Oklahomans to Vote on Medicaid Expansion
By Shawn Crawford
Update: Please note that as you read, after vetoing his own bill for SoonerCare 2.0, Governor Stitt announced he will not be pursuing expanded Medicaid coverage for Oklahoma. This means State Question 802 is now the only option for Medicaid expansion in the state, rendering portions of this article no longer relevant.
Oklahomans will have the opportunity to vote for State Question 802 on June 30. The question would amend the Oklahoma constitution to allow for an expansion of Medicaid coverage for uninsured Oklahomans below 138% of the Federal Poverty Level. Currently that translates into individuals making less than $17,236 or a family of four making less than $35,535.
How We Got Here
Expanding Medicaid coverage formed part of the strategy for insuring all Americans under the Affordable Care Act. States would expand their Medicaid participation under the above guidelines with the federal government paying nearly all the costs (Currently 90% with states contributing 10%). In NFIB vs Sebelius, the Supreme Court ruled the federal government could not make Medicaid expansion mandatory for states. Currently 36 states have expanded Medicaid coverage. Oklahoma has never taken advantage of the program.
After the state legislature declined to opt in for expanded coverage or to reform the current Medicaid program, SoonerCare, over 300,000 Oklahomans signed a petition to create State Question 802, the most signatures for any state question ever gathered in Oklahoma.
What Are the Benefits of 802?
If 802 passes, approximately 200,000 Oklahomans will be eligible for coverage. This number will likely be much higher as estimates were formulated before the spike in unemployment from COVID-19.
Supporters also argue that expanded Medicaid will help rural healthcare and hospitals that can now receive payment for services rather than incurring costs when uninsured patients show up for treatment in emergency rooms.
What Is the Relationship to 802 and SoonerCare 2.0?
In an effort to increase health coverage without fully expanding Medicaid, Governor Kevin Stitt petitioned for a waiver to receive federal money to expand SoonerCare with restrictions on who is eligible. This federal program is now known as the Healthy Adult Opportunity waiver and allows the state to add eligibility requirements including employment, health outcomes, education enrollment, and participation in certain community programs.
SoonerCare 2.0 will also be allowed to charge premiums and co-pays. Right now the Oklahoma Health Care Authority says those premiums will average $5 to $15 a month with 5% co-pays up to a limit that has yet to be specified. If the waiver becomes permanent after two years, the state will have the ability to raise premiums and requirements without federal approval.
In a new twist to the story, the Oklahoma legislature passed a bill to fund SoonCare 2.0 at the request of Gov. Stitt to begin SoonerCare 2.0 on July 1 of this year. However, on May 21 the Governor vetoed the bill, using the logic that since more people will need Medicaid because of the COVID crisis, the state shouldn’t expand Medicaid. He stated in his veto comments, “Due to the current COVID-19 pandemic and uncertainty within the energy markets and commodity prices, unemployment rates are expected to be as high as 14%. This will not only increase the number of individuals currently enrolled in Medicaid, but will also increase the number of potential enrollees in the expanded population.”
SoonerCare 2.0 will not be implemented as planned since there is no funding. The legislature could choose to do so at a later date.
What Happens to SoonerCare 2.0 if 802 Passes?
The language of 802 states: “No greater or additional burdens or restrictions on eligibility or enrollment shall be imposed on persons eligible for medical assistance pursuant to this Article than on any other population eligible for medical assistance under Oklahoma’s Medicaid program.” This means the provisions of SoonerCare 2.0 would be rendered unconstitutional after the passage of 802.
Does the Funding Differ for Either Option?
Contrary to what both sides claim, the funding for both 802 and SoonerCare 2.0 has the federal government covering 90% of costs and the state 10%. Supporters of 802 claim that SoonerCare 2.0 is actually a block grant, meaning the state could spend the money on costs other than coverage, and supporters of SoonerCare 2.0 claim that should the federal government change the amount of monies provided, the state would be liable for the increase. Neither argument changes the fundamental issue of the 90%/10% split in costs currently in place.
If 802 passes, the legislature will have until July 1, 2021 to fund the state’s 10% obligation to the program. This will be a constitutional mandate under the language of 802.
Whether you support 802 or SoonerCare 2.0, the most important decision is to go to the polls on June 30th and let your vote express your wishes for healthcare coverage in Oklahoma.