Oklahoma voters approve Medicaid expansion at the ballot box

Oklahoma is poised to become the 37th state to expand Medicaid to cover more low-income residents after voters narrowly approved State Question 802 on Tuesday.

Voters in Oklahoma's urban metro areas overwhelmingly approved the question to expand Medicaid, but rural voters largely opposed the measure.

State Question 802 passed by 6,488 votes, making Oklahoma the fifth state expand Medicaid through a ballot initiative.

The question will enshrine Medicaid expansion in Oklahoma’s constitution — effectively preventing Oklahoma’s GOP-controlled Legislature or Republican governor from limiting or undoing the expansion.

After nearly a decade of waiting on politicians to act, Oklahomans decided on Tuesday to take health care into their own hands, Yes on 802 campaign manager Amber England said in a statement.

"In the middle of a pandemic, Oklahomans stepped up and delivered life-saving care for nearly 200,000 of our neighbors, took action to keep our rural hospitals open, and brought our tax dollars home to protect jobs and boost our local economy," she said.

The campaign for SQ 802 was launched after years of legislative inaction on Medicaid expansion. The Yes on 802 campaign turned in a record number of signatures to qualify the question for the ballot.

But the majority of Oklahoma's counties opposed the expansion. A mere seven counties, including Oklahoma and Tulsa, out of the state's 77 counties, approved SQ 802.

John Tidwell, state Director of Americans for Prosperity and Chairman of the Vote No on 802 Association, said the lack of widespread support for the question is telling.

"Results are clear: a plan that claims to ‘save rural health care’ was overwhelming rejected by rural communities across Oklahoma," he said in a statement. "Voters in more than 90% of Oklahoma counties voted against SQ802."

Oklahoma will have to expand Medicaid under the Affordable Care Act by July 1, 2021. The federal government will cover 90% of the costs, with the state covering the remaining 10%.

The Oklahoma Health Care Authority estimates Oklahoma’s share of Medicaid expansion would amount to about $164 million annually to cover roughly 200,000 additional Medicaid recipients. State health officials have noted costs could rise due to skyrocketing unemployment caused by the COVID-19 pandemic.

The state spends about $6 billion annually on its current Medicaid program, which covers about 800,000 Oklahomans.

Gov. Kevin Stitt said state legislators will have a difficult time finding the money for expansion.

“You either pay for that by reducing roads and bridge funding, education funding, public safety funding or you raise taxes," he said. "As your governor, I’m not raising taxes.”

But earlier this year, Stitt vetoed the funding mechanism for his plan to expand Medicaid. The funding did not necessitate a tax increase or cuts to state agencies.

The Oklahoma Hospital Association said it looks forward to working with legislators to find a way to pay for the expansion without tax increases.

"We are grateful to the people of Oklahoma who believed as we did that expanding Medicaid was the right thing to do," the group said in a statement. "For more than a decade, Oklahoma hospitals have been working tirelessly to increase health coverage, strengthen rural hospitals and boost our economy by expanding Medicaid. Our work to increase health care access, reduce disparities and lower the number of uninsured will continue."