Oklahoma lawmakers passed two measures that would put state questions before voters on Medicaid expansion, which could remove it from the state constitution or allow the Legislature to not fully cover its costs if federal support changes.
On June 30, 2020, voters approved State Question 802 to expand Medicaid eligibility to adults aged 19-64 with incomes up to 138% of the federal poverty level. It went into effect the following year. That makes Oklahoma one of three states that enshrined expansion in its constitution, meaning an amendment is required to make changes.
Oklahoma expansion adults make up about 22% of total Medicaid enrollment, at 222,211 individuals.
House Bill 4440 by House Speaker Kyle Hilbert, R-Bristow, and Senate President Pro Tem Lonnie Paxton, R-Tuttle, would send a vote to Oklahomans, asking them whether they want to repeal four sections of the state constitution related to Medicaid expansion and move them under state statute. These statutes could then be amended or repealed by the Legislature.
If approved, the election would take place on Aug. 25.
Medicaid expansion has been a focus of Gov. Kevin Stitt, who called on the legislature to send a question to voters that would allow for adjustments to Medicaid expansion during his final State of the State address.
His speech came days after the Oklahoma Health Care Authority requested a nearly $500 million budgetary increase for the next fiscal year.
Hilbert argued that putting Medicaid expansion into the state constitution was a mistake, saying it ties lawmakers' hands when addressing spending.
“Now there's only one option to reduce rates, and that's to cut provider rates,” Hilbert said. “And I think we should have more options than that because it is a dynamic process. And putting this in the constitution was a mistake, and it needs to be remedied.”
House Minority Leader Cyndi Munson, D-Oklahoma City, said she worries Oklahomans could lose access to coverage if Medicaid expansion is removed from the constitution. That impact, she said, is felt by all Oklahomans.
“When folks go to emergency rooms, that cost then falls on us. All of us that do have health care, our premiums go up,” Munson said. “The cost has to go somewhere.”
Munson cited the state’s health care system ranking, which sits at nearly the lowest in the nation. She argued this doesn’t have to be the case.
“These rankings are due to our choices, our investments,” Munson said.
“We're only here anyways and having this conversation mostly due to the federal government,” Munson added. “I wish that our delegation would have spoken up a little bit more, fought for Oklahomans a little bit more about the real health care challenges we face. To say, yes, we're grateful for the Rural Health Transformation fund, but really we need consistent investments to our rural communities and rural health care.”
Rep. Michelle McCane, D-Tulsa, asked Hilbert if he considered whether the people wanted lawmakers' hands tied on this issue.
“Well, sure. I mean, if that's the case, then we'll find out when this goes back on the ballot again,” Hilbert said.
The bill passed with a vote of 74-18.
House Joint Resolution 1067 by Rep. Ryan Eaves, R-Atoka, and Sen. Julie Daniels, R-Bartlesville, was also passed by lawmakers. It would put a vote to the people to amend the Oklahoma Constitution, allowing state lawmakers to not cover additional costs to the state if federal financial participation is less than 90% for Medicaid expansion.
The Health Care Authority estimates the total cost of Medicaid expansion for fiscal year 2027 to be $3,649,189,828, and based on the current 90% federal match rate, the state’s 10% share is $364,918,983.
The measure would also be voted on in August. But it would not be enforced if HB 4440 is approved.
The Oklahoma Hospital Association responded to the approval of both measures in a statement, arguing that removing Medicaid expansion from the constitution would open the door to future state legislatures to eliminate health coverage for those who rely on it.
“Public sentiment remains clear,” the statement added. “A recent statewide poll conducted by the Oklahoma Hospital Association found that 68% of respondents want lawmakers to either maintain or expand Medicaid coverage.”
“That support reflects real results: Medicaid expansion is improving the health of hardworking Oklahomans, lowering healthcare costs, and strengthening access to care across our state.”
Both measures now head to the Senate.
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