Rep. Doug Cox is quick to acknowledge that he's "kind of the black sheep" among state House Republicans.
Now in his fourth two-year term, the Grove emergency room physician never was one to march in lockstep with caucus leaders.
But as they veer deeper into the Fox News echo-chamber -- basic mantra: anything Obama or federal is e-v-i-l -- Cox increasingly finds himself as a lone voice pleading for reason and sanity.
This year's session doesn't get rolling until Feb. 4 but Cox already is at odds with his party's leadership -- this time over Gov. Mary Fallin's decision that Oklahoma will not participate in the federal government's Medicaid expansion.
The governor claims Oklahoma can't afford it, but when the facts are considered, her arguments ring hollow.
Here's the reality: The Medicaid expansion would not cost the state a dime the first three years. The feds pick up the entire tab for making 180,000 currently uninsured Oklahomans Medicaid eligible.
Even after three years, the feds foot 90 percent of the cost. While that does mean direct state costs would increase modestly, it does not take into account the savings the state would realize from the burden of less uninsured care, not to mention the potential tax-generating benefits of a healthier population.
Unfortunately, 180,000 uninsured Oklahomans are victims of wingnut politics. Anything attached to the name Obama or Obamacare is toxic these days in Oklahoma Republican circles.
The anti-federal venom spewed by the new House Speaker T.W. Shannon and new Speaker Pro Tem Mike Jackson during last week's House organizational meeting tells you everything you need to know about the mindset of Oklahoma's legislative leadership.
They live in an alternate reality where the jack-booted federal thugs plot around-the-clock to undermine individual liberties and turn America into totalitarian state.
Which brings us back to Dr. Cox.
Cox, 60, is no fan of Obamacare, but not for the reasons you might think.
It isn't because of alleged federal overreach or because Obamacare "forces" individuals to buy health insurance. Rather, it's because Obamacare fails, in his judgment, to address the primary culprit of skyrocketing health care costs: That there are too many paper-pusher-types in the system that "never see, touch, or talk to a patient."
"I'm not saying Obamacare is great," he said, "but federal law trumps state law. And for us to think our state lawsuit is somehow going to overturn it is just putting our heads in sand."
"My role as a state legislator is to work with the federal law the best I can to serve my constituents," he added.
What particularly troubles Cox is that the knee-jerk, anti-Obamacare sentiment demonizes a decent, hard-working class of Oklahomans, threatens the future of rural health care in a state already battered by poor health outcomes, and betrays sound conservative principles.
Working the emergency room in Grove, Cox sees firsthand the uninsured who turn to his facility because they have no other health care option.
"People have the misconception that the people we're trying to help with Medicaid are deadbeats," he said. "That's really not true. The people who are not covered now are just hard-working families that can't afford health care insurance.
They have jobs but work for lower-end salaries and work for companies that don't provide health insurance."
The Medicaid expansion that Fallin refused would have expanded coverage to Oklahomans making less than 133 percent of the federal poverty level. When you consider that means an annual income of only $30,657 for a family of four, he said, it's easy to see why most can't afford $5,167 for "bare-boned" health care insurance.
For rural health care providers -- like the facility where Cox works -- the state's refusal to participate in the Medicaid expansion is a potentially dire turn of events.
One way the federal government plans to finance the Medicaid expansion is by reducing what it pays hospitals for uncompensated care. The idea is that with fewer uninsured patients, the reimbursement costs won't be as high.
But in states like Oklahoma that refuse to participate, the number of uninsured is not lowered. So hospital emergency rooms get a double-whammy: the high percentage of uninsured remains but federal reimbursements are reduced.
Said Cox: "It's going to put a real financial crimp on the hospitals."
The governor first accepted, then rejected a $54 million federal grant to help set up a health care exchange, an originally Republican idea designed to give consumers a way to compare policies, costs, and coverage. Fallin later announced the state wouldn't set one up at all, leaving it up to the federal government.
"It is so politically charged and it's such a partisan issue," Cox said. "Just because it is connected to President Obama, people dead set against it without knowing the facts about it.
"A lot of these ideas were actually Republican-based ideas. But once they were connected to Obama, forget it."
One of the Obamacare provisions that incensed uber-conservatives was the requirement that people purchase health insurance. The Tea Party types portrayed it as an unconscionable federal overreach, the end of freedom and liberty as we've known them since the founding of the Republic.
Cox views it differently.
"Right now there are a lot of freeloaders in system, people that don't bother to have insurance but by federal law get free care," he said. "Under Obamacare, you've got to take personal responsibility -- either get insurance or pay a fine.
"I always thought personal responsibility was a Republican idea."
Cox, of course, is absolutely right. But that doesn't mean things will change at NW 23rd and Lincoln Blvd. in Oklahoma City. The uber-right noise machine is so omnipresent and persistent in Oklahoma that facts have little hope of trumping ideology.
Ask Oklahomans what they think of Obamacare, for example, and the response is overwhelmingly negative. Ask them about the individual planks in the plan, however, and they like nearly all of them -- no pre-existing conditions, your adult kids get to stay on your policy longer, etc.
Unfortunately, blind hatred of President Obama trumps common sense these days in Oklahoma.
Reality check: Obamacare isn't going away, and neither is the Medicaid expansion plan.
But what is going to go away is a huge pot of tax dollars that should be serving our working-class poor and girding our medical providers, especially in rural areas.
Pure politics. Sheer stupidity.
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