TAHLEQUAH — The clock is ticking for governors of states who have rejected the establishment online state health insurance exchanges and the expansion of Medicaid under the Patient Protection and Affordable Care Act.

U.S. Health and Human Services Secretary Kathleen Sebelius extended the deadline from Nov. 16 to Dec. 14, allowing states the additional time to inform the administration whether they intend to set up their own exchanges, or leave it up to the federal government.

In a column released Dec. 3, Gov. Mary Fallin announced she would not implement either component.

“After careful consideration, I decided last month that Oklahoma would not pursue the creation of its own health insurance exchange,” wrote Fallin. “As I said at the time, any exchange that is PPACA-compliant will necessarily be ‘state-run’ in name only and would require Oklahoma resources, staff and tax dollars to implement.”

But Fallin has faced opposition to her decision from a number of groups, including the Tulsa Metro Chamber of Commerce, according to a report by the Associated Press. The organization has been lobbying Fallin to support the exchange, as members believe it would expand jobs in the health care field - one of the two largest employment sectors in Tulsa.

What may have a larger local effect, though, is Oklahoma’s failure to expand Medicaid. According to PPACA, starting Jan. 1, 2014, Medicaid coverage will be extended to non-elderly people with incomes at or below 133 percent of the federal poverty level.

According to the Oklahoma Health Care Authority, the entity responsible for administering Medicaid in Oklahoma in 2009 about 658,000, or 18 percent, of the state’s residents were uninsured. Of those, 130,000 were children and 528,000 are adults.

Under PPACA, adults under age 65 making up to 138 percent of the federal poverty level will now qualify for Medicaid, as will any adult up to age 26 who was in foster care at age 18.

Former Sen. Jim Wilson was recently appointed to the board of directors of NeoHealth, a community health care agency that provides services on a sliding scale to many low-income families in the area. Wilson said Fallin is under a lot of pressure to accept Medicaid expansion, which would be a boon to this area.

“We have 17,000 Medicaid-eligible folks right here who don’t have any health care,” said Wilson. “If Medicaid is expanded, it would be huge for NeoHealth, as it gets an additional stipend from Medicaid to care for the uninsured. It will be a big deal.”

In her column, Fallin said she has rejected Medicaid expansion, citing it as “unaffordable.”

“[It would cost] the state of Oklahoma $475 million between now and 2020, with escalating annual expenses in subsequent years,” wrote Fallin. “If would also have furthered Oklahoma’s reliance on federal money that may or may not have been available in the future, given the dire fiscal problems facing the federal government.”

The Oklahoma Health Care Authority has estimated that, in 2016, when the state is set to take over 10 percent of the PPACA costs, the amount will be $26.7 million, which would increase to $32.6 million in 2018, $38.8 million in 2019, and $56.6 million in 2020.

Tahlequah City Hospital CEO Brian Woodliff said the local medical community supports Medicaid expansion.

“A Medicaid expansion would provide an additional 180,000 Oklahomans with medical coverage,” said Woodliff. “For our community, that could mean coverage for an additional 20 percent of the people. We understand that this program will cost the state $56 million, but our hospital alone is spending $750,000 a month in uncompensated care. Like TCH, hospitals around the state are providing millions in charity care. We want Oklahomans to have medical coverage, and we encourage Oklahoma’s legislators to support the ACA’s Medicaid expansion program.”

Wilson said the revenue in payroll and subsequent taxes generated by Medicaid expansion would more than compensate for the cost.

“Medicaid expansion would create 24,000 jobs, generate $570 million in payroll, and $76 million of that would come back to us in taxes, which mitigates any cost to the state,” said Wilson. “Even if we pay 90 percent [of the cost of the program] we’ll still make money. Some people say that federal money is still taxpayer money, and that’s true, but I’d rather it come here than go to Mississippi or other states, which it will if we don’t accept it.”

Rep. Doug Cox, R-Grove, who is also a physician, agreed with Wilson.

“I feel [$56.6 million] is a number we can afford,” Cox said in an earlier Daily Press report. “Some studies, including those by the Robert Wood Johnson Foundation and Urban Institute, estimate there would be an additional 16,397 jobs created in Oklahoma, which would generate $495 million in payroll dollars. That would generate $52 million in state income from personal tax revenue. That would offset the cost of the program.”

NeoHealth Board of Directors Bobbie Davis feels confident that whatever happens, the agency will continue to provide quality care. Davis estimates about 60 percent of the provider’s patients use either Medicare of Medicaid.

“Obviously, there is a lot of work yet to do in determining what Neo will have to do in light of the new health care regulations that are coming,” said Davis. “We feel confident that we will be able to continue to meet our mission statement and provide quality health care, with quality providers, to the residents of our area.”