The bottom: Bright red Oklahoma had been one of 14 states that has not expanded Medicaid under Obamacare and has the second highest rate of uninsured in the country, behind Texas. But even senior Republican officials in Oklahoma recently recognized that the state would eventually expand Medicaid coverage, it was just a matter of how.
Supporters of the ballot measure focused on how Medicaid expansion would increase access to health care in Oklahoma and help save the state’s struggling rural hospitals after a series of closings. Opponents argued that the program would bankrupt the state, especially during a pandemic that hit Oklahoma’s budget.
Ballot organizers said the coronavirus crisis would help defend their Medicaid expansion case. The average number of new cases in Oklahoma has more than doubled in the past month, and the state reported a record 585 new infections on Tuesday.
The impact: At least 200,000 Oklahoman adults will be eligible for Medicaid, but enrollment in the program may increase further as the state’s unemployment rate has risen to nearly 13 percent. The ballot measure requires the state to expand Medicaid by July 1, 2021.
Tuesday’s vote may also prevent Republican Governor Kevin Stitt from advancing his plans to implement a more limited form of Medicaid expansion. Stitt is the first governor to seek approval of the Trump administration’s new plan to convert a portion of federal Medicaid payments from an open entitlement into a defined lump sum, known as a global grant. Republicans believe the funding deal will help them control Medicaid spending, but Democrats argue that it is illegal and that it would likely lead to cuts in benefits and enrollment.
The ballot measure inserts Medicaid expansion into the state constitution, which could prevent state leaders from making conservative changes to the program, such as adding job requirements or bonuses. It is an open question whether the ballot measure would avoid a block grant.
Whats Next: Oklahoma must submit documentation to expand Medicaid to the federal government within 90 days. The Stitt administration will likely consider whether to withdraw the block grant plan, which will surely face legal challenges from Medicaid advocates if it gets approval from the Trump administration.
“I think there is room for some legal conversations about what our options are,” Carter Kimble, a senior Oklahoma health official, told POLITICO last week.