Health Care Reform & Exchanges 





OK Republicans Implement "ObamaCare"

On Friday, Feburary 25, 2011 OK Governor Mary Fallin issued a press release announcing "Oklahoma Will Accept $54 M "Early Innovator Grant" to Support Oklahoma-Based Health Insurance Exchange." 

Noticably missing from the announcement is the fact that the "Early Innovators" grants are to fund implementation of the Information Technology (IT) infrastructure needed to operate Health Insurance Exchanges, a cornerstone of the
Patient Protection and Affordable Care Act, aka "ObamaCare."

The grant application, officially called the
Cooperative Agreements to Support Innovative Exchange Information Technology Systems, is a 41-page document outlining the purpose, authority, and background of the funding "opportunity", as well as eligibility requirements states must meet in order to qualify. 

The application also notes the specific sections of the Patient Protection and Affordable Care Act (and the Health Care and Education Reconciliation Act, together referred to as the Affordable Care Act) authorizing the funding of the grant.

Oklahoma was one of seven initial grant awardees, with our state getting the largest dollar amount - $54,582,269.  The grantee in Oklahoma is the Oklahoma Health Care Authority.

According to, the expected number of awards is 51 - all 50 states, plus the District of Columbia.

All of the exchanges are to be interoperable and usable by other states.

Exchanges - Cornerstone of the PPACA

The creation of Health Insurance Exchanges is a cornerstone of  PPACA (ObamaCare), without which there would be no socialized health care plan.  The plan requires an IT infrastructure to be in place in order to function.  No Exchanges, no ObamaCare.

These insurance Exchanges are mentioned 278 times in the Act.

The specific section of PPACA (ObamaCare) noted in the grant application are:

Page 5 of the grant application cites Section 1311 of the PPACA.
"C. Background
On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act. On March 30, 2010, the Health Care and Education Reconciliation Act of 2010 was signed into law. The two laws are collectively referred to as the Affordable Care Act. The Affordable Care Act includes a wide variety of provisions designed to expand coverage, provide more health care choices, enhance the quality of health care for all Americans, hold insurance companies more accountable, and lower health care costs. Among its provisions, the law provides grant funding to assist States in implementing parts of the Affordable Care Act.

Section 1311 of the Affordable Care Act
provides funding assistance to the States for the planning and establishment of Health Insurance Exchanges (“Exchanges”). The Affordable Care Act provides that each State may elect to establish an Exchange that would: 1) facilitate the purchase of qualified health plans (QHPs); 2) provide for the establishment of a Small Business Health Options Program (“SHOP Exchange”) designed to assist qualified employers in facilitating the enrollment of their employees in QHPs offered in the SHOP Exchange; and 3) meet other requirements specified in the Act."

Pages 6 & 7 of the application cite Section 1323 of the PPACA:

"The products of this Cooperative Agreement will be available to all States and the District of Columbia for evaluation and adaptability throughout the process so that non-grantee-States will not have to wait until a complete product is finished to test for adaptability for its existing systems. As IT systems are developed, attention should be paid to assuring that information gathered will be accessible for evaluation purposes. U.S. Territories that establish Exchanges under Section 1323 will be eligible to participate in the evaluation and adaptability process and the products developed under this Cooperative Agreement will be available to them."

Pages 7, 17, 21, 28, and 29  of the application cite Section 1561 of PPACA:

Key Principles of Exchange IT capabilities for Early Innovators
• The organization governing the design, development, and implementation of the core capabilities must follow standard industry Systems Development Life Cycle (SDLC) frameworks including the use of iterative and incremental development methodologies. The governing body must also be able to produce requirement specifications, analysis, design, code, and testing that can be easily shared with other interested and authorized stakeholders (i.e., other States, consortia of States, or any entity that is responsible for establishing an Exchange).
• The design must take advantage of a Web Services Architecture (using XML, SOAP and WSDL or REST) and Service Oriented Architecture approach for design and development leveraging the concepts of a
shared pool of configurable computing resources (e.g., Cloud Computing).
• The services description/definition, services interfaces, policies and business rules, must be published in a web services registry to support both internal and external service requests that are public and private, and be able to manage role-based access to underlying data.
Per Section 1561 of the Affordable Care Act, all designs must follow the standards thatare currently outlined in the recommendations published by the Office of the National Coordinator (ONC). For details on Section 1561 Standards, see:
• Per National Institute of Standards and Technology (NIST) publications, the design and implementation must take into account security standards and controls. (For details on NIST publications, see:

Health Insurance Exchange Legislation

Currently there are several live bills implementing the Health Insurance Exchange but two worth noting are SB 960 by Sen. Bill Brown, and HB 2130 by Rep. Kris Steele.

Health Insurance Exchange Impact on Independent Brokers

Several independent insurance brokers in Oklahoma are concerned about the impact the exchanges will have on their businesses.  The exchanges operate contrary to the free enterprise system and most likely will put the independent insurance broker out of business.  Click here to hear the 2/27/11 interview with Mark Croucher of WHY-Insurance. 

  January 9, 2013
In The News

OHIET–Voucher Program Maps

The attached Hospital Voucher Program maps were distributed at the OHIET meeting, held on Tuesday, January 8, 2013 at The Cancer Treatment Center in Tulsa, OK.

The maps list the names and locations of the Hospitals and Behavioral Health Service Centers in OK that have taken vouchers to offset the cost of signing up with a “certified” health information organization (HIO). In other words, these are the locations that are participating in the ObamaCare compliant health information exchange networks.

Soon these separate HIO networks will be linked together, creating the network of networks envisioned in the reformed federal health care system. Health information will be shared electronically via these networks, transmitting health information both in–state and with the developing federal health information systems.

At this time, there are only three certified HIOs in OK:

  • SMRTNET – Secure Medical Records Transfer Network

  • MyHealth Access Network – Dr. David Kendrick, CEO

  • OPHX – OK Physicians Health Exchange, out of the Norman Physician Hospital Organization

The federally funded vouchers are distributed through the OHIET by the REC (Regional Extension Center), an effort of the Oklahoma Foundation for Medical Quality (OFMQ).

From the OFMQ website:
“For a limited time, rural providers and hospitals can apply to receive federal vouchers ranging from $600–$17,000 to connect to a certified health information organization (HIO). The voucher program funds are provided through the Oklahoma Health Information Exchange Trust (OHIET).”

Those “federal vouchers” are being paid out of Stimulus money which this state secured through the SHIECAP grant.

Everything that OK–SAFE warned about in their presentation on health care reform (Health Care Reform – Security and Privcacy Concerns) is coming to fruition in OK, largely due to the efforts of the OHIET (Oklahoma Health Information Exchange Trust).

The OHIET is a public–beneficiary trust created in 2010 with the passage of SB 1373, a bill authored by Sen. Brian Crain and Rep. Colby Schwartz. An effort the repeal SB 1373 in 2012 was nixed by leadership in the Republican–led Senate.

  December 11, 2012
In The News

The Illegal IRS Rule to Expand Tax Credits Under the PPACA by Jonathan H. Adler – (Case Western Reserve University School of Law) and Michael F. Cannon – (Cato Institute)

The Patient Protection and Affordable Care Act (PPACA) provides tax credits and subsidies for the purchase of qualifying health insurance plans on state–run insurance exchanges. Contrary to expectations, many states are refusing or otherwise failing to create such exchanges. An Internal Revenue Service (IRS) rule purports to extend these tax credits and subsidies to the purchase of health insurance in federal exchanges created in states without exchanges of their own. This rule lacks statutory authority. The text, structure, and history of the Act show that tax credits and subsidies are not available in federally run exchanges. The IRS rule is contrary to congressional intent and cannot be justified on other legal grounds. Because the granting of tax credits can trigger the imposition of fines on employers, the IRS rule is likely to be challenged in court.”


  November 23, 2011
In The News

The American Recovery and Reinvestment Act of 2009 (aka The Stimulus Bill), Public Law 111–5. The real health care reform law.
The HITECH Act of 2009. From Public Law 111–5. Adoption and use of electronic health records, SHIECAP agreements.
The Patient Protection and Affordable Care Act of 2010 – Public Law 111–148 (PPACA, aka “Obamacare”) – funding for the health insurance exchanges, a cornerstone of the Act.


  November 10, 2011
In The News

OK-SAFE Presentation to Joint Committee on Health Care Reform Law - 11-03-2011 - PowerPoint Download and Video

Health Care Reform Defined


These items show the legislative progression toward implementing "health care reform" in Oklahoma, that is really helping to establish the seamless flow of health care information to the department of homeland security, to develop a ‘federal data hub’, aka total information awareness.


2006 - HB 2842 Enrolled Version - By Steele/Adelson Oklahoma Medicaid Reform Act of 2006

Senate Votes on HB 2842 – 5/25/06

House Votes on HB 2842 – 5/25/06

2008 - SB 1420 by Cox/Sparks - Creating the Oklahoma Health Information Exchange Act

Senate Votes on SB 1420 – 5/22/08

House Votes on SB 1420 – 5/23/08

2008 – E.O. 2008–4 – Issued by Gov. Brad Henry – Creation of the Oklahoma Health Information Security and Privacy Council (OKHISPC)

2009 - SB 757 by Steele/Burrage - Creating the Oklahoma Health Information Infrastructure Advisory Board (OHIIAB)

Senate Votes on SB 757 – 5/13/09

House Votes on SB 757 – 5/15/09

2010 - SB 1373 by Crain/Schwartz - Creating the Oklahoma Health Information Exchange Trust. Started out as a COPD bill

Senate Votes on SB 1373 – 5/25/10

House Votes on SB 1373 – 5/27/10

2011 - HB 2130 By Steele/Jolley Making the Secretary of Health and Human Services (Terry Cline)

House Votes on SB 2130 – 3/17/11

The Oklahoma Health Information Exchange Trust (OHIET) trust indenture. Filed with the OK Secretary of State on Sept. 20, 2010.


              OK-SAFE REPORTS
  September 14, 2011
In The News

OK-SAFE Reports: Notes on 1st Joint Committee Meeting on Healthcare Reform & Exchanges - 09-14-11


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.


The following are the presentations shown at the first Joint Committee on the Federal Health Care Law, held in Oklahoma City, OK in the House Chambers on Wednesday, September 14, 2011.

Presenters were Julie Cox-Kain, M.P.A (Oklahoma State Dept. of Health); Mike Fogarty (CEO of the Oklahoma Health Care Authority); Cindy Roberts, CPA and Buffy Heater, MPH (Oklahoma Health Care Authority); and Jason Sutton, J.D. (Oklahoma Council of Public Affairs, OCPA).


Health Outcomes: Oklahoma Department of Health by Julie Cox-Kain

Oklahoma SoonerCare: OHCA by Mike Fogarty CEO on 09-13-11

Summary of PPACA: Oklahoma Department of Health by Julie Cox-Kain

ACA Medicaid: OHCA by Heater and Roberts

Health Reform Task Force Medicaid: OCPA by Jason Sutton


Video of this meeting is available on the OK Legislature website – click on House Video.


  August 12, 2011
In The News

Oklahoma Health Care Act Lawsuit

Pruitt Applauds Ruling on Federal Health Care Law


OKLAHOMA CITY – 8/12/2011 – Attorney General Scott Pruitt released a statement in support of the ruling by the U.S. appeals court: “I am pleased the 11th circuit ruled today that the federal government cannot force Americans to buy health insurance. “Indeed, the ruling affirms and strengthens Oklahoma’s…more


"On August 12, 2011, the 11th Circuit Court of Appeals issued an opinion in appeal State of Florida v. U.S. Dept. of HHS (11-11021-HH). ("Obama Care").  The Court determined that the 'individual mandate' was unconstitutional, and severable. This decision is a tremendous boost to all those who stood firmly opposed to the implementation of this egregious bill."


  April 3, 2011
In The News
  February 27, 2011
In The News

America in the Balance – Interviews Mark Croucher on Oklahoma’s implementation of Obamacare



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