OKLAHOMA CITY — Looming decisions for Gov. Mary Fallin on how Oklahoma will respond to the sweeping federal health care law are prompting an energetic, behind-the-scenes lobbying effort by hospitals, insurance companies, business and industry groups, and other constituencies that will be affected by provisions of the law.

Fallin is expected to announce within the next week her position on whether the state will move ahead with setting up a state-based online health insurance marketplace, or exchange, required under the law. Oklahoma policymakers also must decide whether the state will expand its Medicaid eligibility to provide coverage to thousands of low-income, uninsured citizens.

Fallin has yet to stake out a position on either proposal and faces a delicate political balancing act in a state where Republicans have bitterly resisted the requirements of the new federal health care law. On the one hand, hospital officials and chamber groups are pushing for both a state-based exchange and an expansion of Medicaid. But both of those ideas are fiercely opposed by tea party and other grassroots activists who have been fighting implementation of the law since its passage in 2010.

“It’s a real challenge for the governor, because what it’s done is put her right in between two major constituent groups inside the Republican Party,” said Keith Gaddie, a professor of political science at the University of Oklahoma.

The Tulsa Metro Chamber, which represents more than 3,000 members, is among those lobbying the governor to support both a state-operated insurance ex-change and an expansion of Medicaid.

“Certainly health care is one of the two largest employment sectors in Tulsa, so we’re very cognizant of the jobs health care provides in our community,” said Susan Harris, a senior vice president at the chamber who works on health policy. “Also, we need a healthy workforce. Healthy workers get better jobs, make more money and take care of themselves. It’s better for the whole community if we’ve got a healthy workforce.”

Enid Rep. John Enns said his constituents still are saying they don’t want the federal health care program. He does not know of a plan that has been discussed.

“I’ve been contacted by a lot of people in my district who say don’t take a step in that direction,” Enns said. “We’ll spend a period of time to try to figure things out. It’s funny, everybody doesn’t want us to do it.”

Enns, a Republican, anticipates some consideration will be given to a partnership with other states to establish a health exchange, which he thinks is a better idea than one only for the state.

“I just wish the thing would go away, but it won’t,” he said.

State Sen. Patrick Anderson, an Enid Republican, anticipates there will be resistance from the state of Oklahoma.

Anderson said the state may look at a combination exchange. If Oklahoma doesn’t produce its own, the federal government will provide one anyway, Anderson said.

“I think Oklahoma would look at joining other states in the region to create a health care exchange, but I don’t know which way it will go,” Anderson said.

Fallin herself opposed the law when she was a member of Con-gress and even dangled a “Don’t Tread on Me” flag before a tea party rally at the U.S. Capitol during the health care debate in 2010. Fallin and other Republican leaders initially hoped the U.S. Supreme Court would overturn the law, and when that didn’t happen, she withheld a decision on whether to proceed until after the election, hoping Mitt Romney would be elected and either help overturn the law or the slow its implementation.

Oklahoma was among the states that sued to stop implementation of the law, and even after the Supreme Court’s decision, Attorney General Scott Pruitt am-ended his lawsuit and maintains the law is unconstitutional because, among other things, it gives the federal government control over state legislative and executive power, exceeds Con-gress’ authority and in-fringes on state sovereignty.

“There is political risk in quitting resistance, but after you fail three times, you really have to reassess whether or not you’re going to prevail in this fight,” Gaddie said. “At some point, you just have to leave the battlefield and go home.”

Fallin spokesman Alex Weintz said Friday the governor still is exploring the state’s options as they relate to both the creation of a state exchange and the expansion of Medicaid.

“We feel like we have kept, as of right now, the doors open for the state of Oklahoma to pursue whatever we decide is the best option for our citizens,” Weintz said. “We don’t feel like anything has been ruled out, simply because of time restraints, at this time.”



Staff Writer Robert Barron contributed to this story.