Oklahoma will become the latest state to adopt the Affordable Care Act’s Medicaid expansion after voters passed a ballot measure Tuesday that aims to cover an estimated 200,000 low-income adults.
Prior to the vote, 36 states and the District of Columbia already had expanded Medicaid using money from the 2010 health care law. Oklahoma, where Medicaid is called SoonerCare, had been among the 14 holdouts. The Associated Press and two of the state’s major newspapers, The Oklahoman and Tulsa World, reported that the initiative had passed late Tuesday.
The result also marks the fifth time voters implemented Medicaid expansion at the ballot box after waiting years for their Republican governors and legislatures to act. Two years ago, successful ballot initiatives in Idaho, Nebraska and Utah led to Medicaid expansion, while a similar measure in Montana failed. Maine voted to broaden Medicaid eligibility in 2017. Missourians will have an opportunity to vote on Medicaid expansion this August.
The Oklahoma Medicaid expansion campaign faced considerable obstacles, including opposition from Republican Gov. Kevin Stitt. Instead of adopting a full Medicaid expansion, Stitt had asked the federal government to approve a sweeping Medicaid reform proposal that would significantly reduce funding for the program under a “block grant,” a policy President Donald Trump has aggressively promoted to states. The ballot initiative prevents Stitt from continuing to pursue those cuts.
The ballot measure succeeded on the slimmest of margins, with support barely surpassing opposition by about a percentage point. But even a narrow victory for a progressive priority is notable in a state as Republican as Oklahoma.
The state favored Trump over Democrat Hillary Clinton 68% to 29% in the 2016 presidential election. Both of Oklahoma’s U.S. senators are Republicans, as are four out of five of its U.S. House members. The GOP holds a 77-23 majority in the state House of Representatives and a 38-9 majority in the state Senate.
The success of the Medicaid expansion effort could bring much-needed relief to low-income Oklahomans. The Sooner State’s 14% uninsured rate is the second-highest in the nation, behind only Texas and tied with Georgia.
Under current law, Oklahoma’s Medicaid eligibility rules are very strict. Adults without children living at home and adults without disabilities cannot qualify for Medicaid no matter how little they earn. Parents may be eligible, but only up to 41% of the federal poverty level, which is $8,900 a year for a family of three.
Depending on how long it takes for Oklahoma to get the expansion up and running, the timing could be beneficial for those affected by the pandemic, which has created millions of unemployed people who lost their job-based health insurance. Medicaid serves as a vital safety net during economic downturns and expanding the program makes those benefits available to more people.
Under the Affordable Care Act, Medicaid can be expanded to cover low-income adults with incomes up to 133% of poverty, which is about $17,000 for a single person. The federal government covers 90% of the cost of covering those new beneficiaries and states pay the remainder.
Stitt and the majority-GOP Oklahoma legislature did not agree on a financing plan for Stitt’s block-grant proposal, but a leading option was to levy fees on hospitals. A separate ballot initiative on deck for November would tap tobacco settlement funds to pay for part of the cost of Medicaid expansion.
Including Oklahoma, an estimated 5.7 million adults in the 14 states that haven’t implemented Medicaid expansion would have access to Medicaid benefits if those states reversed course, according to an analysis by the Henry J. Kaiser Family Foundation.