Oklahoma lawmakers are fast-tracking legislation that would place two proposed state questions on Medicaid expansion and judicial selection on the August primary runoff election ballot. The state’s largest physicians’ organization denounced this measure Tuesday, arguing against a special election where voter turnout is generally lower.
House Bill 4063 by Rep. Trey Caldwell, R-Faxon, and Sen. Chuck Hall, R-Perry, would order an Aug. 25 election on House Bill 4440 and House Joint Resolution 1024, despite Senate Democrats and Freedom Caucus members blocking their special election clauses.
HB 4063 passed out of both chambers’ joint appropriation and budget committees during separate meetings Monday, and it received the necessary two-thirds vote to advance off the House floor Tuesday. House Speaker Kyle Hilbert, R-Bristow, said there are plans to hear it in the Senate later this week.
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.
HB 4440 by Hilbert and Senate President Pro Tem Lonnie Paxton, R-Tuttle, would ask Oklahomans to decide whether to remove Medicaid expansion from the state constitution and add it into statute, where it can be adjusted, if federal financial participation drops below 90%. The current match is 90-10.
HJR 1024 by Rep. Anthony Moore, R-Clinton, and Sen. Todd Gollihare, R-Kellyville, would ask voters to consider reforms to the Judicial Nominating Commission. Both policies are waiting to be considered again in the House.
Republican leadership has said they want to avoid “ballot fatigue” by moving these proposed measures off the November general election ballot. But Democrats argue the November election, where turnout is higher, would be best for considering such measures.
Oklahoma State Medical Association President Dr. Julie Strebel criticized lawmakers’ continued effort to send a question on Medicaid expansion changes to the August ballot. She said bills addressing expansion come at a challenging time in Oklahoma medicine, after INTEGRIS recently confirmed plans to adjust service lines in anticipation of Medicaid and Medicare cuts outlined in the One Big Beautiful Bill.
“The legislature is showing that they don’t trust most of Oklahoma’s voters to decide this issue,” Strebel said. “Healthcare is serious business; people’s lives and careers are on the line right now, and the legislature is trying to game the system so all of Oklahoma loses.”
Rep. Mickey Dollens, D-Oklahoma City, asked Caldwell, who presented HB 4063, if the purpose of setting the election in August is to coincide with the primary runoffs. Caldwell said yes. Dollens then asked if Caldwell agreed there would be more Republican runoffs versus Democratic ones. Caldwell said yes.
Dollens questioned whether setting this vote on Medicaid expansion in August would, therefore, be advantageous to Republicans.
“I think on an issue of this type and kind and with the size of this and how important this is to the state of Oklahoma, I would hope that every single Oklahoman that cares about it, whether they're an Independent, Republican or a Democrat, would come to the polls that day in August, and let their voices be heard,” Caldwell replied. “And then we, this legislative body, will follow that edict.”
Caldwell added that, as an appropriations chair, he is worried about growing Medicaid costs.
Lawmakers have expressed concerns about Medicaid spending after receiving a request for a nearly $500 million budgetary increase from the Oklahoma Health Care Authority. 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.
Rep. Suzanne Schreiber, D-Tulsa, also asked why lawmakers are having to vote on a measure that sends two unrelated questions to voters in August. Caldwell said it is one less joint appropriation and budget committee bill staff had to write.
“I think both of these have passed overwhelmingly off of this floor,” Caldwell said. “There are issues all the time where there are pieces of legislation where we like one piece of it, and then we dislike another piece of the legislation. That's a decision that every individual representative will have to make.”
On Monday, some Democrats questioned whether the legislation could violate the single-subject rule. The provision of the state constitution precludes individual legislation or ballot initiatives from dealing with more than one main issue.
Hilbert argued in committee that this measure’s purpose is related to putting questions on the August ballot.
Constitutional attorney Bob Burke said in an email the single-subject provision exempts general appropriation bills. He said HB 4063 “no doubt contains two different legislative subjects,” but the Supreme Court, to his knowledge, has never answered the questions this current matter presents.
“If a bill is approved by the Joint Appropriations Committee, is that a general appropriation bill? Does the bill appropriate any money from the State Treasury? Or does the bill just set the election dates?” Burke said. “If there is no money appropriated, is it truly an appropriation bill? If not, it would be subject to the single subject rule.”
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