State Question 802: Voters Decide Medicaid Expansion

States that have accepted and rejected expansion, by Kurykh (Wikimedia Commons), edited by Bailey Walker, licensed CC3.0

Story by Bailey Walker - Previous staff member

   SQ 802’s petition signatures were submitted Oct. 24 in aims to bring Medicaid expansion to Oklahoma in a vote scheduled for Nov. 3, 2020. 
   Medicaid expansion began in 2014 under the Affordable Care Act, and Oklahoma is one of 14 states that has refused the measure. An expansion would allow people ages 18 to 65, making under 133% of the poverty line (around 16,600), to be Medicaid-eligible in a population of about 200,000 in Oklahoma according to the OK Policy Institute. The federal government would foot 90% of Medicaid costs, leaving 10% for the state to cover itself. Depending on the number of people in a given household, that income level can vary from $12,490 for an individual to $43,430 for eight people. Above that add an extra $4,420 per person.
Supporters 
   Many major medical organizations in the state came out in support of the measure, citing various benefits it could bring to average Oklahomans. A statement from the Oklahoma Hospital Association said, “Medicaid expansion will make families healthier and our economy stronger. In addition to providing health care to nearly 200,000 hardworking Oklahomans, it will create thousands of new jobs, keep rural hospitals open, and boost our economy.” 
   The Oklahoma Osteopathic Association said, “In addition to Oklahoma’s health being ranked 47th in the United States, our state also has the second highest uninsured rate. We must seek out every opportunity to improve the health of Oklahomans, and providing access to insurance has been shown to improve healthcare outcomes.” Other notable medical groups in support of the measure include the Oklahoma State Medical Association, Saint Francis Health System and the Oklahoma Nurses Association. 
   House Rep. Melissa Provenzano wrote “For every dollar Oklahoma spends on Medicaid expansion, the Federal government will match that with 9 dollars. If you were running a business, wouldn’t you take that deal? Expanding Medicaid will provide the funding to bring critical health care jobs to our state, help keep our rural hospitals open and improve the overall health and well-being of our workforce, leading to greater productivity, less time off work and a positive economic impact for our state.” This one to nine ratio is cited by other supporters in the legislature including House Rep. Colin Walke and Jacob Rosecrants. 
   It is possible that, although these organizations and data do support the fact that more people will be insured and have better health outcomes, professionals and organizations working in this field have a financial incentive in seeing more insured people and more money invested into their services.
Opposition 
   There have been groups such as the American Legislative Exchange Council that publish reports claiming Medicaid expansion has actually increased prices for those who use private insurance. The argument is: as more people use the cheaper government program, insurance companies and hospitals will shift extra cost to private plan holders. Conservative organizations point to this as a reason to cut the whole program; Medicaid causes prices to be low for those who use it, and high for those who do not. 
   Progressives like Bernie Sanders and Alexandria Ocasio-Cortez point to this as a reason to expand a government system fully, like Medicare for All, to eliminate private insurance all together and spread those low costs, similar to the UK’s National Health System which is entirely free at the point of use. 
   There’s only been one major organization to make a move against SQ 802, The Oklahoma Council of Public Affairs- a conservative think tank. In June the group made a legal challenge against SQ 802 calling its ballot summary misleading. The group also called it unconstitutional as Medicaid expansion would be written into the Oklahoma constitution. And though 90% of funding is supposed to be from the federal government, the federal government may defund the program leaving Oklahoma to fill the gap. The challenge was denied by the Oklahoma Supreme Court on June 18 this year. 
   Representative Jim Olsen published an article on the matter on Aug. 19, 2019, claiming Medicaid expansion is “too good to be true.” He explained his reasoning as distrust in the federal government to continue funding the program. He also cites Health Affairs and the New England Journal of Medicine that said the majority of doctors (69%) accept Medicaid and Medicaid recipients were six times more likely to be turned down. These are people who otherwise would not have been able to see a doctor, though Olsen omits that fact. Olsen thinks healthcare should be a “free market” so that one can shop around for cancer treatment or immediate medical emergencies. Olsen also claims that prices increase under Medicaid expansion, which isn’t supported by the vast majority of available data.
What Does the Data Say? 
   One of the largest meta-analyses available is from the Kaiser Family Foundation which incorporated 324 studies between Jan. 2014 and June 2019. The three main takeaways from the study were: first, that coverage of uninsured and low-income people increased, second, access to care, health outcomes, and financial stability among low-income people largely improved, and third, economic effects of budget saving, economic growth and employment gains were largely positive. 
   Medicaid expansion would disproportionately benefit rural areas, which in 2010 held about 40% of Oklahoma’s population according to census data. Something pointed out by Jane Nelson, CEO of the Oklahoma Nurses Association, is that Medicaid expansion would bring money back into the state, “The Oklahoma Nurses Association supports returning Oklahomans’ own hard-earned federal tax dollars back to our state to provide health coverage for low-income working Oklahomans, to reduce the uninsured rate, to ease the costly burden of healthcare, and to protect the health care infrastructure and the well-being of all Oklahomans,” she said. 
   Between insurance providers, hospital administration, government services and political obfuscation healthcare policy is incredibly complicated. If SQ 802 passes, like most policies, it is going to require monitoring and backup plans in case federal funding falls through. The benefits are clear and proven, and the drawback of federal funding is a real concern. Whether an emergency funding plan is cooked up or not is up to policy makers, while Medicaid expansion is up to the voters.