Medicaid Matters Rally

A woman takes part in a Medicaid Matters rally at the state Capitol in Oklahoma City last year. JIM BECKEL/The Oklahoman file

State Question 814 won’t be on the Aug. 25 ballot, and that’s good news.

It probably will be on the November ballot, which is also good news.

But it’s still up in the air, and that is the bad news.

SQ 814 is the logical answer to the how-will-we-pay-for-it question concerning Medicaid expansion. If voters approve it, the state’s Medicaid programs would have a dedicated source of future funding that doesn’t involve a penny in new taxes.

Remember, economic growth and costs savings associated with Medicaid expansion should add up to more than the state’s costs for the move, which is good news.

But — bad news — the Medicaid expansion windfall is indirect and only develops after the program begins. With SQ 814, there would be little doubt of how Oklahoma would find future Medicaid money in directly countable cash from the beginning. So, good. Right?

Bad news: There’s a lot of background involved in unwinding this complicated story. My apologies.

In 1998, Oklahoma was one of 46 states to settle a massive lawsuit with big tobacco companies. Under the settlement, the tobacco companies agreed to send at least $206 billion to the states over the first 25 years of the agreement. That was rocking good news.

In 2000, nearly 69% of Oklahoma voters approved State Question 692, a constitutional amendment that created the Oklahoma Tobacco Settlement Trust and provided that most of the settlement money would go there. Good!

Initially, half of Oklahoma’s share of the tobacco money went to the trust and the rest went to the Legislature to be spent on any legal purpose. Under SQ 692, the endowment has gotten 75% of the money since 2007.

So far, the trust has accumulated more than $1.3 billion. (Good.) Its citizen-led board allocated about $49.3 million of the trust’s earnings in fiscal year 2019 with the biggest chunks going to tobacco prevention programs, research and programs aimed at obesity prevention, physical activity and nutrition. (Good, good, good.)

While some other states spent through their tobacco settlement money, Oklahoma has saved most of its money and applied the earnings to improving the health of its citizens. The fund has some impressive evidence that its programs are effective. (All good.)

But Medicaid expansion could change the SQ 692 arrangement.

Last month, voters approved State Question 802, which requires the state to expand Medicaid to cover eligible working-age adults who live in poverty by next July 1. That was definitely good news for thousands of uninsured Oklahomans.

In anticipation of that, the Oklahoma Senate gave final legislative approval to Senate Joint Resolution 27, which created SQ 814. The proposal would flip the way the tobacco money is split: 25% to the endowment, 75% to a special fund dedicated to Medicaid costs.

So far, so good.

But Gov. Kevin Stitt — who has an on-again, off-again relationship with Medicaid expansion — hasn’t scheduled SQ 814 for a vote yet. Bad.

A lot of the delay had to do with the bureaucratic process of getting the issue ready for voter consideration. You can’t blame the governor for that.

At one time, it looked like Stitt would have the option for putting it on the August runoff election, but the deadline has passed for that ballot. Because the August election will have a much smaller turnout than the November presidential vote, that’s good news.

Baylee Lakey, a spokeswoman for Stitt, told me Friday that all the bureaucratic processes have all been completed and Stitt expects to decide when to put it before voters “in the coming weeks.” Good news there, but why keep us waiting, Gov. Stitt?

Lakey said the measure has to go before voters in a statewide election this year and there’s only one more of those scheduled right now — the November general election. So, unless something very strange happens, that’s when we’ll get to decide how we want to fund the Medicaid expansion we have already approved.

It boils down to this: We’re probably going to get to consider SQ 814 on the November ballot. It’s a good idea and there’s no better time to vote on it. All of which, it turns out, is very good news.


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Editorial Pages Editor

Wayne is the editorial pages editor of the Tulsa World and a political columnist. A fourth-generation Oklahoman, he previously served as the World’s city editor for 13 years and as a reporter at the state Capitol of four years. Phone: 918-581-8308