Advocates Praise, Will Monitor, Oklahoma Medicaid Expansion

July 01, 2020

Health care advocates are celebrating Oklahoma voters’ move to defy state leadership and expand Medicaid under the Affordable Care Act, which is expected to provide health care to about 200,000 Sooners. Under the new constitutional amendment, the state now has 90 days to apply for an expansion that will start by July 1, 2021, and the language bars the state from seeking policies that make it more difficult for people to qualify for Medicaid than they would under existing requirements.

The ballot initiative passed by a narrow 1%, or less than 10,000 votes, and is seen by health advocates as a major rebuke to the Trump administration’s efforts to undermine and overturn the ACA. Oklahoma voters also defied GOP Governor Kevin Stitt who opposed a clean Medicaid expansion.

Stitt initially pushed to expand the program under the administration’s new block grant policy. But the governor pulled that application on May 28 over funding concerns.

Yet the state still has an application pending for a Medicaid 1115 waiver that would require some beneficiaries to pay premiums, add work requirements, add a co-pay for non-emergency services provided in an emergency room and eliminate presumptive eligibility, among other changes. The federal comment period on that waiver, dubbed SoonerCare 2.0, ended June 27.

Although the expansion is now imbedded in the state's constitution, and presumably more difficult to alter, advocates will keep a close eye on the state to make sure its next steps align with the voters’ choice. “With any ballot measure, implementation is key,” Chris Melody Fields Figueredo, executive director of the DC-based Ballot Initiative Strategy Center, tells Inside Health Policy. “Florida’s amendment 4 is a good example of a constitutional amendment where the state legislature changed how the law has been implemented and that has been challenged in court. So the work continues to ensure that the constitutional amendment is implemented in the way intended,” she adds.

The Oklahoma Policy Institute, which strongly backed the initiative, said in a statement that staffers will continue to monitor the implementation process. The group wants to ensure that, “in accordance with the voters, the state is moving expeditiously to give people health coverage and not placing additional burdens or restrictions on low-income Oklahomans who are joining the state’s Medicaid population."

The institute further stressed that since the Oklahoma Health Care Authority had been prepared to expand coverage by July of this year under the governor’s block grant application, OHCA should be well positioned to meet the 90-day deadline to submit the needed documents to CMS.

And, they say, the state should be ready to expand coverage by January. “Given the urgent need for health care in Oklahoma, we look forward to working with our partners to ensure that expansion is implemented as quickly and responsibly as possible.”

While next steps may not be settled, health care advocates and other stakeholders still celebrate that voters in a deep red state put their own health and that of their community over their politics.

“Oklahomans took a big step to improve health across the state by approving the expansion of Medicaid coverage for nearly 200,000 people,” says Jabraan Pasha, Tulsa president of the American Heart Association and associate professor of medicine with OU Physicians.

Pasha added: “I see at least one patient every day who is forced to make tough choices regarding their health due to a lack of insurance coverage. Expanding Medicaid provides a lifeline for Oklahoma families who are slipping through the cracks in our health care system, and it halts the agonizing choice that too many families face when deciding if they can afford critical medical care -- including heart disease treatments and medications…This will also bring billions of our tax dollars home from Washington to benefit our local economies and keep rural hospitals open -- ensuring Oklahomans have access to health care no matter where they live.”

Protect Our Care Executive Director Brad Woodhouse called the vote a rejection of the president’s war on health care. “Voters in this deep red state passed Medicaid expansion, a key aspect of Obamacare, because they want expanded access to health care and are fed up with President Trump’s handling of the coronavirus crisis and his lawsuit that would rip their health care away,” he said.

Jerry Vitti, founder and CEO of Healthcare Financial Inc., which connects Medicaid populations with public benefit programs, said Oklahoma’s move is a plus for the state and speaks volumes about many things - Trump, the national election and the general mood of the country. It also shows that GOP leaders are misreading the electorate and missing the direction they want to go, he said.

Vitti speculated that, prior to COVID-19 and the economic downturn, it is possible the Oklahoma vote might have gone differently.

But now Republicans are worried about their own health, their families, their communities, and even their rural hospitals that are still struggling to survive, Vitti said. A yes vote on the initiative was a vote for health equity, preventable hospitalizations, preventable bankruptcies and a more stable economy, he added. And therefore, he expects to see more states embracing the Medicaid expansion.

So far, five states have put expansion on the ballot, and it’s succeeded every time. Missouri is next - with a vote slated for Aug. 4 - and Vitti predicts that it will pass there as well.

Melody Fields Figueredo says there may be other states in play for 2022, but it is still too early to know. -- Amy Lotven (alotven@iwpnews.com)