Oklahoma Needs Medicaid Expansion
On June 30, voters can give 178,000 state residents access to health care — just in time to respond to a pandemic
The COVID-19 pandemic, the economic collapse, and a life-altering presidential election six months from now dominate current headlines. But there’s a very important election flying under the radar on June 30 in Oklahoma, where State Question 802 offers voters a chance to accept the Affordable Care Act’s Medicaid expansion.
If passed, the initiative would provide health coverage to an estimated 178,000 state residents who currently lack it.
To paraphrase a certain former Vice President, that’s a big deal.
Medicaid is the joint state-federal program created in 1965 that traditionally covers the poor and disabled. Before the Obama era, Medicaid was designed for classes of so-called “deserving” poor: children, pregnant women, the disabled and elderly, and some parents of dependent children.
The ACA expanded Medicaid to all citizens in households earning under 138 percent of the poverty line. This was the first time that the United States created a guarantee of health insurance for every low-income person, regardless of whether they were “deserving” or not. It is the single largest step since the formation of Medicare and Medicaid toward universal health care.
In addition to be being generous to the poor — for most recipients Medicaid offers comprehensive coverage with no out-of-pocket costs — the expansion was generous to the states as well: the federal government paid for 100 percent of the costs for the first year of expansion, and 90 percent over the long term of expansion. That reimbursement rate is far above the 50 to 83 percent share of costs it funds for most other parts of the program.
But the expansion got sidetracked by the U.S. Supreme Court in 2012 as part of the case National Federation of Independent Businesses vs. Sebelius. As written in the ACA, the expansion was supposed to be mandatory for all 50 states — fitting in with many other expansions in the past. However, while upholding the law as a whole, the court ruled that states needed to have the right to choose whether or not to accept the expansion.
The opinion opened a large hole in the ACA’s attempt to provide something close to universal insurance: instead of all 50 states insuring all of their poor and near-poor households, the fight for Medicaid expansion became a state-by-state slog. States controlled by Democrats quickly adopted the expansion, but states under GOP control were much slower to adopt and more likely to outright block it, though a considerable number ultimately did embrace reform.
Failure to expand Medicaid has likely cost tens of thousands of lives. Reams of scholarly literature and governmental reports strongly suggest expansion succeeds in improving access to health care and health outcomes, as well as stabilizing the finances of safety net and rural hospital systems, while not having adverse impacts on state budgets.
Frustrated by lack of progress, advocates in some non-expansion states turned to a new way to bypass recalcitrant Republican legislative majorities and cranky GOP governors: ballot initiatives. Some states grant residents the opportunity to gather signatures on a petition that proposes a constitutional amendment or law. The process varies by state, but in general if enough state residents sign, the proposal goes on the ballot and voters get to decide whether or not to adopt the proposal.
Since 2017, four states have adopted Medicaid expansion via ballot initiative. Because expansion has strong bipartisan polling support among voters, it has succeeded in winning majorities at the ballot box in some of the most conservative states in the union, notably Nebraska, Idaho and Utah in 2018.
Thirty-six states and Washington D.C. have now expanded Medicaid. Oklahoma remains one of the holdouts. Republican state officials have been dithering around the problem for several years now: a current proposal to “expand” Medicaid by governor Kevin Stitt would impose work requirements, and out-of-pocket costs on recipients, both of which function to reduce the effectiveness of the program (without helping people find work). Proposition 802 avoids the stupidity of needless bureaucracy in favor of quickly enrolling people in Medicaid — critical during a pandemic that is causing significant economic dislocation.
If you’re an Okie from Muskogee, Tulsa or Broken Arrow, you have power. On June 30, use it help 178,000 of your fellow citizens get access to lifesaving healthcare during a pandemic and beyond. Vote ‘Yes’ on Question 802.
