OKLAHOMA CITY – After a decade’s worth of debate, Oklahoma voters endorsed a state question to expand the state’s Medicaid system Tuesday night – but just barely.
Unofficial election returns show State Question 802 gathered 340,279 yes votes and 333,761 no votes – a difference of 6,518 or 50.48 percent to 49.52 percent. The vote put a capstone on years of political wrangling over the idea of expanding the state’s public health insurance system.
That vote, records show, was one of the closest in years and pitted many rural areas of the state against their urban neighbors.
In Comanche County, voters supported the proposal by a vote of 6,455 to 4,984. Data from the State Election Board shows that 11,403 voters cast ballots in the election.
With Medicaid expansion now written in the state’s constitution, an additional 200,000 families with incomes near or slightly above the federal poverty level will qualify for the program. Opponents of the question predict the program’s expansion will cost the state millions of dollars and won’t save Oklahoman’s ailing rural hospitals.
Part of then-President Barack Obama’s Affordable Care Act, Medicaid expansion was required for all states when act became law in 2010. The program added coverage for people younger than age 65 who had incomes below 133 percent of the federal poverty level.
However, in June 2012, the U.S. Supreme Court struck down the portion of the law that penalized states that did not expand Medicaid. Following the high court’s ruling Fallin issued a statement saying Medicaid expansion would be unaffordable and could cost the state up to $475 million between 2012 and 2020.
“We are very conscientious of the fact that there are Oklahomans that don’t have healthcare coverage. We are certainly very aware that many people show up at emergency rooms and hospitals have to pick up that cost,” Fallin said in 2012. “It’s something we’re working on, and actually we have begun drafting proposals to look at to find ways to find solutions to reducing our healthcare costs.”
With the help of Republican majority in both houses of the Oklahoma Legislature, Fallin prevented expansion during the eight years she served in office. Fallin’s political heir, Gov. Kevin Stitt, has continued to prevent Medicaid expansion.
Tuesday evening, the state’s policy changed.
Expanding the Medicaid system will provide life-changing healthcare coverage for more than 200,000 Oklahomans and create significant economic stimulus when implemented, the Oklahoma Policy Institute, a left-leaning think tank, said in a statement Wednesday morning.
“With the need for health coverage greater than ever, Oklahoma policymakers should act quickly to implement SQ 802,” the group said. “The clock has now started on the 90-day window for the Oklahoma Health Care Authority to submit a state plan amendment to federal regulators.”
Tribal leaders also applauded the passage of the state question. Cherokee Nation Principal Chief, Chuck Hoskin Jr., said Medicaid expansion would be boon for northeast Oklahoma.
“Not only is it financially responsible to bring those dollars back to our home state, but morally it is the right thing to do as more Oklahomans, including our most vulnerable - elders and young children, will have improved access to quality healthcare,” Hoskin said.
“It will lay the groundwork for a better and healthier Oklahoma, with improved results in public education metrics, workforce development and life expectancy. Expansion of Medicaid is also a clear win for Cherokee Nation’s growing healthcare system and all of our patients.”
Cherokee County, home to the tribe’s Capitol, is one of seven counties across Oklahoma where voters approved State Question 802. The question passed in the northeastern Oklahoma county by more than 1,400 votes.
State Question 802’s passage also means that many tribal healthcare facilities are now eligible for full federal funding.
A 2016 guidance issued by the Centers for Medicaid and Medicare, said Medicaid services received at Indian Health Services direct care sites, such as the Lawton Indian Hospital, and tribally operated healthcare facilities, such as those run by the Cherokee Nation, can receive full federal funding. The state of Oklahoma does not have to provide any matching money for those patient visits.
American Indians and Alaska Natives account for about 16 percent of the participants in Insure Oklahoman and SoonerCare. In Comanche County – one of only seven counties in the state that voted for Medicaid expansion – about 2,000 tribal citizens are enrolled in the programs.
Former state Representative Joe Dorman, now the CEO of the Oklahoma Institute for Child Advocacy, said Medicaid expansion was “absolutely a step in the right direction” for Oklahoma.
Dorman said he has supported taking the federal healthcare funding for years.
“When I was campaigning for governor (in) 2014 that was the very first issue I announced support for (in my campaign); so I’ve been a staunch supporter for that long and even going back further to my time serving in the state legislature when I felt Oklahoma should have taken those dollars early on,” he said.
Dorman said it has taken the state a decade to expand Medicaid because it was opposed by then-Governor Fallin and members of the Oklahoma Legislature.
“We had governors who have been opposed to expanding Medicaid. Governor Fallin was opposed to this as well as lawmakers serving at the Capitol, but as the years have gone by more lawmakers have looked into the issue and realized the benefits of what we can see with the nine to one match with the improved healthcare for Oklahomans,” he said.
Opponents for the measure, including the Oklahoma Council for Public Affairs and the group Americans for Prosperity, countered that the proposal won’t reduce costs and that it won’t save struggling rural hospitals.
“There have already been 24 hospitals that have closed after Medicaid expansion in 16 states, and that number is expected to continue increasing with time,” former Governor Frank Keating, a Republican, wrote in an essay on the OCPA’s website. “Five of those shuttered hospitals were in Arkansas, Kentucky, and Louisiana.”
The OCPA’s president, Jonathan Small, said the passage of the state question will pressure state lawmakers “to impose higher taxes yet again on their constituents back home.”
“With oil prices still depressed and the response to COVID-19 continuing to wreak economic havoc, it’s easy to anticipate next year another billion-dollar budget shortfall for state government, which Medicaid expansion will only worsen,” Small wrote.
Still, while Medicaid expansion is now a part of the state Constitution, the state will have until 2021 to put an expansion plan info effect. Lawmakers will have to develop a funding source, expected to be about $160 million. And those costs could increase because of the COVID-19 pandemic.
But Dorman and others remain optimistic. Even with the additional costs of the pandemic, he said the state has enough funds to cover the expansion costs. “It will inevitably grow somewhat due to the pandemic, people losing their jobs, the economy we’re facing, but it won’t be a significant jump and I do believe lawmakers will be able to find the dollars to cover that,” he said.