Gov. Mary Fallin has applied to participate in an Affordable Care Act program designed to help states develop innovative models for delivering care and reducing costs for participants in Medicaid, Medicare and the Children’s Health Insurance Program.
In a story posted on July 31, Oklahoma Watch reported inaccurately that the state had chosen not to participate in the State Innovation Models grant program. The inaccuracy was caused by a series of miscommunications between Oklahoma Watch and the governor’s office. Oklahoma Watch regrets the error.
Fallin’s grant application is significant because it suggests she is willing to pursue federal funding opportunities provided by the Affordable Care Act despite her opposition to two of its key components: Medicaid expansion and creation of a state-run health exchange.
In an application dated July 18, Fallin requested $3 million, the maximum amount allowed for the type of grant the state is seeking, to develop an Oklahoma State Innovation Model based on “health system innovation that makes good business sense.”
The grant application targets four pervasive health problems: obesity, diabetes, hypertension and tobacco use. It notes that Oklahoma has high rates of deaths caused by heart disease, stroke, cancer and diabetes.
“In a time of great confusion and transition in health care, our state’s citizens, businesses and health care providers need to be engaged and supported in improving health,” Fallin wrote to the U.S. Department of Health and Human Services.
“I have personally assembled a team of proven leaders and experts to serve as the OSIM leadership from both the private and public sectors to take up this monumental challenge, and my office will provide the necessary policy guidance to ensure this project’s success.”
The governor’s coalition is led by the Oklahoma State Department of Health and includes 36 collaborating partners. Among them are four other state agencies, two large employers, four health insurers, three hospital systems, three academic medical centers, six medical associations, four Native American tribes and the State Chamber of Oklahoma.
The State Innovation Models program was authorized by the Affordable Care Act, often called “Obamacare.” It was launched last year with a first round of federal funding totaling $300 million. Twenty-five states were chosen to participate, including nearby Texas, Arkansas and Colorado.
Oklahoma did not apply to participate in the first round.
This year the Obama administration solicited applications for a second round of funding totaling $730 million. The application deadline was July 21. The awardees will be announced sometime this fall.
Julie Cox-Kain, Oklahoma’s deputy secretary of health and human services, said the state chose to apply for the second round because the grant program was retooled in ways that fit well with Oklahoma’s health reform objectives.
Cox-Kain said the Oklahoma State Innovation Model, if approved, would put more emphasis on preventive health services, encourage insurers to develop alternatives to traditional fee-for-service payments, and improve coordination of chronic disease treatments.
“This is really about working with people who work in health care to make the system better at improving health outcomes and more sustainable and affordable for all of us,” she said.
The governor’s decision to seek the grant is notable because the Affordable Care Act has become a hot-button political issue and because she has chosen in the past to avoid participating in some of its biggest components.
In 2011, shortly after taking office, Fallin joined legislative leaders in initially supporting, then abruptly rejecting, a $54 million grant that would have helped Oklahoma develop its own state-based health insurance exchange. As a result, Oklahomans must use the Obama administration’s online exchange to purchase subsidized private health policies.
In 2012, Fallin rejected another central element of the Affordable Care Act: a proposed expansion of the state’s Medicaid program, called SoonerCare, to include more than 100,000 low-income, working-age adults who don’t qualify for government health insurance under current state law.
The Affordable Care Act of 2010 is widely considered to be President Obama’s signature first-term legislative initiative. It remains highly controversial, though, and Fallin has denounced its key provisions on numerous occasions.
“Every month, we learn a new lesson about why the state of Oklahoma should stay as far away from Obamacare as possible,” the governor said in a recent prepared statement. “The law has cost millions of people their health insurance, is failing to bend the cost curve for medical care, and is constantly in danger of being thrown out by courts for being constitutionally suspect.”
Alex Weintz, Fallin’s communications director, said the governor considered the State Innovation Models grant program to be a worthy exception to her general dislike for the Affordable Care Act’s main components.
“We do not support expanding Medicaid, and we do not support creating a state-run exchange,” Weintz said.
“In terms of other grants, basically we listen to our agencies … If the experts are telling us that we’ve got a good shot at getting some federal support to make an Oklahoma program more robust or to improve it somehow, we’re generally interested in pursuing those grants.”
Weintz said that distinction applied to the State Innovation Models program even though it was authorized by the Affordable Care Act.
“I wouldn’t label this an Obamacare grant,” he said. “I think that classification is confusing to people and, in a sense, inaccurate.”
Weintz noted that the state passed up another Affordable Care Act funding opportunity, called the Health Insurance Exchange Establishment Grants, because the governor considered it to be an extension of the law’s central provisions.
The state did attempt to participate in another Affordable Care Act program, called Health Care Innovation Awards. The Health Department was one of several partners in a grant application submitted by the MyHealth Access Network, a Tulsa-based coalition. The application was not among those accepted by the Obama administration.
Oklahoma Watch reported inaccurately in July that the governor had decided not to participate in the second round of the State Innovations Models program.
The erroneous report was the result of several miscommunications between the governor’s office and Oklahoma Watch, involving a series of telephone interviews, emails and prepared statements.
“I think what was happening was that we were all calling around…” Weintz said. “There are several grants with similar names. … People in your office and people in our office were using imprecise terminology, and didn’t realize which grants that we were talking about.”
During interviews for the story, posted July 31, neither Fallin’s office nor the state Health Department disclosed that the state was applying for the second round of State Innovation Models. In one interview, Oklahoma Watch inquired specifically about a $700 million grant program with a July 21 application deadline.
It was not until Aug. 15, after Oklahoma Watch obtained a copy of the governor’s grant application from a confidential source and verified its authenticity, that it became clear the state had applied for the grant.