In 2020, Aisha Patterson had just given birth and was breastfeeding when she felt a lump in her breast. At the time, she thought it was just a clogged milk duct and “no big deal.”
The small business owner with four children and no health insurance waited to get things checked out. She didn’t want to spend money just to be told it was nothing. But as six months passed and more lumps appeared, she decided to go to the doctor.
There, at 30 years old, Patterson was diagnosed with stage two triple-positive breast cancer. In two months, the money she hoped to save by avoiding the doctor turned into around $20,000 in medical debt.
“It was devastating,” Patterson said. “It was like, this is going to take us a very long time to recover.”
But in January 2021, Patterson enrolled in Oklahoma Medicaid, also known as SoonerCare. It covered her chemotherapy, a double mastectomy with reconstruction, radiation and immunotherapy. She said it helped her focus on staying alive instead of bills.
Now she’s worried other Oklahomans won’t be afforded that same support.
On Monday, two measures that would clear a path for adjusting or reversing Medicaid expansion made it one step closer to the governor’s desk. The American Cancer Society Cancer Action Network warns these bills could threaten access to preventive care and screenings in a state with the fourth-highest cancer mortality rate in the country.
‘It's too important’
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.
Republican lawmakers have argued this vote was a mistake, saying it ties lawmakers’ hands when addressing state spending.
“Currently, Medicaid budgets are increasing dramatically and, ultimately, there are only two mechanisms with which to decrease the expenditures of Medicaid,” said House Speaker Kyle Hilbert on the floor in late March. “One is to reduce who qualifies for Medicaid expansion and what benefits they get. The other is the provider rates, and unfortunately, due to Medicaid expansion being in our state constitution, we have only one lever available to us.”
The Oklahoma Health Care Authority requested a nearly $500 million budgetary increase for the next fiscal year. Approximately $42.3 million of this ask accounted for Medicaid expansion growth and utilization increases, according to an agency spokesperson. Based on the budget agreement announced last week, the agency is only set to receive about half of its initial request.
House Bill 4440 by Hilbert and Senate President Pro Tem Lonnie Paxton, R-Tuttle, would add a state question to the Aug. 25 primary runoff ballot, asking Oklahomans whether they want to remove Medicaid expansion from the state constitution and add it into statute. If voters approve this measure, Medicaid expansion could be amended or repealed by the legislature.
House Joint Resolution 1067 by Rep. Ryan Eaves, R-Atoka, and Sen. Julie Daniels, R-Bartlesville, would create an additional state question that, if approved, would allow Oklahoma to not cover low-income adults under Medicaid if federal financial participation drops below 90% for Medicaid expansion. It would not go into effect if the state question from HB 4440 passes.
Oklahoma and Arkansas Government Relations Director for the American Cancer Society Cancer Action Network, Matt Glanville, said the organization worked on the campaign to bring expansion to Oklahoma. He said it was approved as a constitutional amendment to prevent the legislature from undermining it and provide long-term stability to the nearly 228,000 Oklahomans who now rely on it for health coverage.
Glanville said Medicaid expansion has been crucial for detecting and treating cancers.
“It's too important for lawmakers to be looking here for budget flexibility,” Glanville said.
“We believe that the legislature has the ability to fund the core functions of state government without limiting access to Medicaid. There are options for that – and certainly the rainy day fund is something that they could look at.”
Patterson, who survived breast cancer, said she is grateful to share her story so other Oklahomans can understand the importance of Medicaid coverage.
“I wish I would have known that early detection can save your life, because then once I found the first lump, I would've gone a lot sooner,” Patterson said. “Medicaid expansion gives us that ability to find something [and] get it taken care of as soon as possible.”
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