Well, I’m certainly glad I voted Tuesday.
Reports that State Question 802 would have an easy time at the polls after Gov. Kevin Stitt inexplicably vetoed the funding mechanism for his own version of Medicaid expansion were, well, exaggerated.
Pushed by an unprecedented number of absentee voters — including me — the measure passed. It rewrites the Oklahoma Constitution to mandate Medicaid expansion to cover income-eligible working-age adults.
It passed by a very narrow margin.
The proposal got 50.48% of the vote, a margin of about 6,500.
But with state questions it doesn’t matter if the margin is one vote or one million, the effect is the same.
After a decade of arguing about it, Medicaid expansion is coming to Oklahoma. We’ll be the 37th state to go that way, one of five to do it by direct action of the voters.
The irony of democracy is that rural counties, which probably stand to gain most from the vote, rejected SQ 802. Seven urban, suburban and collegiate counties gave enough of a margin to carry the day over the state’s 70 least densely populated areas.
One of the most important potential impacts of Medicaid expansion is financial stability for the state’s rural hospitals.
In the past 10 years, 120 rural U.S. hospitals have closed. Eight of them were in Oklahoma. More are teetering. A 2019 court filing by the Oklahoma Hospital Association and other SQ 802 proponents says that 17 rural Oklahoma hospitals are at risk of closing and 54% of the state’s rural hospitals have a negative operating profit margin.
About $1 billion a year in federal Medicaid funding will come to the state, much of it directed to the health care of indigent, rural residents.
Medicaid expansion will begin no later than July 1, 2021, a year from now. It will bring health care to somewhere around 200,000 working-poor Oklahomans and will help alleviate the nation’s second-worst rate of uninsured citizens.
Over the course of a generation, that should result in healthier, more prosperous Oklahomans and a more financially stable health care system.
The measure doesn’t allow for a work requirement. Patients can’t be required to volunteer, go to school or do anything else to qualify. The federal government will pick up 90% of the cost of the newly eligible patients.
A lot of the state’s 10% may come directly from state government cost savings. Some state medical costs will be transferred to Medicaid. Instead of paying 100%, the state will only pay 10%. A lot of the rest of the cost will come from economic growth associated with a $1 billion a year infusion into the state economy. Beyond that, it’s not unreasonable to consider using some of the money now going to the Tobacco Settlement Endowment Trust to pay for Medicaid expansion. State Question 814, which would do that, will go before voters later this year.
Medicaid expansion ends a hidden tax on Oklahomans who have health insurance. Uninsured Oklahomans still get health care, although they typically get it in emergency rooms, the most expensive place for treatment. If they aren’t able to pay hospital bills, the costs are transferred to insured patients, who make up the lost revenue in higher prices and higher insurance premiums.
Oklahoma has wasted a decade on this issue and lost nearly $10 billion that could have been making our people healthier, more productive and happier. We did it for no reason other than an obstinate refusal to be part of “Obamacare.”
We’ve been paying the cost of Medicaid expansion for a long time. It’s about time we started getting some of its benefits.