Many sick people cannot afford the costs of such "high-risk" plans, and the new law provides some $5 billion in federal money to help people across the country pay for the insurance premiums.
The program is slated to be fully funded by the federal government, with no state costs.
But Oxendine, a Republican candidate for governor, said he believes the program is underfunded and Georgia would eventually be saddled with costs.
U.S. Secretary of Health and Human Services Kathleen Sebelius said that while she is interested in working with states to set up the pools, a state's participation is not needed. She said the federal government would carry out a coverage program in those states.
In a letter Monday to Sebelius, Oxendine said, "Unfortunately, I have no confidence in any federal assertion that this so-called temporary program will not burden the taxpayers of Georgia."
He added, "I cannot commit the state of Georgia to ... a scheme which I believe the Supreme Court will hold to be unconstitutional, leads to the further expansion of the federal government, undermines the financial security of our nation, and potentially commits the state of Georgia to future financial obligations."
Sebelius spokesman Nicholas Papas responded to Oxendine's refusal by saying, "For too long, Georgians with pre-existing conditions have been locked out of the insurance market. ... Our department will work to ensure Georgians with pre-existing conditions have access to affordable insurance through the federal high-risk pool program that we will establish this year."
Papas said he could not say whether any other states have declined to participate.
The effect on Georgians of Oxendine's decision remains unclear. Papas said the federal government would later address the federal structure of running these pools in states.
Bert Brantley, a spokesman for Gov. Sonny Perdue, said the creation of such a pool would require state legislation and therefore the responsibility of creating it stands with the Legislature and the governor.
Brantley said that while the governor's office is still analyzing the plan for insurance pools, the governor's office is also concerned that the plan would wind up costing Georgia. He also did not expect the Legislature to take up the issue, since only about two weeks remain in this session.
Brantley said he saw no difference to Georgians whether the state or the federal government ran the program.
Sebelius gave states until April 30 to say whether they would participate in the program. The money to help people is expected to become available July 1.
The "high-risk" pools are considered a stopgap measure to help people until the federal government greatly expands the eligibility for Medicaid in 2014. People would have to have been uninsured for six months to apply for the money.
Government economists estimate that 375,000 uninsured people would gain coverage through the pools. But they also question whether the $5 billion allocated is enough to fund the program until 2014.