaid to the state's poorest residents, or create a health insurance exchange, Fallin said in a press release and a letter to Health and Human Services Secretary Kathleen Sebelius.

Not expanding Medicaid to the poor and refusing to establish health insurance exchanges -- online marketplaces to shop for coverage -- jeopardizes the health care reform law's aim to enroll 30 million people into coverage by 2022. The health care reform law permits anyone who earns up to 133 percent of the federal poverty level, which is $14,856, to enroll in Medicaid. The law also provides tax credits to people who earn up to four times the poverty level -- $44,680 in 2012 -- to help pay for private health insurance.

Fallin joins a long list of governors, mostly Republican, who have informed federal authorities in recent days that their states won't create a health insurance exchange and will leave the task to the federal government. Including Oklahoma, 17 states won't operate health insurance exchanges, which are supposed to be up and running by Oct. 1, 2013, in order for uninsured people and small businesses to enroll in health benefits for 2014, according to the Henry J. Kaiser Family Foundation.

"After careful consideration, I have today informed U.S. Secretary of Health Kathleen Sebelius that Oklahoma will not pursue the creation of its own health insurance exchange," Fallin said in a press release. "Any exchange that is [health care reform] compliant will necessarily be 'state-run' in name only and would require Oklahoma resources, staff and tax dollars to implement."

"I have also decided that Oklahoma will not be participating in the Obama Administration’s proposed expansion of Medicaid. Such an expansion would be unaffordable," Fallin said. Oklahoma and seven other states have declared they won't expand Medicaid to their poorest residents, despite the fact that the federal government will pay the full cost from 2014 to 2016, then scale back its share until it reaches 90 percent in 2022 and beyond. When the Supreme Court upheld the health care law in June, it ruled that states could opt out of the expansion.

Fallin also said she supports Oklahoma Attorney General Scott Pruitt's lawsuit against the health care law, which asserts the federal government doesn't have the authority to provide tax credits to poor and middle-class people through exchanges that the government runs, instead of states.

The health care law allows the federal government to create exchanges in states that do not, and permits states to reclaim their authority in future years. Many states, especially those run by Republicans, remain opposed to the health care law and didn't make preparations as Congress attempted to repeal it, the Supreme Court considered striking it down and GOP presidential nominee Mitt Romney vowed to eliminate it.

States have until Dec. 14 to inform the Obama administration whether they will run their own exchanges, work in partnership with the federal government or leave the entire task to the Department of Health and Human Services. Sebelius has twice pushed that date back, including last week when she canceled a Friday deadline.

Despite the additional time, a slew of governors formally notified the Obama administration last week that they wouldn't go ahead with a health insurance exchange, including Wisconsin Gov. Scott Walker (R) and Maine Gov. Paul LePage (R). Other governors who have always opposed Obama's health care law have reiterated their refusal to help implement it, including Texas Gov. Rick Perry (R) and Louisiana Gov. Bobby Jindal (R).

A handful of governors haven't announced their intentions, including Florida Gov. Rick Scott (R), New Jersey Gov. Chris Christie (R), Arizona Gov. Jan Brewer and Idaho Gov. C.L. "Butch" Otter (R).

Seventeen states and the District of Columbia will operate their own health insurance exchanges, while five states will assist the federal government in establishing them, according to the Kaiser Family Foundation.