Affordable Care Act Rules Specify Exemptions, Penalties ; the Coverage Requirement Will Be Enforced

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Read the Tulsa World continuing coverage of the health care law.

The Obama administration issued regulations Wednesday making it clear that the state's choice not to accept Medicaid expansion funding won't set up thousands of poor Oklahomans for penalties under the Affordable Care Act.

The rules released by the IRS and the U.S. Department of Health and Human Services also gave further definition to other exemptions to the federal law's individual mandate, including members of Indian tribes and adherents of religious sects whose tenets prohibit health coverage.

But the rules also make it clear that the coverage requirement will be enforced, meaning anyone who isn't exempt will have to pay a tax penalty if they don't have qualifying coverage.

The regulations are in clear conflict with the Oklahoma Constitution, which prohibits any law or rule that compels participation in any health care system. The constitutional right, added by voters on a 67 percent votes in 2010, was a direct response to the Affordable Care Act and its individual mandate.

Oklahoma Attorney General Scott Pruitt has included the conflict between the individual mandate and the state constitution in his federal court challenge to the Affordable Care Act. That challenge is currently pending before U.S. District Judge Ronald White in the Muskogee-based Eastern District U.S. Court.

Pruitt's suit argues, among other things, that while the U.S. Supreme Court upheld the constitutionality of the individual mandate as an exercise of the federal government's taxing power, the state constitutional protection remains valid.

A spokesman for Gov. Mary Fallin reiterated her opposition to the federal health law and made reference to the state's constitutional provision.

"Gov. Fallin is strongly opposed to Obamacare and the new taxes included in the law," said spokesman Alex Weintz. "She believes the people of Oklahoma have spoken on this issue."

Rep. Mike Ritze, R-Broken Arrow, is a physician and a leading opponent of enforcing the federal health care law in Oklahoma. He said the federal regulation will help opponents mold legislation to block the Affordable Care Act at the state border.

"We didn't know what the guidelines were going to be, so we didn't know how to respond," he said. "Now that we know the guidelines ... then we'll move forward with legislation to block that."

More important than blocking the individual mandate is blocking the entire law in the state, he said.

Ritze has proposed a bill to nullify the law in Oklahoma and provide criminal penalties for any government official who tries to enforce it. He said about a dozen other state legislatures are also looking at nullification laws.

Rep. Lewis Moore, R-Arcadia, is chairman of the new States Rights Committee in the state House and the author of another nullification proposal.

The people of Oklahoma have spoken clearly in opposition to the individual mandate, Moore said.

"The problem is, how do we cleanly enforce what our people want?" he said.

Under the Affordable Care Act, people who don't have qualifying coverage and aren't exempt from the mandate will have to pay a tax penalty of either a flat amount or a percentage of the person's taxable income, whichever is higher. …