State Question 802 is an effort to expand health care coverage for Oklahoma’s lowest-income residents or an unfunded mandate that will raise havoc with the state budget, depending on your point of view.
Supporters and critics have been making their points in recent weeks about the state question that was created by initiative petition and placed on the June 30 ballot by Gov. Kevin Stitt.
Simply stated, approving the question would amend the Oklahoma Constitution, creating a provision requiring the state to expand Medicaid coverage for people between ages 18 and 65, who are not already covered and whose annual income, as calculated by federal law, is at or below 133 percent of the federal poverty line. The provision would not allow the State Legislature to create additional restrictions that would make it more difficult to qualify for the expanded Medicaid coverage than it is to qualify for the program already in place.
The program would be jointly funded by the federal and state governments. Implementation would be required by July 1, 2021.
State officials estimate an additional 200,000 Oklahomans would qualify for insurance coverage if the proposal is enacted.
Amber England, campaign manager for Yes on 802, said residents are getting an opportunity to vote on the issue because politicians wouldn’t make a decision.
“For almost a decade now we waited for politicians to bring our tax dollars back home from Washington, to deliver health care to those who need it. They didn’t,” England said, adding residents organized their initiative petition effort so they could do it themselves.
England said one of the greatest arguments for the state question boils down to economics: for individuals who will have health coverage while still being able to afford daily necessities; for hospitals that will be able to continue to operate; and for rural communities that will continue to have health care options.
Supporters say the measure will bring back $1 billion to Oklahoma, money that would otherwise be left on the table in Washington, D.C.
England said those funds would have an effect beyond their initial number.
An economic impact study commissioned by hospitals found the impact of that initial investment would be $15 billion in the first five years, creating 27,000 jobs.
England discounts an argument that mandating the expansion would force drastic cuts in the state budget, saying hospitals worked with the Legislature and the governor to craft a plan to pay for the expansion without raising taxes or taking money from core services.
But at its heart, the state question is a way to provide basic health care to residents least able to afford it, people England defines as hardworking Oklahomans working two or three jobs to get by, jobs that may not offer health care.
“These are essential workers, those on the front lines who are dealing with COVID-19, quite frankly,” she said. “They work hard every single day and don’t quite make enough money to get insurance.”
On the broader scale, the initiative will ensure hospitals in rural communities remain open, she said.
“This is critical for rural communities to save rural hospitals,” she said.
Jay Johnson, president of Duncan Regional Hospital, knows that rural situation first-hand. It’s the reason Duncan Regional Hospital stepped up in February 2017 to save Waurika’s hospital, now Jefferson County Hospital and affiliated with Duncan Regional.
Johnson said the choice was taking action or watching as another rural hospital closed its doors.
“Often smaller hospitals don’t have the resources invested that they need to,” he said, explaining that joining forces allowed the smaller hospital to continue to provide health care.
Johnson said the issue is linked to State Question 802 because it is the lack of Medicaid dollars that is forcing rural hospitals to close their doors.
He said when the Affordable Health Care Act (frequently called Obamacare) passed, hospitals were promised that in exchange for surrendering Medicare dollars states would expand Medicaid to help cover uninsured residents seeking hospital services.
That didn’t happen. Johnson said that when the Supreme Court ruled the federal government could not mandate states had to expand Medicaid, some states – including Oklahoma – opted out of expanded Medicaid. As a result, hospitals lost both Medicare and Medicaid dollars.
The effect was dramatic. Johnson said six hospitals have closed since 2016 and another eight have declared bankruptcy. Three have closed their birthing units.
“State Question 802 will reverse that trend,” he said. “Not expanding Medicaid contributed to those hospitals closing.
Opponents of State Question 802 say there are too many unknowns about the proposal and that the State of Oklahoma may be left responsible for a bill it cannot afford if federal dollars don’t come through.
And, they say the proposal is an amendment of the State Constitution, meaning its provisions cannot be amended without another vote of the people.
Americans for Prosperity, a Political Action Committee organized to fight the initiative, said expanding Medicaid would harm the state’s already overburdened budget.
“There is no question that overburdening an already fragile system will lead to cuts of core services we all rely on and trigger tax increases at a time when Oklahomans can least afford additional financial burdens,” said Oklahoma State Director John Tidwell, in a statement released earlier this spring.
Critics said the state question doesn’t address how the state would finance its share of the Medicaid expansion (the federal government would provide 90 percent of the cost). While the provision allows the federal government to dictate that the state must provide medical assistance to adults at or below 138 percent of the federal poverty level, there is no guarantee the federal government would continue to provide the bulk of the funds –- or any funds.
The Oklahoma Council of Public Affairs, which challenged the ballot summary of the measure, said the amendment would allow the federal government to set the federal poverty level, the qualifying factor for eligibility. Oklahoma’s Legislature would “merely be a conduit to finance the federal government’s policy decisions,” the council said in a statement.
Steve Fair, the Oklahoma Fourth District Republican chairman, challenged the state question in a column, arguing the measure equates to deficit spending for the federal government and funding challenges for Oklahoma. Fair estimated the state would have to come up with $150 million to $250 million to match the federal allocation in its first year, and asked where Oklahoma legislators would find the money in a year already facing economic challenges.
Fair also said the proposal amends the State Constitution, meaning the Legislature will have no choice but to pay for the local match.
“Other than unconstitutional ‘creative financing’, our lawmakers will have little to no choice but to raise taxes. That means even more burdens on the people and businesses,” he wrote.