The decision last month by the U.S. Supreme Court upholding the Affordable Car Act (or ACA) has opened up new avenues of opposition --- or, as some states would have it, new grounds on which to reject the law. In its momentous decision, the Court said basically that any state could opt out of the law's expansion of Medicaid with no penalties to its existing programs. Under the ACA, the federal government will help states expand their coverage of Medicaid patients to 133% of the poverty line. Already, several states --- Texas, Florida, Louisiana, Mississippi, and South Carolina --- have stated that they will reject the expansion, and many other states seem to be likewise leaning in that direction. (This is despite the federal government's planned infusion of nearly all of the cost of the expansion.) What will Oklahoma do on this front? And what will happen if our state does, or doesn't, reject this expansion? And, in a closely related question, should Oklahoma create a health insurance exchange? And again, what will most likely happen if we do, or don't, decide to create one? (Keeping in mind that, per the laws that will take effect with the enactment of the ACA, the federal government will establish such an exchange for Oklahoma if we decline to establish one of our own.) Our guest on ST today helps us explore these questions; he is Dr. Jeffrey Alderman of OU-Tulsa, who specializes in matters of palliative medicine as well as health care policy.