The background: Deep red Oklahoma had been one of only 14 states that did not expand Medicaid under Obamacare and has the highest uninsured rate in the nation, behind Texas. But even Oklahoma’s top Republican officials recently acknowledged that the state would eventually expand Medicaid’s coverage – it was just a matter of how.
Proponents of the vote focused on how expanding Medicaid would increase access to health care in Oklahoma and help save rural hospitals in state difficulties after a series of closures. Opponents argued that the program would bankrupt the state, especially during a pandemic that hit Oklahoma̵
Voting organizers said the coronavirus crisis would help support their expansion of Medicaid. The average number of new cases in Oklahoma has more than doubled in the past month and the state recorded a record 585 new infections on Tuesday.
The impact: At least 200,000 adults in Oklahoman will again be eligible for Medicaid, but enrollment in the program may go up even further as the state’s unemployment rate has risen to nearly 13 percent. The vote requires that the state expand Medicaid by July 1, 2021.
Tuesday’s vote may also prevent Republican governor Kevin Stitt from moving forward with 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 indefinite right into a defined lump sum, known as a block grant. Republicans believe that the funding agreement will help them control Medicaid’s spending, but Democrats argue that it is illegal and would likely result in cuts in performance and enrollments.
The vote inserts Medicaid’s expansion into the state constitution, which could prevent state leaders from making conservative changes to the program, such as adding job requirements or awards. It is an open question whether the voting measure provides for a block grant.
What’s next: Oklahoma must submit documents to expand Medicaid to the federal government within 90 days. Stitt’s administration will likely consider withdrawing the block subsidy plan, which is intended to address the legal challenges of Medicaid supporters 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 POLITICIAN.