Oklahoma representatives shucked a Senate resolution and replaced it with language that would send Medicaid expansion back to voters during a Thursday meeting.
House Speaker Kyle Hilbert said it was the only way to get a sought-after state question on the ballot before they adjourn sine die, after the Senate abruptly gaveled in and out for the week on Wednesday.
How has the effort to address Medicaid expansion evolved?
It’s the latest installment in Republicans’ efforts to gain control over state Medicaid spending on adults making up to 138% of the poverty level, or $22,025. In 2020, voters narrowly approved State Question 802 to expand eligibility to that population. Now, Medicaid expansion covers 233,530 low-income Oklahomans.
Their eligibility cannot be adjusted because the ballot initiative enshrined Medicaid expansion in Oklahoma’s constitution. Oklahoma is one of three states where advocates sought to prevent lawmakers from rolling back the measure. Changes would require an additional vote of the people.
Republicans have argued the 2020 vote was a mistake, saying it ties lawmakers' hands in addressing spending. Gov. Kevin Stitt demanded changes to Medicaid expansion in his final State of the State address, and lawmakers responded with two proposed state questions: House Bill 4440 and House Joint Resolution 1067.
HB 4440 would have asked voters to decide whether to remove Medicaid expansion from the constitution and add it into statute, where it can be amended or repealed by lawmakers, if federal financial participation drops below 90%. HJR 1067 also relied on a lower federal match, but it would have allowed lawmakers to choose not to cover expansion.
Currently, the federal government covers 90% of the costs of Medicaid expansion. States fill in the remaining 10%.
The plan was to send HB 4440 to voters during the August primary runoff election and HJR 1067 during the November general election. But Senate Democrats and Freedom Caucus members blocked efforts to put HB 4440 on the August ballot.
On Tuesday, the concepts of both measures were combined into HJR 1067 by Rep. Ryan Eaves, R-Atoka, and Sen. Julie Daniels, R-Bartlesville, to avoid sending two state questions to voters in November. The language garnered the necessary signatures to advance out of conference by the House Rules Committee.
The Senate only met for around seven minutes on Wednesday. In that time, Senate Pro Tem Lonnie Paxton, R-Tuttle, said he didn’t see enough senators to constitute a quorum. Reporting from NonDoc found at least 34 senators were present in the Capitol within an hour of the adjournment – more than enough to meet the 25 needed for a quorum.
Hilbert said during a Thursday press conference, representatives were “perplexed” when they did not have enough Senate signatures to get HJR 1067 out of conference. The House met until 11:09 p.m. on Wednesday, considering more than 100 bills and resolutions.
“With that, we had to do the only option that was available to us, and, thankfully, we had two SJRs related to the Health Care Authority,” Hilbert said.
What does the proposed state question on expansion say now?
Senate Joint Resolution 50 by Sen. Micheal Bergstrom, R-Adair, originally covered proposed permanent rules filed by the Oklahoma Health Care Authority. Those rules were moved into Senate Joint Resolution 52 by former House author Gerrid Kendrix, R-Altus.
Now, SJR 50 carries the HJR 1067 House conference committee report language.
It would ask November voters to decide whether to remove Medicaid expansion from the state constitution and place it into statute, where it can be amended or repealed, if the 90% federal match is modified. If approved, it would also outright remove the portion of Oklahoma's constitution saying the Medicaid expansion population cannot face additional restrictions on eligibility than other enrollees.
New language included in the measure would also create protections for Indigenous Oklahomans.
The federal government’s share of Medicaid expenditures is 100% for Medicaid-eligible American Indians and Alaskan Natives when Indian Health Service and tribal facilities provide the care.
The population has benefited from Medicaid expansion through a reduced uninsured rate, which also generated revenue to support health and specialty care. Several tribal leaders have come out in support of Medicaid expansion, including the Inter-Tribal Council of the Five Civilized Tribes.
Under SJR 50, Oklahomans would continue to qualify when the federal match for their care is 100%. This amendment followed conversations with tribal partners, Hilbert said.
Hilbert argued this language aligns with requirements under the One Big Beautiful Bill. President Donald Trump’s massive spending measure extended 80 hours per month work requirements to those under Medicaid expansion, but provided several mandatory exceptions, including Indigenous groups.
“Ultimately, if someone’s coverage is reimbursed 100% by the federal government, from a state fiscal policy perspective, everyone who's on that program getting 100% reimbursed means care that's being provided in the state of Oklahoma, for providers in the state of Oklahoma, people who have families and work in our communities in the state of Oklahoma,” Hilbert said “And that's good for Oklahomans.”
Several Democrats debated against SJR 50 on the House floor, including Rep. Meloyde Blancett, D-Tulsa. She said Oklahoma lawmakers aren’t living up to their responsibility to manage a voter mandate.
“I would suggest, while recognizing that we do have a fiscal challenge, we take this and send it back, and we look at what other ways we might be able to do from a proper management perspective and do a better job of managing those expenses and not just throw it right back to the people,” Blancett said.
Eaves argued the measure offers flexibility to future legislatures.
“The revised language gives the legislature discretion to decide whether to continue or discontinue expansion coverage,” Eaves said. “This is a piece of legislation designed to protect Oklahomans in their most vulnerable time. Fiscally, if we're not responsible enough to be able to address some of these problems, people will suffer. Nobody in this body wants that.”
The measure passed with a vote of 69-18. Rep. Nick Archer, R-Elk City, was the only Republican who voted against it. It now returns to the Senate.
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