OK-SAFE, Inc. Blog

July 3, 2012

Letter To Governors – Don’t Build An Exchange!

OK-SAFE, Inc. – This was forwarded by a friend in Idaho.  A few key legislators have signed a letter urging the state Governor’s to reject Obamacare State Exchanges.  Twelve Senators and 61 Legislators have signed the letter already – don’t you think OK Governor Mary Fallin should sign this letter, too?

See below for details and a link to the letter.

DeMint, Bachmann, Jordan Urge Governors to Reject Obamacare State Exchanges.

Twelve Senators, 61 Representatives join them in sending a letter to all 50 governors
(Washington, D.C.) Senator Jim DeMint (SC), Congresswoman Michele Bachmann (MN-06) and Congressman Jim Jordan (OH-04) sent a letter to all 50 governors urging them to oppose the implementation of the state health care exchanges mandated under President Obama’s health care law.  Twelve Senators and 61 Representatives joined them in writing in opposition to these exchanges, which could cost businesses up to $3,000 per employee.
“Now that we know the courts will not save us from this harmful and unsustainable law, we urge all governors to join our fight full repeal by stopping its implementation,” said DeMint. “Americans have loudly rejected this law because it raises costs, lowers quality of care, and hikes taxes. The President’s health care law will not reform anything, but will hurt state budgets, destroy jobs, and reduce patient choices. States should reject these complex and costly exchanges. We cannot build a free market health care system on this flawed structure of centralized government control, we must repeal all of it and start over with commonsense solutions that make health care more affordable and accessible for every American.”
“While Republicans in Congress will continue to push for a full repeal of Obamacare, the states can take immediate action to reject these exchanges that will increase health care costs and add more layers of bureaucratic red tape. I encourage all 50 governors to do what’s best for the American people. They should refuse to implement an exchange and instead work towards common sense solutions that lower costs and return important health care decisions to patients and their doctors,” said Bachmann.

“The harmful impact on jobs is just one of many reasons we remain committed to fully repealing this law. If governors want to raise the cost of hiring people in their states, they should create an Obamacare exchange. If they want more jobs in their state, they should not. It’s that simple,” said Jordan.
The text of the letter is included below, and a list of signers is available here.
Dear Governors:
The Supreme Court has ruled significant parts of the Medicaid expansion of the President’s health care law unconstitutional as well as ruling that the individual mandate violated the Commerce Clause and will therefore be implemented as a punitive tax on the middle class. This presents us with a critical choice: Do we allow this reprehensible law to move forward or do we fully repeal it and start over with commonsense solutions? The American people have made it clear that they want us to throw this law out in its entirety. 
As members of the U.S. Congress, we are dedicated to the full repeal of this government takeover of healthcare and we ask you to join us to oppose its implementation. 
Most importantly, we encourage you to oppose any creation of a state health care exchange mandated under the President’s discredited health care law. 
These expensive, complex, and intrusive exchanges impose a threat to the financial stability of our already-fragile state economies with no certainty of a limit to total enrollment numbers. Resisting the implementation of exchanges is good for hiring and investment. The law’s employer mandate assesses penalties – up to $3,000 per employee – only to businesses who don’t satisfy federally-approved health insurance standards and whose employees receive “premium assistance” through the exchanges.  The clear language of the statute only permits federal premium assistance to citizens of states who create a state-based exchange. However, the IRS recently finalized a regulation that contradicts the law by allowing the federal government to provide premium assistance to citizens in those states that have not created exchanges. The IRS had no authority to finalize

such a regulation. By refusing to create an exchange, you will assist us in Congress to repeal this violation which will help lower the costs of doing business in your state, relative to other states that keep these financially draining exchanges in place.  
State-run exchanges are subject to all of the same coverage mandates and rules as the federally-run exchange. Clearing the hurdles of crafting an exchange that complies with the 600 plus pages of federal exchange regulations will only result in wasted state resources and higher premiums for your constituents.
Implementation of this law is not inevitable and without the unconstitutional individual mandate it is improbable.  Join us in resisting a centralized government approach to health care reform and instead focus on solutions that make health care more affordable and accessible for every American. Let’s work to create a health care system of, for, and by the people, not government or special interests.
(Signers include Jim DeMint, Michelle Bachmann, Tom Coburn (yes, Coburn), and more.)
Say NO to any insurance exchange in Oklahoma, whether state-based or otherwise.

Supreme Court Decision on the Affordable Care Act

OK-SAFE, Inc. – On June 28, 2012 the Supreme Court of the United States struck down the “individual mandate” contained in the Patient Protection and Affordable Care Act, (PPACA), aka “ObamaCare”.

At least, some of the Supreme Court Justices struck down the individual mandate, others did not.

The Court’s Opinion is divided into Parts I through IV, each with a decision, with the opinions rendered via different pairing of Justices.  Scalia, Kennedy, Thomas, and Alito, JJ., filed a dissenting opinion.  The dissenting opinion is where the controversial exchanges are cited.

Justice Roberts wrote that the commerce clause of the U.S. Constitution cannot be used to compel an individual to purchase something, whether that something is a product or a service.  This includes health insurance.

Roberts went on to render an opinion that the “penalty” described in the Affordable Care Act is in reality a “tax”.  The Court did affirm that Congress does have taxing authority under the Constitution – and taxing us is apparently what Congress aims to do.

The opinion reads, in part, “The Affordable Care Act’s requirement that certain individuals pay a penalty for not obtaining health insurance may reasonably be characterized as a tax.  Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”[1]

The U.S. Congress is now in the uncomfortable position of being caught in a very big lie about the true effect of “ObamaCare”, which was never really about caring for health.   What the Affordable Care Act has done is set out the parameters for a complex series of interconnected information technology systems; insurance exchanges (voluntary, by the way) that fundamentally redesign the insurance industry; and (apparently) set up an onerous taxing mechanism.

The Court also seems to have struck down the penalty to States that choose not to participate in the Medicaid expansion program “by taking away their existing Medicaid funding.”  The Government argued that this expansion was a modification of the existing program, but Justices Roberts, Breyer and Kagan disagreed, stating that the “expansion accomplishes a shift in kind, not merely degree. The original program was designed to cover medical services for particular categories of vulnerable individuals.  Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire non elderly population with income below 133 percent of the poverty level. ”[2]  (Bold and italics added throughout.)

Roberts further declared, “A State could hardly anticipate that Congress’s reservation of the right to “alter” or “amend” the Medicaid program included the power to transform it so dramatically. The Medicaid expansion thus violates the Constitution by threatening States will the loss of their existing Medicaid funding if they decline to comply with the expansion.[3]

Health Insurance Exchanges and Their Federal Subsidies

The Scalia, Kennedy, Thomas, and Alito dissenting opinion contains roughly 22 mentions of the insurance exchanges.[4] The dissent links the exchanges to the federal subsidies (again, voluntary) and reads, in part, “The ACA requires each State to establish a health ­insurance “exchange.” Each exchange is a one-stop mar­ketplace for individuals and small businesses to compare community-rated health insurance and purchase the policy of their choice. The exchanges cannot operate in the manner Congress intended if the Individual Mandate, Medicaid Expansion, and insurance regulations cannot remain in force. The Act’s design is to allocate billions of federal dollars to subsidize individuals’ purchases on the exchanges.”[5]

Regarding the insurance exchanges, these are intended to plug into the health information exchange “network of networks” currently being established in the states, including Oklahoma.[6]

The dissent continues, “Individuals with incomes between 100 and 400 percent of the poverty level receive tax credits to offset the cost of insurance to the individual purchaser. By 2019, 20 million of the 24 million people who will obtain insurance through an exchange are expected to receive an average federal subsidy of $6,460 per person. See CBO, Analysis of the Major Health Care Legislation Enacted in March 2010, pp. 18–19 (Mar. 30, 2011). With­out the community-rating insurance regulation, however, the average federal subsidy could be much higher; for community rating greatly lowers the enormous premiums unhealthy individuals would otherwise pay. Federal subsidies would make up much of the difference.”

“The result would be an unintended boon to insurance companies, an unintended harm to the federal fisc, and a corresponding breakdown of the “shared responsibility” between the industry and the federal budget that Congress intended. Thus, the federal subsidies must be invalidated.”

Further, “Without the federal subsidies, individuals would lose the main incentive to purchase insurance inside the exchanges, and some insurers may be unwilling to offer insurance inside of exchanges. With fewer buyers and even fewer sellers, the exchanges would not operate as Congress intended and may not operate at all.”

The insurance exchanges continue to be a problem, but despite the warnings and the evidence of their failure (Utah), proponents continue to advocate for their establishment.  Perhaps this is due to the expectation that an insurance exchange would result in “an unintended boon to insurance companies”?

OK-SAFE maintains its’ position against the establishment of an insurance exchange in Oklahoma, state-based or otherwise.

Endnotes:[1]National Federation of Independent Business v. Sebelius, page 44. Page 50 of the pdf.

[2] Ibid, page 5

[3] Ibid, page 5

[4] Ibid. pp. 52-63 of the Scalia, Kennedy, Thomas, and Alito, JJ., dissenting. Pp. 178 – 189 of the pdf

[5] Ibid, page 59 of the dissent.  Page 185 of the pdf.

[6] The information exchange works via information technology (i.e. computers) systems that connect the patient, the provider and the payer, where the payer means the insurer. The American Recovery and Reinvestment Act, or ARRA, which passed in 2009, was the real health care reform law, funding the creation of an electronic health record on everyone, and the necessary information exchanges for data sharing.  Oklahoma took $8.8 million to set up Oklahoma’s exchanges.  Created in 2010, the Oklahoma Health Information Exchange Trust, or OHIET, is busy setting this up in this state The insurance exchange detailed in PPACA fits into this “network of networks”, linking the patient, the provider, and the payer into one interconnected system.  There is only one exchange system and it i the federal system.  There is no such thing as a state-based exchange that is functionally different than the one designated in ObamaCare.  See the Model is the Message diagram at http://www.exposinghealthcareform.com

March 9, 2012

Insurance Exchange Bill on “Hold” Pending Supreme Court Action – OK Senate Changes Mind on SB 1629??

OK-SAFE, Inc. – In a very interesting move the OK Senate on Thursday (3/8/12) issued a press release stating that, “legislative leaders and the chairmen of the Joint Committee on Federal Health Care Law have opted to wait until the outcome of the Supreme Court proceedings before moving further forward with SB 1629.”

SB 1629 would have established the “Health Insurance Private Marketplace Network Trust”, governed by an appointed Board, that would administer a premium assistance plan (low income insurance, Medicaid), and assist small businesses and/or employees to purchase employer-sponsored insurance.

In other words, a state-based insurance exchange, tying users of Medicaid and private insurance together; a sort of public/private partnership exchange.

But, those phone calls, emails, in-person lobbying, and robo calls, all objecting to an insurance exchange (state-based or otherwise), paid off.   One bad bill has been stopped.

For now.

Score one for the people of Oklahoma!

However, in politics, there is always a Plan B.   What Oklahomans can expect is some other tactic being used to achieve the same end – the establishment of some sort of web-based insurance exchange in the state of Oklahoma, that will tie into the health information exchange, which is being advanced by the Oklahoma Health Information Exchange Trust (or OHIET), unstopped.

What may happen is the utilization of the existing HUB law (HB 2026 in 2009) passed a few years ago, to create an exchange, possibly bidding out some service to a third party.  (See details below press release.)

Send Thank Yous

If you would like to send a thank you for putting SB 1629 on hold, you may want to contact the following legislators, in addition to your own Senator:

  • Senator Brian Bingman – bingman@oksenate.gov
  • Senator Gary Stanislawski – stanislawski@oksenate.gov
  • Rep. Kris Steele – krissteele@okhouse.gov
  • Rep. Glen Mulready – mulready@oksenate.gov


Below is the text of the 3/8/12 Press Release, issued jointly by Senate and House leadership.

Oklahoma State Legislature

For Immediate Release: March 8, 2012

SB 1629 is on hold pending Supreme Court action

The Legislature will wait until after the U.S. Supreme Court rules on the constitutionality of the federal health care law before proceeding with Senate Bill 1629, legislators announced Thursday.

The U.S. Supreme Court is expected to rule this summer, perhaps as early as June, on a legal challenge brought by several states alleging the federal Patient Protection and Affordable Care Act is unconstitutional.

Should the high court overturn the law, the possibility exists that health insurance exchanges would not be necessary. And should the high court uphold the federal law, nuances within the majority opinion could help legislators craft the most effective Oklahoma-based marketplace possible to defend against the imposition of a federal exchange.

Given these dynamics, legislative leaders and the chairmen of the Joint Committee of Federal Health Care Law have opted to wait until the outcome of the Supreme Court proceedings before moving further forward with SB 1629. If the court upholds the law, the Legislature is already prepared to continue defending against federal intervention into the Oklahoma health care market.

“There are many common-sense solutions conservatives can agree on to lower the cost of healthcare, expand access and choices to more individuals, and increase the quality of our care – all through tried-and-true principles of the free market,” said Sen. Gary Stanislawski, R-Tulsa, co-chairman of the Joint Committee on Federal Health Care Law.

“These are ideas worth pursuing, and we eagerly await the Supreme Court’s repeal of ObamaCare so we can begin the very serious business of addressing our healthcare challenges with solutions that expand freedom instead of government,” Stanislawski said.

The Joint Committee on Federal Health Care Law met five times throughout the interim to determine the effect the law will have on Oklahoma. Among its recommendations was to craft a state-based marketplace in order to prevent the federal government from imposing a federal exchange in Oklahoma.

“If the court doesn’t reject this law as we hope, developing a state-based exchange remains our best defense against unwanted federal intervention,” said Rep. Glen Mulready, R-Tulsa, the committee’s other co-chairman. “We think we have fashioned a good plan. We are willing to wait to ensure we have the best possible solution to protect Oklahoma from federal intervention.”

Legislative leaders supported the committee co-chairmen’s decision.

“Republicans in the state Senate will do everything in our power to block ObamaCare in Oklahoma. When President Obama rammed through a trillion dollar unconstitutional assault on the healthcare freedom of Oklahomans, he proved his values are fundamentally at odds with ours,” said Senate President Pro Tempore Brian Bingman, R-Sapulpa. “The fight to preserve healthcare freedom is far from over.”

“Developing a state-based solution has always been and remains the best, most realistic way to defend against a federal exchange. The reality is we’re not yet at the point where we absolutely have to deploy that defense,” said House Speaker Kris Steele, R-Shawnee. “Should the time come, we’ll be prepared to act thanks to the groundwork the committee has laid for us.”

For more information, contact:
Nathan Atkins

John Estus
405.962.7674 desk, 405.706.0084 cell

Title 36, Section 4601 – 4603:

Article 46 – Health Care for Oklahomans Act

§ 4601. Short Title

§ 4602. Duties of Health Care for the Uninsured Board

§ 4603. Program to Encourage Individuals to Enroll in Health Insurance Programs – Referral of Uninsured Individuals to the HUB

This is the section of law last year’s HB 2130 was attempting to amend.  This will bear watching for the rest of this session.


March 1, 2012

SB 1629 – Exchange “Marketplace” Bill Models ObamaCare

OK-SAFE, Inc. – Things are “getting curiouser and curiouser” in the Oklahoma legislature.  According to some Senate Republicans, if you’re against “ObamaCare,” you would be for a bill implementing “ObamaCare.”

Alice in Wonderland  pretty well sums up what it felt like when SB 1629 was being presented by Tulsa Senator Gary Stanislawski.   To read a great parable about the Senate’s Health and Human Services committee meeting see the Oklahomans for Liberty site here.)

For the record, OK-SAFE opposes legislation that facilitates the implementation of “ObamaCare” health reform, and therefore opposes SB 1629, establishing a state-based exchange called a marketplace.

Senate Bill 1629 by Pro-Tem Brian Bingman, which passed by a vote of 7-2 on Monday,  would establish the very insurance exchange, or “marketplace” model called for in the PPACA, aka “ObamaCare.” Even though the Republican members of the Senate Health and Human Services committee said they oppose “ObamaCare,” not one of them voted against SB 1629, or even mentioned the actual content of the bill,  which included the creation of yet another trust to oversee the exchange/marketplace.

The word marketplace is alternately used to describe an exchange; the word exchange has now become too notorious to use.  Curiously, Sen. Tom Adelson has submitted an amendment to the bill, nullifying it if the Supreme Court shoots down PPACA, or if a new Congress does.

The Individual Mandate

Most of the questions in this committee were about the “individual mandate” (not included in the bill.) A fraction of the Affordable Care is about the individual mandate; most of the rest of the bill deals with items such as the exchanges and the reconfiguration of the insurance market.

The committee members either hadn’t read the bill, or they were working from talking points or a summary; they did not discuss what the bill actually says.

SB 1629 Creates a Marketplace/Exchange and Another Trust – The Middle Man Model

SB 1629 creates a public-beneficiary Health Insurance Private Marketplace Network Trust.   [See diagram below]

This Marketplace Network Trust would (initially) do two things: 1) take over and administer the premium assistance program (Insure Oklahoma) from the OK Health Care Authority, and 2) “develop and implement a marketplace assistance program to assist small businesses in the offering of employer-sponsored insurance purchased from the private market insurance carriers.” (In other words, an insurance exchange.)

This new trust has a twin called the Oklahoma Health Information Exchange Trust, or OHIET.  Created by  stealth in the last week of session in 2010, the OHIET is busy establishing the network of networks that facilitate the transfer of electronic health records everywhere.

Why would insurers be advocates for an exchange?  “Insurance companies are urging state officials to set up exchanges because they generally prefer state regulation.  In addition, they stand to gain because the United States Treasury will send subsidy payments directly to insurers on behalf of low- and moderate-income people who enroll in health plans offered through an exchange.”(National Center for Policy Analysis article here.)

Kinda explains SB 1629 doesn’t it?

The Model as Devised by SB 1629This diagram depicts the middle-man model. (For a great explanation of the not-free-market model, see the Vicky Davis article entitled The Model IS the Message.)

OK-SAFE Summary of the Bill:

  • Section 1 of the bill describes the legislative intent: to expand the “mission” of Insure Oklahoma by “moving the administration of the Insure Oklahoma program from the purview of the Oklahoma Health Care Authority to a state public trust established in this act.”

Translation: they’re moving management of government-sponsored insurance from one state bureaucracy to a newly created one.

  •  Section 2 establishes the new trust – B. The Health Insurance Private Marketplace Network Trust shall be established as a state-beneficiary public trust.
  •  Translation: Oklahoma (government) is the beneficiary of the trust.
  • Section 2 defines the trust governance:  C. The Health Insurance Private Marketplace Network Trust shall be governed by a Health Insurance Private Marketplace Network Board.

Translation: This section increases the power of the Executive branch due to powers of appointment; Fallin would get to appoint most of the Board members.  Board members are unelected and not accountable to the public.

  • Of the 7-member board Governor Fallin would appoint three  members, the Pro-Tem and the Speaker each appoint one; the other two are Insurance Commissioner John Doak and Secretary of Health and Human Services Dr. Terry Cline (also appointed by Fallin.)
  •  C. …The board of trustees shall consist of seven (7) members as follows:
  1. One member appointed by the Governor representing health insurance carriers granted a certificate of authority by the Oklahoma Department of Insurance;
  2. One member appointed by the Speaker of the House of Representatives representing consumers and who has purchased policies through the Trust or is reasonably expected to purchase policies through the Trust;
  3. One member appointed by the Governor who shall be a health care provider;
  4. One member appointed by the Governor who shall be a representative of employer groups;
  5. One member appointed by the President Pro Tempore of the Senate who shall be an insurance agent or broker;
  6. The Insurance Commissioner – (John Doak)
  7. The Secretary of Health and Human Services- (Terry Cline).
  •  F. The board of trustees shall promulgate rules as necessary to implement the provisions of the act.

Translation: The appointed board will be insiders, and they can make the rules for the trust, not the legislature.  Also the board members elect the Executive Director, who will likely be Dr. Cline – just as was proposed in HB 2130 the HUB bill.

  • Section 4 is New Law authorizing trust to administer a premium assistance program for low-income individuals, and to assist small businesses (up to 250 employees for a for- profit; up to 500 employees for a not-for-profit).  This was the Insure Oklahoma section, being defined for the trust.
  • Section 5 reads in part:  A. The Health Insurance Private Marketplace Network Trust is authorized to develop and implement a marketplace assistance program to assist small businesses in the offering of employer-sponsored insurance purchased from private market insurance carriers which shall go into effect January 1, 2014. 
  • E. The board of trustees shall, by rule, determine the funding mechanism for the marketplace assistance program authorized in subsection A of this section

Translation: The new trust is given full authority to develop and implement the exchange (oops, marketplace) in any manner they see fit. The board of trustees can make any rules they’d like to govern the funding mechanism.  Nothing in this section prohibits the trust from seeking federal funding, including federal grants that are available for states to develop an exchange – one was called the Early Innovator Grant, remember?

  • Section 6 severs Insure Oklahoma from the OHCA, and gives it to the trust.  Section 7 deals with waivers.


  • And finally,  Section 8 of the bill reads:  NEW LAW   A new section of law not to be codified in the Oklahoma Statutes reads as follows:
    The Oklahoma Health Care Authority is hereby directed to seek any and all Federal approval necessary to implement the provisions of this act.

This really shows the legislative intent.  Federal approval.  And Stanislawski said it would not be “ObamaCare” compliant?  Want to bet?

[Aside: One wonders how and where that 40% excise tax will fit in once that becomes effective by 2018?]

Call Your Senator and Say NO to ObamaCare SB 1629

OK Senate Switch board: 1-800-865-6490, or 1-405-524-0126

Republican Senators who voted Yes in Committee for SB 1629 on 2/27/12:

  1. Senator Brian Bingman:                 1-405-521-5528                 Email: bingman@oksenate.gov
  2. Senator Gary Stanislawski:           1-405-521-5624                 Email: Stanislawski@oksenate.gov
  3. Senator Rick Brinkley:                    1-405-521-5602                 Email:Brinkley@oksenate.gov
  4. Senator Brian Crain:                        1-405-521-5620                 Email: crain@oksenate.gov
  5. Senator Rob Johnson:                    1-405-521-5592                 Email: johnsonr@oksenate.gov
  6. Senator Dan Newberry:                1-405-521-5600                 Email: newberry@oksenate.gov
  7. Senator Steve Russell:                   1-405-521-5618                 Email: Russell@oksenate.gov

January 12, 2012

UPDATED! OK-SAFE Training in Dates – Citizen Involvement in the Legislative Process – One Class Left

UPDATE 1/31/12: One more training class left:  Saturday, February 18, 2012 in Norman, OK.  See time, location and agenda below.  Remember to bring your pcs and/note taking material as these are working sessions. Handouts provided.

UPDATE: Due to Tulsa County’s precinct meetings being scheduled for Saturday, February 4th, 2012, the Norman Tea Party has agreed to move their Citizen Involvement training date to Saturday, February 18th, 2012.  Same time, same location.   Thanks!

OK-SAFE, Inc. – Upcoming Training Dates

In anticipation of the upcoming 2012 Legislative Session in Oklahoma, OK-SAFE will be conducting their annual Citizen Involvement in the Legislative Process Training.  These training classes are working sessions, so please be prepared to bring a laptop/notebook pc and notepaper.  Handouts will be provided.

These events are free and open to the public. We do ask, however, for a small donation to offset the associated expenses. Light refreshments will be served.

The Oklahoma Legislative session begins on the Monday, February 6, 2012 and runs through the last Friday of May.  This year plans to every bit as contentious as last, since more people are aware of the bad legislation being passed in this state.

For instance, last year’s HB 2130, dealing with the health insurance exchanges, is still a live round. This highly controversial bill passed the OK House by a narrow margin on March 17th, 2011.  Due to all the backlash the bill was not heard in the Senate, but because it was not voted on, it is still an active bill.  Diligence will be needed by all those with concerns about the “Obama Care” health insurance exchanges – there will be several attempts by this legislature to establish one.

Training/Working Session Dates and Locations

Tulsa –

Date: Saturday, January 21, 2012 (COMPLETED – Thanks for attending)

Time: 9:00 am to 1:00 pm

Location: HQ building, 1008-B N. Hickory Ave., Broken Arrow, OK

Oklahoma City –

Date: Saturday, January 28, 2012 (COMPLETED – Thanks for attending!)

Time: 1 pm to 5 pm

Location: The Village Library, 10307 N. Pennsylvania Ave., north Oklahoma City, OK


Date: Saturday, February 4, 2012  February 18, 2012

Time: 9:30 am to 1:00 pm

Location: First Assembly of God Church in Norman, 2500 E. Lindsey, Norman, OK (NOTE: Address Correction Made 1/18/12!)

Note: Host is Norman Tea Party.


 1st Hour

  • Introductory – The basics of citizen involvement in the legislative process.  1) Overview of the Legislative Process in OK; 2) Identifying your legislator, 3) Entering contact information in cell phones and contact list; 4) How to write an email to a legislator; 5) Making the OK Legislature/OSCN your home pages.

2nd Hour –

  • Intermediate – Builds on Hour 1. 1) The OK legislative process, i.e. interim studies, bills introduced, bill committee assignments; 2) The committee process, and when to advocate for a bill; 3) Creating group email lists for both House and Senate Committee members, 4) Understanding the role of Speaker, Pro-Temp, Floor leader, and Whips.

3rd Hour –

  • Advanced – Builds on Hours 1 & 2. 1) Understanding political doublespeak, i.e. smaller, smarter government; economic development; knowledge-based economy; 2) How to read a bill with understanding and find the titles of law; 3) Understanding Health Care Reform and the OHIET Trust: 4) Federal grants and who benefits from the passage of legislation.

The OK Legislative Session begins on Monday, February 6, 2012 and ends on the last Friday on May.  This year will prove to be

December 8, 2011

One Weird Meeting on Health Insurance Exchanges at the Capitol – Update and Correction!

12-9-11 Update and Correction  to this post –

We received a call today from Kate Richey of the OK Policy Institute, offering to correct some of the information in the post below, for which we are grateful.  Prior to this morning, information on who called this meeting was not exactly forthcoming.

Item #1- The OK Policy Institute did not sponsor this meeting on Health Insurance Exchanges.  Kate Richey was invited to speak by Claudia Kamas of Kamas Consulting, and Sandy Ruble of Rx Net,. (Kamas and Ruble are both registered lobbyists in Oklahoma).  According to Richey, the invitation to the meeting went out to several lists, not just the legislative assistants.  The purpose of the meeting was informational for those who missed the prior health care meetings.

Item #2 – Richey clarified her statement about who would run the exchanges to mean within the context of Medicaid expansion of coverage. The quotation marks have been removed, per her clarification.

Item#3 – We agreed to disagree on the statement that it doesn’t matter who establishes the insurance exchange or who governs it – either way it will be operating according to federal requirements.

OK-SAFE, Inc. 12/8/11 –

Off the record – it doesn’t matter who establishes the exchange or governs it – it will be run according to federal requirements. (In the context of Medicaid expansion of coverage, per Richey’s call  12/9/11)

“Utah is working to make their state compliant with the federal law.”

“Those are the only two choices available now – a state-run exchange, or a partnership with federal government.” Regarding the interim study just finished – there is one basic fact – if Oklahoma establishes a state-run exchange, it has to be basically compliant with the feds.  “If we do one poorly, we will end up with a federally facilitated exchange anyway.”   – Kate Richey, OK Policy Institute


For some reason that is still unclear, the progressive OK Policy Institute sponsored Claudia Kamas of Kamas Consulting, and Sandra Ruble of Rx Net, invited a member of the OK Policy Institute to speak at a meeting this morning on Health Insurance Exchanges in room 419-C at the Oklahoma State Capitol.   They invited only the legislative assistants. The invitations, according to Richey on 12/9/11, went out to several lists, not just legislative assistants. (OK-SAFE Note:  Sen. Stanislawski’s office did not know of this meeting until a day or so before the event.)

Both Kamas and Ruble are registered lobbyists in Oklahoma.

From the online view of the meeting, however, it looked like several of the attendees were not legislative assistants.  Lobbyists?

Not Part of the Joint Committee

This meeting was not part of the Joint Legislative Committee meetings on Federal Health Care Reform Law held earlier, and which concluded on November 15, 2011.

The speaker was Kate Richey, hired by the OK Policy Institute in January 2011, who gave a somewhat rambling presentation on the provisions of the Affordable Care Act and the requirements for the Insurance Exchanges.

Blame the Tea Party!

When it came to the discussion of the federal timelines, and the grants, a couple of men attendees complained about  “the Tea Party” causing the establishment grant money to be rejected.  (One can only assume they meant the Early Innovator Grant, rejected by the Governor in March of 2011, after first accepting it.)

(The term “Tea Party” is thrown out there randomly by people who are generally unfamiliar with the conservative grassroots efforts in this state.  It’s another way of saying,  “There are organizations and groups out there I know nothing about so I’ll just call all of them Tea Partiers.” )

The questioner would be more accurate if he meant the 65% of Oklahomans who rejected the implementation of “Obama Care” in this state caused the rejection of the establishment grant – then he’d be right.

A few of the notes from Richey presentation, 12/8/11 –

  • Question from attendee on the governance of exchange.
  • Richey – No opinion on which form is best.  Wait until the state moves forward with legislation.  Each model has their pros and cons.  “We need to take action and move forward.”
  • On Feb. 29, 2011 the federal government issued some answer in the form of Q & A on State Exchanges.  Is OK ready to run an exchange by Jan. 2013?  The exchanges have to launch by 2014, so has to be “beta ready” by Oct. 2013.
  • Regarding states not being ready – “the feds are willing to meet you where you are and walk with you through the exchange.  If we turn down establishment grants, there is money still out there.  If we miss the deadlines the funds will still be available.
  • Question about grants – Yes, they will be available on a rolling schedule through 2014.
  • Question: Where is the advocate in Oklahoma for the exchanges? Seems like we got derailed by the Tea Party they just didn’t want the state to commit…? 
  • We’re working on the governance structure.
  • Not sure why the money was returned.  Will have to reapply for another establishment grant.
  • Comment from attendee: NAHU (National Association of Health Underwriters) are behind (advocate) it.  The OHCA working groups are active.  We were sad to see those funds return.  The Tea Party blocked it.
  • There were groups there at the beginning, various advocates.
  • Feds will set up exchange if they need to, but they don’t want to run it for long run.  Will eventually turn it back over to the states for most of the functions.  (Except data hub?)
  • Grant agreements come with benchmarks that must be achieved. “Even if we miss the deadlines on these grants the money will still be available until 2014.”  As far as Richey knows no one has applied for a Level 1 or Level 2 grant.  “Even if we move ahead there will be some level of federal involvement.”
  • There is a tentative federal-state partnership plan being developed.  There will be some sharing of some responsibilities.  Feds will regulate, run the hotlines, operate data hub.  It will take more planning, some sort of partnership model.
  • Those are the only two choices available now – a state-run exchanges, or a partnership with federal government.
  • Regarding the Interim study just finished – there is one basic fact – if Oklahoma establishes a state-run exchange, it has to be basically compliant with feds. If we do one poorly we will end up with a federally facilitated exchange anyway.
  • Health care reform requires the electronic health records infrastructure.  A group in NE Oklahoma is working to get the state compliant with the electronic information technology infrastructure.
  • OK’s High Risk Pool will be folded in to the state exchange for their coverage.

For the entire OK-SAFE notes on today’s Health Insurance Exchange meeting, a pdf is available here.

For the real definition of Health Care Reform see this OK-SAFE post

So, Who Gets the Grant Money Now?

The question that is on the table is this – has there been a move to change the State Designated Entity (SDE), overseeing the distribution and use of the federal grant money, from being the Oklahoma Health Care Authority (OHCA) to the Oklahoma Health Information Exchange Trust (the OHIET)?  This Trust is working behind the scenes to implement the information technology provisions of the Affordable Care Act (“Obama Care”) in this state, and has already been instrumental in awarding contracts.

Despite the wishes of the people of Oklahoma.

Richey PPT –

Supposedly, the Kate Richey/OK Policy Institute power point presentation will be available online at some point in time via their website – http://www.okpolicy.org .   As of this writing, it is not yet posted.

In the meantime, keep calling your legislators and tell them “Oklahomans said No to Obama Care in 2010” – and we still mean No!

OK House: 1-800-522-8502

OK Senate: 1-800-865-6490

For contact information for the OK House members, click here.  OK Senate members, click here.

November 29, 2011

Another Meeting about the Health Insurance Exchanges – 12/8/11 at the Capitol in OKC

We just received noticed that there will be an additional legislative meeting dealing with the subject of health insurance exchanges in Oklahoma.

This meeting will take place on Thursday, December 8, 2011 at 10:00 am in room 419C at the Oklahoma Capitol.  (Details below).

It is important that all those with concerns about the establishment of an insurance exchange – state-based or federal – in Oklahoma should attend.












Announcement (received 11/29/11):

There will be a presentation at 10:00 a.m. on Thursday, December 8th in Room 419C of the Oklahoma Capitol to cover Health Insurance Exchanges under the Affordable Care Act:  State-run vs. federally facilitated.  This overview will include federal requirements for a compliant state-run health insurance exchange; Oklahoma ‘s readiness to enact such an insurance exchange; recent developments/predictions about legislative/executive action at the state-level on exchanges; and updates on other federal/state health policy partnerships.

The presenter, Kate Richey of the Oklahoma Policy Institute, has a degree in International Business from the University of Texas at San Antonio and a Masters degree in Political Science from the University of Central Oklahoma .  She is currently a PhD Candidate in Political Science from the University of Oklahoma and works as a Policy Analyst for the Oklahoma Policy Institute specializing in health care, immigration, and anti-poverty issues.

This program can also be accessed remotely.

Ashley Olmstead

Legislative Assistant to

Speaker Pro Tempore Jeffrey W. Hickman

Oklahoma House of Representatives

Phone: 405.557.7339

Fax: 405.962.7620

November 2, 2011

OK-SAFE to speak at 4th Meeting on Health Care Reform Law – 11-3-11 Tulsa Tech. Ctr.

November 2, 2011


SUBJECT:                  Fourth Meeting

MEETING DATE:       Thursday, November 3, 2011

MEETING TIME:        9:00 A.M.

LOCATION:                Tulsa Technology Center, Riverside Campus, 801 E. 91st St., Tulsa, Oklahoma.



1.         9:00 – 10:00 AM, Exchange options, federal, federal/state partnership, state – Krista Drobac, Director of Health Division, National Governors Association

2.         10:00 – 10:45 AM, Technology and privacy issues with exchanges – Amanda Teegarden, Executive Director, OK-SAFE, Inc.

3.         10:45 – 11:30 AM, Current Technology – David Kendrick, Director of HIT

4.         1:00 – 1:45 PM, Agent Compensation – Ryan Young, Director, Federal Government Affairs, Independent Insurance & Brokers of America

5.         1:45 – 2:45 PM, Exchange Options – Ed Haisimaier, Heritage Foundation

6.         2:45 – 3:30 PM, Exchange Providers – Josh Beckett, Benefit Focus

7.         3:30 – 4:15 PM, Exchange providers – Ceridian

8.         Other Business


Senate Appointees: House Appointees:
Sen. Gary Stanislawski, Co-Chair Rep. Glen Mulready, Co-Chair
Sen. Cliff Aldridge Rep. Doug Cox
Sen. Bill Brown Rep. Randy Grau
Sen. Brian Crain Rep. Jeannie McDaniel
Sen. John Sparks Rep. Jason Nelson

Senate Staff:

Jennifer Mullens, Legislative Analyst Andrew Messer, Fiscal Analyst
Alicia Emerson, Legislative Analyst Anthony Sammons, Staff Attorney
Lori Block, Staff Attorney Darrell D. Washington, Admin. Asst.


September 18, 2011

OK-SAFE, Inc. Reporting – 1st Joint Committee Mtg on Federal Healthcare Reform/Exchanges

OK-SAFE, Inc. –  The first meeting of the Oklahoma joint legislative committee formed in spring 2011 to examine the impact of the federal healthcare reform law/exchanges on the state of Oklahoma was held in the House Chambers on Wednesday, Sept. 14, 2011 at the OK Capitol.

Below are the notes taken during this presentation by OK-SAFE, Inc.  Included in these notes are:

  1. The minute markers for the start and stop times for the individual speakers
  2. Some notes on their presentations
  3. Some key transcriptions of the comments by two presenters – Julie Cox-Kain of the OK Dept. of Health on the exchanges, and Buffy Heater of the OK Health Care Authority on the information technology system changes required.

Consider their presentations as confirmations of what OK-SAFE and others have been researching regarding the intent and purpose of healthcare reform and the role the exchanges play:  the creation of a ‘fused’ technology system that contains comprehensive information about all individuals, connected to/interfacing with a developing federal data hub, or federal data ‘cloud’ as it was referred to.

It is confirmation of the Vision 2015 document issued by the Director of National Intelligence – a roadmap for the systemic change of our entire governmental structure.


Notes on First Joint Committee Meeting on Health Care Reform in Oklahoma

Wednesday, September 14, 2011

9:00 am to 4:00 pm

House Chambers, OK Capitol

Oklahoma City, OK

Link to OK House Video:  http://okhouse.granicus.com/MediaPlayer.php?view_id=2&clip_id=387

Video Minute Markers indicated in [brackets]


Key Excerpts:


Question by Rep. Nelson to Julie Cox-Kain (OK Dept. of Health)– “One other question I’ve got is, what my understanding is that probably the states’ health care authority would be where an exchange would be housed, but where are other states putting it, is that the best place for an exchange here? If the federal government produces an exchange, would they house it in Washington, would they house it here, where are these things going to be housed?”


Answer by Julie Cox-Kain –  “States have an option for governance of an exchange, governance and operation of an exchange, and it can be implemented through a state agency, or you could have a non-profit entity, and you can contract out certain functions of the exchange.  And so, in fact, you could even have a quasi-governmental entity. This has been addressed or mentioned some in the dialogue about how we would govern and operate an exchange. Actually could even have a trust, there are some in existence now, that govern that exchange.  There is a little bit of state flexibility in how we choose to go forward and implement and/or operationalize an exchange.  Again the question about the federal government exchange, there’s very few answers to what the federal government exchange would look like, so it is very hard to make that particular decision without that part of the equation being known.”


Buffy Heater (OHCA) presentation – “Now we’re going to talk about the technical aspects of information systems changes. So I think I’ll start off by addressing the question that was brought up earlier in the session about the federal data hub or the federal data exchanges that are being established as part of the ACA through both the exchange set-up as well as for the Medicaid income verification pieces.  So basically, the federal government is creating a data hub, or a data cloud, as it be, in that there will be sources from federal agencies, the IRS, the Social Security Administration, and the Department of Homeland Security, where there will be member level or individual level information that is fed up to this data cloud. 


Then there will be queries from the states or from a federal exchange that will be able to be sent up to that federal data hub and a match return, that basically says for this person’s last IRS data here was their modified adjusted gross income. Or validating that that individual’s social security number is as was reported matches, yes indeed, it matches on that individual’s name and date of birth. As well as the Homeland Security is going to verify individual citizenship and identity, if possible. 


So the federal data hub is going to require that it is a state level entity that engages in the contractual relationship between the federal government, and so the way the proposed rules that Cindy had mentioned before, right now those proposed rules do limit states in that it is restricted to only state operated  entities that can be able to engage in that federal data hub. I will tell you that the feds are specifically soliciting comment on states that might be looking at having a private entity run and operate their exchanges and how the rules might accommodate that…. the ACA requires a ‘plug’ of sorts to be ready to plug Medicaid into the exchanges….”

(Slide) New CMS IT Guidance – Service Oriented Architecture, Reusable, Interoperable, Scalable, Ease of Use.  Some states are still using legacy mainframe systems.  So federal government required (above list).

(Slide) CMS IT Funding – Enhanced funding available – Medicaid Eligibility Systems (thru 12-15-2015) – 90% match – design, development and implementation.  75% match – ongoing operations. In the past was only 50%.


Opening Comments by co-chairs Rep. Glen Mulready and Sen. Gary Stanislawski [00:00:00 to 00:22:00]


I)                    Julie Cox-Kain, Chief Operating Officer, OK State Dept. of Health

[Minute Marker 00:22:01 to 00:53:26]

Topic – “Present State of Health Outcomes and Health Care in Oklahoma”


Slides:       (NOTE: Missing one slide on an OK health stat)

  1. OK has excess death and mortality & overall health rankings
    1. Chart of Determinants of health and their contribution to premature death.  Environmental, social circumstances (stressful), healthcare 10%.  Insurance reform addresses access to health care, genetic disposition, behaviors.
    2. United Health Foundation rankings for Oklahoma 2010 – showed selected health measures: cardio vascular disease, tobacco use (25%) 48th in nation, access to care measures, leads to other outcomes we’d like to track in our state.  (Prevalence of obesity in our state), preventable hospitalizations, i.e. people aren’t controlling their conditions very well; infant mortality rate (significantly higher than other states); immunization coverage, lack of health insurance; primary care physicians availability.  Overall health ranking is 46.
    3. United Health Foundation Rankings Oklahoma 2010. We track fruits and vegetables consumption.  Only 14% of our population gets 5 fruits and vegetables/day.  Other stats on people’s behaviors. How are you feeling?  19% of our population responded that they don’t feel very well.
  2. Leading causes of death in Oklahoma.
    1. Total Mortality Rate per 100,000 Population  – 2005-2007.  Source: State of our State Health Report.  Some counties earned an “F” due to chronic conditions and behaviors.
    2. Leading Causes of Death in Oklahoma – heart disease, cancer, chronic obstruction/pulmonary
    3. Heart Disease Rates – Oklahoma is in the bottom for heart disease rates. (Burden of disease.)
    4. Leading risk factors for Heart Disease: Physical inactivity, overweight and obesity, high blood pressure, smoking, high cholesterol, diabetes.
    5. Cancer Rates per 100,000 Population 2007.  OK has one of the worst rates of cancer death
  3. Cancer Death Rate per 100,000
  4. Leading Cancer Types in Oklahoma – Lung disease, etc.
  5. Risk Factors for Lung Cancer
    1. Chronic Obstructive Pulmonary Disease in US 1999-2006.  Oklahoma has high rate of burden.
  6. Chronic Lower Resp. Disease Death Rate per 100,000 Popl 2005-2007
  7. Risk Factor for COPD in OK
  8. Stroke Rates – U.S. Map
  9. Stroke Death Rate per 100,000 Population in OK
  10. Risk Factors for Stroke Death – High blood pressure, etc
  11. Hospital Cost Associated with Top Four Cause of Death in OK 2009 Heart Disease $2.1 B,
  12. Infant Mortality in Oklahoma
  13. Infant Mortality Rate per 100,000 Population 2001-2006
  14. Infant Mortality Rate per 1,000 Population 2005-?
  15. Top 3 Cause of Infant Mortality Death in Oklahoma
  16. Risk factors for Infant Mortality – lack of prenatal care, poor nutrition, etc.
  17. Health Behaviors and Risk Conditions in OK
  18. Adult Obesity – OK at 32%, trending up.  Expensive to treat, this is an economic issue.
  19. Tobacco Use – slight reductions in use, still over 25% of our population still smokes.
    1. Physical Inactivity – our citizenry is not active enough.  If more active they are well, and less sick. A lot of these are due to choice and we can contribute to that choice, to encourage them to choose health
    2. Fruit and Vegetable Consumption – we trend down.  We are teaching our children that we don’t eat enough fruits and vegetables (teaching this in our schools.)
  20. Summary of Health Status in Oklahoma.

Q & A – [00:53:27 to 1:07:30]

Q.   Mulready – cancer state question;

Q.   McDaniels – women’s health conditions;

Q.   Rep. –  obesity;

Q.   Morgan re Hospital Costs associated with top four causes of death in OK 2009.  A: These health outcomes are the result of multiple factors, per capita cost for treatment, will factor in to cost of insuring them. Mulready re United Health Care Rankings about infant mortality and access to prenatal care.  “We want mothers to get proper nutrition and supplements and get them early in her pregnancy.”

Q.   Mulready re $5 billion attributed to obesity, could you name the top three things we could do to impact that, those are public dollars.

A.    One thing we can do is create the expectation that we expect wellness, physical activity in school, we need to support communities and empower them to make good choices, increase access to fruits and vegetables.  These are available in Certified Health Communities program. Certified Healthy Business program, too.  Q. Rep. Grau re ratio of primary care physicians ranking near the bottom, physician assistance, nurse practitioners, telemedicine?

A.    Run the state office of primary care.

Q.    Grau re pancreatic cancer – outside factors that contribute?

A.   Can’t answer.

Q.   Rep. Nelson re death and mortality rate, is there any correlation between infant

mortality and teen pregnancy?

A.    High teen pregnancy rate so parents don’t have time to educate their offspring on the issue.


Additional speakers included Mike Fogarty, CEO of the Oklahoma Health Care Authority (OHCA); Buffy Heater and Cindy Roberts, both with the OHCA; and Jason Sutton of OCPA. (Sutton was the only non-government presenter, and the one who provided a dose of reality about the tremendous growth of expenditures (169%) versus number of enrollees (47%)  since the creation of the OHCA.)

The rest of notes on this meeting are on the OK-SAFE, Inc. website here.

September 13, 2011

UPDATE to Action Alert – 1st Healthcare/Exchange Meeting will be aired 9/14/11


Update to the OK-SAFE Action Alert that went out this morning – it now appears that the first meeting of the joint committee to examine the effects of healthcare reform/exchanges, scheduled for Wednesday, Sept. 14, 2011 will be aired live and viewable  online via the Oklahoma House of Representatives website.  The meeting begins at 9 am and runs until 4 pm.  See prior OK-SAFE post for the agenda.

To view online go to http://www.oklegislature.gov/, click House Video – Live on the House Floor.

This information is being provided for those not able to attend this important meeting in person.

If you would like to contact your OK legislators about this subject, go to the OK Legislature home page, then click on Legislators to find their contact information.

The phone number for the House and Senate switchboards are:

  • OK House of Representatives:  800-522-8502,  or 405-521-2711
  • OK Senate:    800-865-6490,  or 405-524-0126


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