Lawmakers held over two measures Thursday, which would send state questions to voters that could pave the way for changes to Medicaid expansion. Senate President Pro Tem Lonnie Paxton, R-Tuttle, said lawmakers need more time to meet with health care leaders on their provisions.
In 2020, Oklahomans voted to expand Medicaid eligibility to adults aged 19-64 with incomes up to 138% of the federal poverty level. This went into effect the following year. Oklahoma is one of three states that enshrined expansion in its constitution, meaning an amendment is needed to make changes.
House Bill 4440 by House Speaker Kyle Hilbert, R-Bristow, and Paxton could change that. It would add a state question to the Aug. 25 primary runoff ballot, asking voters whether they want to remove Medicaid expansion from the state constitution and add it into statute. If approved, the legislature could amend or repeal expansion.
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 in the November general election, would allow Oklahoma to not cover expansion if federal financial participation drops below 90%. It would not go into effect if the state question from HB 4440 passes.
Republican lawmakers have argued the 2020 vote was a mistake, saying it ties lawmakers’ hands when addressing state spending. Paxton said during a Thursday news conference that receiving a request for a nearly $500 million budgetary increase from the Oklahoma Health Care Authority was “eye-opening.”
“We can't afford that – especially if that happens year, after year, after year,” Paxton said. “We have to be able to manage that system a little bit better. So we're trying to figure out what that means when you talk about managing that.”
Approximately $42.3 million of this ask accounted for Medicaid expansion growth and utilization increases, according to an agency spokesperson. The agency is set to receive only half of its initial request.
Paxton said lawmakers need the ability to help better manage programs like Medicaid, especially as Oklahoma prepares for the impacts of the One Big Beautiful Bill.
He said the legislators he’s spoken with have no intention of repealing Medicaid expansion. But, he said, hospitals and tribes are worried about what future lawmakers might decide.
The votes on HB 4440 to HJR 1067 were held off to continue that discussion with stakeholders, he said.
“I hadn't planned to be at the Capitol tomorrow,” Paxton said. “It sounds like now I will be so we can meet and try to figure out something that both protects the hospitals, and the health care and the tribes from the Medicaid side of it, but also protects the state from these unknown expenses.”
Senate Minority Leader Julia Kirt, D-Oklahoma City, said during a Thursday news conference that democrats were prepared to “defend the people’s will on Medicaid.” Now that both measures have been laid over, she said they don’t know what to expect.
Senate lawmakers reject special election
Kirt criticized Republicans' efforts to get measures like HB 4440 on the Aug. 25 primary runoff ballot. Such elections generally have a lower turnout.
“We have closed primaries, and that's been reaffirmed. So we know that people who are unaffiliated – they don't have a party, they don't want to be part of a party – they're going to feel disengaged in June and August. They're not motivated to go vote,” Kirt said. “November is when everyone's included, so it should be in November.”
Kirt said she believes other lawmakers share her concerns, citing a Thursday vote on House Joint Resolution 1024 by Rep. Anthony Moore, R-Clinton, and Sen. Todd Gollihare, R-Kellyville. The measure would send a state question to voters on reforms to the Judicial Nominating Commission.
Gollihare filed an amendment to the measure to include an Aug. 25 special election for the state question. Lawmakers passed HJR 1024 mostly on party lines, but a second vote to order a special election required the support of 32 legislators.
That effort failed with a bipartisan vote of 27-17. Gollihare said he may move to reconsider that vote in the future, but, for now, it would appear on the November ballot.
Paxton said this outcome and the Senate’s decision to lay over the measures on Medicaid expansion were unrelated. He said he doesn’t know why some lawmakers voted against HJR 1024 appearing on the August ballot.
Both Paxton and Hilbert said they’re trying to avoid “ballot fatigue.”
“It's going to be a very busy ballot, and we don't want to put 10 state questions or upwards of 10 in the same ballot,” Paxton said. “So we're trying to separate those out.”
Kirt said she thinks it is confusing to put two state questions on Medicaid on different ballots.
“If one fails in August, so the voters turn out and turn down that state question, they would turn around and have another related one in November,” Kirt said. “That is rigging the rules epically.”
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