Oklahoma’s Medicaid Expansion Debate Rollercoaster

On June 30, Oklahoma voters will have a chance to require their state to expand affordable health coverage through expanding Medicaid. This would follow the lead of 37 other states (including DC) that have already expanded the program to cover more working adults since 2014. No state has gone back on its expansion decision and multiple reviews have found that states benefit financially from the new federal dollars flowing into the state for health care. While states have to put up a small portion of the expansion cost, the newly insured people enrolled in Medicaid include many residents where the state was already subsidizing their care with only state funding.

The road to this Medicaid vote has been long and there have been very confusing twists and turns over the last few months. Back in 2012, then Governor Mary Fallin made clear that she had no interest in more affordable health insurance for Oklahomans through Medicaid expansion. Seven years of refusal to seriously consider the option by the legislature followed. Finally, over the last year, an effort to put the question to voters directly gained steam and qualified for the 2020 ballot.

Regardless of lack of interest from some political leaders, affordable health coverage through Medicaid has bipartisan support of the state’s voters. Even Oklahoma’s GOP legislative leadership, long opposed to expansion, expects the ballot measure to pass. But this forthcoming vote has prompted some political contortions among Oklahoma’s current Governor Kevin Stitt and the legislature. Stitt, hoping to put his own stamp on Medicaid expansion, put forward his own plan to expand Medicaid that would eventually become much more restrictive than the plan put before voters on June 30. Expansion under this plan would have started July 1, with restrictive measures like work requirements and premiums set to begin the following year,  and was “intended to preempt” the ballot vote. The legislature worked with the Governor and passed a bill funding the Governor’s Medicaid plan – which the Governor promptly vetoed.

After Governor Stitt vetoed funding for his own plan for Medicaid, he then withdrew the state plan amendment submitted to the federal government that  would have started enrollment in expansion July 1. He is still pursuing his plan, entitled “SoonerCare 2.0,” that would make Medicaid more restrictive for expansion adults – although how this would work with Medicaid expansion passed by voters is unclear.

And after easily finding funding for the Governor’s plan to expand Medicaid, suddenly Oklahoma’s legislative leadership is back to wondering wherever they will find money to fund a Medicaid expansion passed by voters. Voters could be excused for wondering why a plan proposed by the Governor was so easily funded yet a Medicaid expansion proposal from voters is somehow an insurmountable obstacle.

The Medicaid expansion opposition cry of “where will we find the money” is now nearing a decade of use and seems to have lost some of its force. What worked for Governor Fallin in 2012 seems to be more of an admission of failure in 2020 as successive legislatures and Governors over the years have managed to find state funding for multiple programs – just not the Medicaid expansion they oppose. And Oklahoma’s legislators this year are getting what is framed as a “constitutionally mandated” 35% pay raise – so a constitutional mandate from voters to expand Medicaid should no doubt be equally welcomed by legislators as well.

Expect more confusion on Medicaid expansion in Oklahoma in coming weeks. But on June 30 Oklahoma voters will finally have a chance to cut through the debate and make their voices heard.

Adam Searing is an Associate Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.