The Long Road To Oklahoma’s Medicaid Expansion Vote

President Barack Obama during a joint session of Congress on September 9, 2009. (screenshot)

Campaign signs are appearing along roadways and advertisements are popping up on screens of all kinds as voters prepare to decide on expanding Medicaid coverage in Oklahoma. The June 30th election for State Question 802 was a long time coming.

To understand why Oklahoma voters are being asked to decide if the state will provide health insurance to more people through the federal Medicaid program, September 9, 2009 is a decent place to start. That’s when President Barack Obama addressed a joint session of Congress to talk about his healthcare plan, the Patient Protection and Affordable Care Act, first derisively and then co-optively known as Obamacare.

“There are now more than 30 million American citizens who cannot get coverage,” Obama said. “In just a two year period, one in every three Americans goes without health insurance at some point. And everyday 14,000 Americans lose their coverage. In other words, it can happen to anyone.”

The Affordable Care Act, or ACA, was signed into law in the spring of 2010. Two years after the provisions of Obamacare were put in place, the Congressional Budget Office reported the number of people without health insurance in the U.S. dropped by half. Part of that drop was due to an expansion of Medicaid, called SoonerCare in Oklahoma.

Oklahoma’s Obamacare Response

Despite the success of Obamacare in insuring more Americans, Oklahoma was a firm, “No,” in taking part in its programs.

Because of opposition in the legislature, it didn’t take long for lawmakers to offer Oklahomans their first chance to express their ACA opinions at the ballot box with State Question 756, an anti-Obamacare provision. Despite the vote overwhelmingly approving the ballot measure, the courts decided that such attempted preemptions of the federal law were unconstitutional.

Gov. Mary Fallin announcing the decision to not expand Medicaid during a November 2012 press conference. (Screenshot)

In that same year, Oklahoma voters put Mary Fallin in the governor’s office.

“The choice has been forced on the people of Oklahoma by the Obama Administration, in spite of the fact that voters have overwhelmingly expressed their opposition to the federal healthcare law through their support of State Question 756,” Fallin said at the time.

In November 2012, Fallin decided Oklahoma can’t afford Obamacare, even though the expansion would be largely funded by the federal government and cut the number of uninsured Oklahomans by half.

A Plan Vetoed By Its Creator

There were other flirtations with expanding Medicaid at the state Capitol but a group of Oklahomans decided to stop waiting on the governor and lawmakers and take the issue directly to the people.

“When I first came out here I thought, ‘nobody is going to sign this. I’m just going to be out here sunburning for an hour,’” Ashton Gores said as she gathered signatures to get SQ 802 on the ballot. “But it’s actually been very receptive and people were very nice.”

Ashton Gores spoke with StateImpact Oklahoma while gathering signatures for Oklahomans Decide Healthcare at Tulsa’s Gathering Place park in 2019. Her experience foreshadowed the avalanche of signatures which put Oklahoma politicians on notice: Medicaid expansion has significant public support.

Gov. Kevin Stitt gives his annual State of the State address on February 3, 2020. (Robby Korth)

With this pressure, Governor Kevin Stitt announced his own version of Medicaid Expansion in January, SoonerCare 2.0, intended to preempt State Question 802.

“If it passed, then we would not be able to take advantage of any of these waivers or different ways to administer healthcare in Oklahoma like the Trump Administration is saying,” Stitt said.

A bill Stitt pushed to increase revenue to pay for his version of the SoonerCare expansion, with a spending cap, premiums and other requirements, made its way through the legislature. It passed. And here is the next surprise: Stitt vetoed his own bill.

And, that is where we are. The legislative session ended with no Medicaid expansion and no way to pay for it.

While State Question 802 looks to be popular with Oklahoma voters, a lot has changed since it was placed on the ballot. The coronavirus pandemic has put thousands of Oklahomans out of work. Oil prices have plummeted. And no one is sure what normal will look like next.