Oklahoma becomes latest red state to approve Obamacare's Medicaid expansion at the ballot box

Voters in Oklahoma narrowly approved an expansion of Medicaid on Tuesday night, making it the latest conservative-leaning state to approve of the Obamacare provision at the ballot box.

State Question 802 passed with just 50.5 percent, or by 6,488 votes. The measure bypasses the Republican-controlled Legislature and governor’s mansion to enshrine insurance coverage for low-income Oklahomans via the Affordable Care Act (ACA, or Obamacare) in the state’s constitution.

“In the middle of a pandemic, Oklahomans stepped up and delivered lifesaving care for nearly 200,000 of our neighbors, took action to keep our rural hospitals open, and brought our tax dollars home to protect jobs and boost our local economy,” Yes on 802 campaign manager Amber England said in a statement after the victory.

Oklahoma is one of the states dealing with a “Medicaid gap,” the result of Republican state governments’ choosing not to use the ACA’s Medicaid expansion provision. The expansion provides federal funds to help low-income Americans get health care, with the federal government picking up the lion’s share of the cost.

Amber England, who headed the campaign to put Medicaid expansion on the ballot in Oklahoma, speaks before supporters of Yes on 802 Oklahomans Decide Healthcare deliver petitions to the Oklahoma Secretary of State's office, Thursday, Oct. 24, 2019, in Oklahoma City. (AP Photo/Sue Ogrocki)
Amber England, who headed the campaign to put Medicaid expansion on the ballot in Oklahoma, speaks before supporters in Oklahoma City in October. (AP Photo/Sue Ogrocki)

Without the expansion, some residents — specifically those who make too much to qualify for Medicaid but not enough to qualify for subsidies — are left in a difficult position when it comes to obtaining health insurance.

According to the U.S. Census Bureau, as of 2018 Oklahoma had the second highest rate of uninsured residents in the country, behind only Texas. More than half a million people in the state do not have health insurance. But with Question 802 passed at the ballot box, the state must now expand Medicaid by July 1, 2021.

Republican Gov. Kevin Stitt opposed the initiative, saying the state could not afford to cover its 10 percent share of the expansion — the rest of which is covered by the federal government. Projections for the expansion’s cost have risen due to more residents being out of work amid the coronavirus pandemic, which has also resulted in lower revenue projections for the state budget due to the economic slowdown. Stitt’s alternate plan for expansion fizzled earlier this year.

Oklahoma has seen a surge in coronavirus cases in recent weeks. There have been nearly 14,000 cases in the state and at least 387 people have died of the disease.

The organizations opposing the Medicaid expansion used progressive Rep. Alexandria Ocasio-Cortez in their advertising in an attempt to convince Oklahoma voters that the expansion amounted to a government takeover of health care, a campaign the congresswoman noted on Twitter Wednesday.

“How’s that ‘anti-AOC’ advertising going, Oklahoma GOP? Oh, it ended with voters supporting Medicaid expansion? Nice,” she wrote, adding a smiling emoji.

The vote in Oklahoma follows a recent trend of voters in GOP-leaning states passing the Medicaid expansion via ballot initiatives. In 2018, voters in the traditionally red states of Idaho, Nebraska and Utah voted in favor of Medicaid expansion. This was preceded in 2017 by voters approving a similar measure in Maine. Missouri, where voters will choose whether to expand Medicaid on Aug. 4, is up next.

In this Dec. 17, 2019, file photo, Oklahoma Gov. Kevin Stitt gestures during a news conference in Oklahoma City. (AP Photo/Sue Ogrocki, File)
Oklahoma Gov. Kevin Stitt. (AP Photo/Sue Ogrocki, File)

Republican governors and legislators have pushed back against some of the ballot initiatives. Former Republican Gov. Paul LePage of Maine refused to implement his state’s Medicaid expansion, which was supported by Democrat Janet Mills, who won the race to replace LePage’s open seat in 2018. Mills made the expansion one of her first acts in office.

The Trump administration is attempting to overturn Obamacare in the Supreme Court after Congress refused to get rid of it in 2017. Even some conservatives who favor repeal of the ACA — like the Wall Street Journal editorial board — expect the lawsuit to fail when the justices hear it later this year.

If the lawsuit is successful, however, an estimated 15 million who rely on the expansion would lose their insurance, while tens of millions more with preexisting conditions could also be denied coverage.

Jonathan Schleifer is the executive director of the Fairness Project, a nonprofit organization that pushes progressive ballot measures at the state level. He told Yahoo News in 2018 that the attempts to repeal the ACA have increased its popularity, something corroborated in recent polling, including a June Fox News survey that showed record-high support for the program.

“Every attempt to repeal the ACA increasingly clarified two things for Americans: what was at stake for them and their families and just how committed opponents of the ACA were, even if it meant millions losing coverage and personal costs skyrocketing,” said Schleifer.

“It became clear to Americans that they could not count on D.C. nor their statehouses to do the right thing. So they decided to grab a clipboard and take their future into their own hands.”


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