Chris Gatliff, a 38-year-old diabetic, says he feels like a victim of politics.
His home state, Oklahoma, opted against accepting the expansion of Medicaid under the Affordable Care Act. The result is that thousands of Oklahomans who would have qualified under the expanded program are left in limbo about their health insurance.
At the same time, a Medicaid-linked program called Insure Oklahoma that provides Gatliff with his current coverage was due to expire Dec. 31. That left him facing the prospect of having no insurance at the end of the year, so the part-time pizza shop employee began planning to stockpile his medications.
In mid-September, however, Oklahoma Gov. Mary Fallin announced a temporary reprieve for the 30,000 Oklahomans who receive coverage through Insure Oklahoma, saying the program would remain operating for one more year.
Gatliff said he was grateful for the temporary extension but said he felt like a victim of Oklahoma's resistance to implementing the Affordable Care Act.
"I'm glad she did it," said Gatliff, who makes between $7,000 and $9,000 annually . "It's a year, which is good, but it's still only a year. After that, I'll have to worry about it."
He said he believed the governor should have simply accepted the Medicaid expansion that was offered to states under the federal health care reforms. The federal government pays for the full expansion for the first few years and 90 percent thereafter.
Opting for the Medicaid expansion under the federal law would have provided medical coverage to as many as one-third of Oklahoma's 636,000 uninsured residents, about 17 percent of the state's population.
But for Fallin, agreeing to an expansion of Medicaid would be politically dangerous. She voted against the Affordable Care Act when she served in Congress, railed against it during her campaign for governor and consistently opposed it during her first term.
She said she is concerned the expansion could cost Oklahoma $850 million through 2020.
Although the Insure Oklahoma program was pushed by former Democratic Gov. Brad Henry and uses federal Medicaid dollars, Republicans prefer it to a Medicaid expansion because thousands of small businesses use it to provide coverage to their employees. Recipients also are required to make modest premium payments and medical co-pays.
"There's some personal responsibility in the plan," Fallin said.
Gatliff would have qualified for the Medicaid expansion offered under the Affordable Care Act, which gives eligibility to those making up to 138 percent of the federal poverty level, or $15,400 for an individual and about $31,000 for a family of four. Under Insure Oklahoma, he currently pays a $27 monthly premium as well as co-pays for doctor visits and the five medications he takes regularly.
"I don't mind paying it," Gatliff said from the mobile home he shares with a friend at the Sherwood Village Manufactured Home Community in Lawton, about 90 miles southwest of Oklahoma City. "I'm not looking for a handout. I want to pay something."
If Insure Oklahoma had not been extended for a year, Gatliff would have been caught in a coverage gap: He would not have qualified for Medicaid, but he also did not earn enough to qualify for tax subsidies to purchase insurance on the federal exchange.
The gap exists because the Obama administration did not anticipate a U.S. Supreme Court ruling giving states the option to reject the Medicaid expansion. Individuals with an income of 100 percent to 400 percent of the federal poverty level would be eligible for government subsidies on the exchange, but Gatliff does not qualify because he earns less than 100 percent of the federal poverty level.
He hopes the decision to extend Insure Oklahoma for one year gives the first-term governor a chance to change her mind and agree to the Medicaid expansion.
"If she could just not worry about the politics and do what's right for the people of Oklahoma — that's what her job is," Gatliff said. "That's what politicians forget sometimes."