Medicaid Expansion May Drive Key Rural Votes In Oklahoma Governor’s Race

Democratic gubernatorial candidate Drew Edmondson says if elected, he will make expanding Medicaid in the Sooner state a top priority. (Jackie Fortier / StateImpact Oklahoma)

On a hot Monday afternoon, Zora Sampson stands behind rows of chairs set up in the lobby of the hospital in Pauls Valley. Sampson supports the Democratic candidate for Governor Drew Edmondson — and turned up to hear his plan to help rural hospitals.

Administrators at Pauls Valley Regional Medical Center say they can barely make payroll. Sampson is scared that if it closes, elderly people would have to drive at least half an hour for care. She credits the hospital with saving her mother’s life.

“She would have never made it without this emergency room because they had to evaluate her allergic reaction and then they ended up sending her to Oklahoma City because it’s more than most places can handle,” she said.

That’s how rural hospitals are supposed to work: Patients are stabilized locally, then sent onto larger hospitals for more specialized care if they need it. But that link in Oklahoma’s healthcare chain may soon be missing.

Zora Sampson fears for elderly residents if Pauls Valley Regional Medical Center closes. She supports Democratic gubernatorial candidate Drew Edmondson’s plan to expand Medicaid to help keep it a float. (Jackie Fortier / StateImpact Oklahoma))

Sampson says locals are helping by organizing bake sales and donations to save the 60-bed hospital. There’s even a GoFundMe page. Sampson is exasperated and doesn’t think residents can do much more.

“It’s hard we’ve been calling on the community to help and donate money, but there’s only so much you can do, it’s just really hard,” she said.

The Pauls Valley situation isn’t unique. About 60 percent of the hospitals in the state serve midsize to rural communities. Of those, the Oklahoma Hospital Association says more than half are at risk of closing.

What is Medicaid expansion?

“One of my priorities, if I’m your next governor, is to opt in to the Medicaid expansion,” Edmondson told the crowd of mostly retirees and supporters at the Pauls Valley hospital.

Medicaid, known as Soonercare in Oklahoma, uses state and federal dollars to provide some low-income Oklahomans with health care. States decide if they want to expand Medicaid under the Affordable Care Act — meaning many low-income adults making less than $12,000 a year would then qualify for subsidized care.

Edmondson says expanding Medicaid in Oklahoma will help rural hospitals by increasing the number of people with health insurance.

“Part of it is a product of funding, so to get the reimbursement rate up, you gotta get the funding up, and that’s what I’m working on,” Edmondson said. “It may not solve the problem on the monetary side, but it would help.”

Gov. Mary Fallin in 2012 declined to expand Medicaid under the Affordable Care Act.

At that time, the federal government would have covered the cost completely. Five years later, Oklahoma has the second highest uninsured rate in the nation, at 14.2 percent. Expanding Medicaid could add health care coverage for up to 270,000 people, but now the federal government will only cover 93 percent of the cost, or about $1 billion.

Oklahoma would have to contribute $100 million. That’s a problem for Kevin Stitt, the Republican nominee for Governor. He says fewer Oklahomans should be on Medicaid, not more.

“We’ve got to also audit our rolls. We’ve got to get those folks that should not be on our system off our system,” he told Oklahoma Engaged.

But some Republicans on a local level aren’t so sure.

Sherrie Conley, who is running for the state House of Representatives in District 20, which includes Pauls Valley, said she only recently became aware of the situation with the hospital and doesn’t know if she’d support a Medicaid expansion or not.

“I have not done any research into the effect that Medicaid has had, I’m sure that my opponent has done lots of reading and research because he lives in Pauls Valley and is directly affected,” she said.

Steve Jarmin is the Democratic candidate running for the state House of Representatives in District 20, where Pauls Valley is located. He thinks expanding Medicaid is the only way to keep the local hospital open. (Jackie Fortier / StateImpact Oklahoma)

Her Democratic opponent Steve Jarmin is staunchly in favor of expanding Medicaid and was at the hospital to hear Edmondson speak. If elected to the state House, Jarmin said he would support Edmondson as governor.

“I agree with him, if he doesn’t want anyone in the House or the Senate getting in his way, I’m going to be behind him, I’m not going to be in his way because it has to happen, we have to have it [Medicaid expansion] to keep this hospital open,” Jarmin said.

Rural voters want a plan for local hospitals

Recent polls suggest Stitt has a small lead in a tight race for governor. One poll from Cole Hargrave Snodgrass and Associates conducted from Sept. 25-29 shows Stitt leading by 6 points, while one by SoonerPoll conducted in early September gave Stitt a two-point lead.

Rural areas are likely key to either candidates’ victory, but it won’t be easy: Oklahoma’s rural voters don’t reliably support expanding government programs like Medicaid, even if many are worried about their future access to healthcare.

Sampson liked Edmondson’s plan to expand Medicaid and said she’d vote for him, but she’d like to see Stitt visit the hospital as well.

“People say they want to run the state like a business. You can’t do that. We have to care about each other,” she said. “We’re poor people around here, but we’re still people.”

Following an afternoon of applause from supporters and a warm response to his Medicaid expansion, Edmondson left for a campaign stop in Oklahoma City — his black sedan passing by a Stitt lawn sign on his way to Interstate 35.