Medicaid Expansion Ballot Initiative is Not the Best Option
A ballot initiative to expand Medicaid in Oklahoma was filed on April 19. If the groups--some from which are from out-of-state--behind the measure gather the requisite signatures and complete the required filings, you will see SQ802 on the ballot in 2020 The filing of SQ802 did not catch Senator Greg McCortney (R - Ada) or me off guard. We had substantiated information this would happen and it did.
Our Republican-controlled government failed to repeal the Affordable Care Act (ACA) in Washington in July of 2017. Since then, unfortunately, Democrats have taken control of the House. There seems to be little chance of repeal, which means the ACA is here to stay; it is not going away. Sure, there are court cases challenging the ACA, but the likelihood of the courts overturning it in its totality is low. A court decision to overturn the ACA would result in chaos because 20 million Americans would lose health coverage and hospitals across the country would be in jeopardy.
37 states have expanded Medicaid in some fashion. Expansion was passed in 2018 in Nebraska, Idaho and Utah. All three of those states voted for President Trump AND Medicaid Expansion on the same ballot. This outcome seems extraordinary to some. However, polling from last summer suggests this ballot measure will pass here, as well. With ballot success in the three red states just mentioned, polling numbers, and the inability or unwillingness of Republicans to repeal the ACA, we knew Oklahoma would be a probable state for the same type of ballot initiative.
SQ802 will add a new Article to our state’s Constitution expanding Oklahoma’s Medicaid program with a full, Obamacare State Plan. This is problematic. First, once Medicaid Expansion is placed in the Constitution it will remain there; it will be very difficult to remove or amend should the Federal government decrease funding, add new mandates, or require broader coverage. Second, a State Plan is a one-size-fits-all, inflexible approach to healthcare; it does not take into account Oklahoma’s needs and unique healthcare environment. Third, a State Plan is nearly impossible to amend at the federal level in the future.
Oklahomans are better served by Medicaid waivers. Medicaid Waivers allow the federal government to waive rules that usually apply to a Medicaid State Plan. Waivers allow states to be creative and innovative, reduce costs, require health outcomes, accomplish goals, and improve health for specific populations.
Waivers are preferred by President Trump, and this preference has paved the way for enterprising states to take advantage of them and tailor their plans to their populations. We can and should do the same. Waivers are a more nimble approach. They allow us to amend our plan should the federal government decrease funding or increase mandates or requirements. Waivers also allow the legislature to change course if health outcomes are not met or the price tag gets too high. We can do none of these things if SQ802 passes at the ballot box and we are forced into a State Plan.
Oklahoma ranks far below top 10 states in healthcare access and outcomes. Frankly and sadly, Oklahoma ranks in the bottom 5 states. We must do better. Improving access to healthcare will mean more covered working Oklahomans, less uncompensated care at our rural hospitals and fewer rural hospital closures.
I have traveled to Washington, DC to research and learn more about this issue. I have spoken with many health experts, legislators from other states, business leaders and economists. This is why I have been working with like-minded Senator McCortney (R- Ada) for over a year on our Oklahoma Plan to help working Oklahomans who cannot afford health insurance and do it in a fiscally responsible way. In our opinion, not having an alternative plan for SQ802 is irresponsible, foolish and sets Oklahoma up for problems in the future.
Increasing access to health care for hard-working Oklahomans is good for our district, our hospitals, our health clinics and our state. Being a business person like Governor Stitt, I see the 900% return available to us on the tax dollars we pay to the federal government and I want to bring those dollars back to Oklahoma. Would you turn down a 900% return on your money? Oklahoma has been turning that rate of return down for years. The best part is we can leverage Medicaid waivers without raising taxes and receive the 9 to 1 federal match. We have been subsidizing other states' Medicaid plans for years. It is past time for us to use our own tax dollars to subsidize healthcare for our fellow Oklahomans. Our Oklahoma Plan will bring those taxes back to us instead of sending them to states like California for Nancy Pelosi to distribute.