Oklahoma senators passed two measures Tuesday that could pave the way for changes to voter-approved Medicaid expansion, which currently covers health care for 228,000 Oklahomans.
In 2020, Oklahomans voted to expand Medicaid eligibility to adults aged 19-64 with incomes up to 138% of the federal poverty level. Changes 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 and House Joint Resolution 1067 seek to change that, giving lawmakers power to adjust Medicaid expansion as they see fit.
Votes on these measures were delayed after Senate President Pro Tem Lonnie Paxton, R-Tuttle, said lawmakers needed to meet with health care leaders. Paxton said he worked with the Oklahoma Hospital Association over the weekend and spoke with multiple tribal leaders who were against the measures.
What came out of those conversations was a compromise on the language of HB 4440, Paxton said.
“They are not endorsing this language, but they are the ones who helped me write it because it's a fair balance,” Paxton said.
House Bill 4440
HB 4440 by House Speaker Kyle Hilbert, R-Bristow, and Paxton would put a state question before voters to decide whether to remove Medicaid expansion from the state constitution and add it into statute if federal financial participation drops below 90% for Medicaid expansion. The current match is 90-10.
If approved, the legislature could then amend or repeal the expansion. Republican lawmakers have argued the 2020 vote was a mistake, saying it ties lawmakers’ hands when addressing state spending, but Paxton was adamant that the measure will not repeal expansion.
“There is no desire from me or anybody I've talked to in this building to repeal Medicaid expansion,” he said. “Simply, we need the ability to manage the system a little bit better than what we can right now.”
Democratic lawmakers pressed Paxton, asking how many people could lose health care coverage if future legislators change the statutory language.
“You've used the phrase ‘manage the program,’” said Sen. Mark Mann, D-Oklahoma City. “That would be to either cut the reimbursement rate that hospitals and providers receive, cut the amount of benefits provided to Medicaid recipients, or to cut the number of people who qualify for the program.”
The state question would also ask voters to remove the portion of Oklahoma’s constitution saying the expansion population cannot face additional burdens or restrictions to eligibility or enrollment than other Oklahomans on Medicaid. Paxton said the measure would allow lawmakers to “repeal the part of Medicaid expansion” he is “most concerned with.”
“We're not doing anything that hurts our neighbors who need this benefit,” Paxton said. “We just can't afford to have everybody on Medicaid.”
HB 4440 passed the Senate floor, but an emergency clause that would have put the state question on the August ballot failed to get a supermajority vote. Democrats voted against the bill while members of the Senate’s Freedom Caucus abstained.
Some lawmakers expressed concerns that attempting to put the state question before voters in August is a tactic to help it pass during lower-turnout midterm elections.
“It's clear you don't trust the voters if you're putting two measures forward to try to make sure you've covered all your angles,” said Sen. Julia Kirt, D-Oklahoma City. “This is specifically about the legislature making a power grab from voters.”
House Joint Resolution 1067
HJR 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 future legislatures to choose not to fund Medicaid expansion if the federal match rate falls below 90%.
“This would actually repeal the duty on the legislature to provide medical assistance to low-income adults,” Daniels said.
She said the legislature could still decide to fund Medicaid, but unlike HB 4440, it will not be in state statute.
Both measures must be reconsidered by the House.
