Oklahoma voters approve Medicaid expansion as coronavirus cases climb


Oklahoma voters on Tuesday narrowly approved a ballot measure to extend Medicaid to tens of thousands of poor adults, making their state the first to expand government-backed health insurance during the pandemic.

The vote, which passed with 50.5 percent support, also throws a wrench in the Trump administration's plan to make Oklahoma the first state to receive its permission to cap Medicaid spending, a longtime goal of conservatives hoping to constrain the safety-net entitlement program.

Oklahoma has become the fifth state where voters defied Republican leaders to expand Medicaid through the ballot. Missouri will hold a similar vote on Medicaid expansion later this summer.

The background: Deep-red Oklahoma had been one of just 14 states that hasn't expanded Medicaid under Obamacare and has the nation's second-highest uninsured rate, behind Texas. But even top Republican officials in Oklahoma recently acknowledged the state would eventually expand Medicaid coverage — it was just a question of how.

Supporters of the ballot measure focused on how Medicaid expansion would increase health care access in Oklahoma and help save the state’s struggling rural hospitals after a run of closures. Opponents contended the program would bankrupt the state, especially during a pandemic that’s whacked Oklahoma’s budget.

Ballot organizers said the coronavirus crisis would help make their case for expanding Medicaid. The average number of new cases in Oklahoma has more than doubled in the past month, and the state reported a record 585 new infections on Tuesday.

The impact: At least 200,000 Oklahoman adults will be newly eligible for Medicaid, but program enrollment may climb even higher as the state's unemployment rate has surged to nearly 13 percent. The ballot measure requires the state to expand Medicaid by July 1, 2021.

Tuesday's vote may also block Republican Gov. Kevin Stitt from advancing his plans to implement a more limited form of the Medicaid expansion. Stitt is the first governor to seek approval for the Trump administration's new plan to convert a portion of federal Medicaid payments from an open-ended entitlement into a defined lump sum, known as a block grant. Republicans believe the financing arrangement will help them control Medicaid spending, but Democrats argue it is illegal and would likely result in benefit and enrollment cuts.

The ballot measure inserts Medicaid expansion into the state’s constitution, which could bar state leaders from making conservative changes to the program, like adding work requirements or premiums. It's an open question whether the ballot measure would preempt a block grant.

What’s next: Oklahoma must submit paperwork to expand Medicaid to the federal government within 90 days. Stitt's administration will likely consider whether to withdraw the block grant plan, which is bound to face legal challenges from Medicaid advocates should it gain the Trump administration's approval.

"I think there is some space for some legal conversations about what our options are," Carter Kimble, a top Oklahoma health official, told POLITICO last week.

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