In 2020, Oklahoma voters passed Medicaid expansion, adding more people to Soonercare. Republican lawmakers are advancing proposed constitutional changes to reverse that vote: House Bill 4440 and House Joint Resolution 1067.
If approved, both state questions would give lawmakers the ability to adjust or reverse Oklahoma's expanded Medicaid eligibility without a majority vote of approval by Oklahomans, with one acting as a failsafe in case the other is unsuccessful during the Aug. 15 primary runoff.
Senate Pro Temp Lonnie Paxton, R-Tuttle, said the current language in Oklahoma's constitution is restrictive to lawmakers – and could negate the coverage of other Medicaid recipients.
"This gives us the flexibility to require something like work requirements for people that are eligible, to try to limit the participation in the program to only those who really need it," Paxton said. "We do know there are some people that just cannot take care of themselves because of mental or physical incapacitation, and that's where we want to help out."
Paxton says the change would allow lawmakers to balance the state budget and better manage Medicaid in light of new federal mandates. Democrats say it's a ploy to reverse the will of the people.
Both measures passed the Senate Rules Committee along party lines on Monday.
Democrats say the process to approve the measures in the Senate feels 'intentionally chaotic.'
Expanded Medicaid eligibility extends government-subsidized health coverage to adults aged 19-64 with incomes up to 138% of the federal poverty level. Today, adults made eligible by the expansion vote account for just over a fifth of all Oklahomans enrolled.
Congress's "One Big Beautiful Bill" requires states to re-verify eligibility for most Medicaid expansion adults every six months instead of annually, and to implement new work requirements.
Republicans are worried about what might happen to their ability to balance future state budgets if they're forced to pay for the new federal requirements.
"We do need to have flexibility in how we spend our money," Paxton said. "And when this went to the Constitution, it really became a very rigid way for us to …the health care expenditures in the state. I think Oklahomans have a kind heart as a whole, and we want to make sure we can take care of those people who have a difficult time taking care of themselves."
Oklahoma's Medicaid expansion rules are enshrined in the state constitution, which means lawmakers can't just make the money-saving changes they want to within the regular legislative process.
They have to ask the voters who voted for expansion in the first place. So, HB 4440, if approved on the Senate floor and signed by the governor, would add a state question to the Aug. 25 primary runoff ballot. Then, Oklahomans could vote to remove Medicaid expansion from the constitution and add it to the state's statutory code, allowing lawmakers to make changes – or completely repeal the provisions – at their own discretion.
HJR 1067 was drafted with different language but would have a similar effect if certain stipulations are met. It proposes a state question asking if voters would be willing to absolve the state from the responsibility to fill in gaps in Medicaid expansion funding if the federal government pays anything less than 90% of the total costs to do so.
If passed by the legislature and signed by the governor, the measure would appear on the November general election ballot. But it would only go to a vote of the people if HB 4440 fails to pass.
Democrats in the Senate Rules Committee said they were caught by surprise when they saw the bills were scheduled for a hearing over the Easter weekend. Republicans had made amendments to them with less than 24 hours to review the changes.
Sen. Carri Hicks, D-Oklahoma City, explained the gripe to reporters.
"The process feels intentionally chaotic, and that is a decision by the majority party to have state employees working over the Easter holiday weekend in order to expedite or rush through these proposals," Hicks said. "Because we anticipate that the ultimate goal is to have all of these for consideration by the full Senate on Wednesday."
The Senate Rules committee usually meets on Wednesday mornings, she said, but these bills are getting special treatment because of the need to meet looming deadlines if HB 4440 is to appear on the August ballot.
Sen. Mary Boren, D-Norman, said the move by Republicans is meant to keep Oklahomans from knowing the measures are moving quickly.
"They have to get it done by mid-April," Boren said. "So that's what we're talking about right now. The only way that they can get this done is to do this fast-track system. It leaves the people in the dark. And that's just unacceptable."
Democrats said that instead of making it easier not to pay for Medicaid expansion, Republicans should tap into the more than $3.5 billion sitting in the state's various savings accounts for now, and then stop giving corporations tax cuts and credits.
"We collect a lot of revenue that we siphon back out into incentives and tax breaks for the wealthy and well-connected for their pet projects that they really love," Boren said. "There are a lot of conservative states that make sure that their people are educated, and they have a doctor."
"Oklahoma's not one of those conservative states."
StateImpact's Jillian Taylor contributed to this report.
