Medicaid expansion ruling puts pressure on Oklahoma’s governor, Legislature

Jun. 24--Within a matter of hours last week, the Oklahoma Supreme Court solidified the state's political landscape by upholding an effort to bring an expansion of health coverage for uninsured and low-income Oklahomans to a statewide vote.

The court's decision puts the question of Medicaid expansion one step closer to going before voters in 2020 and increases pressure on Gov. Kevin Stitt and Republican legislators, who oppose the ballot language, to formulate a Plan B.

Stitt vowed this year to present Oklahomans with an alternative health care plan, one that would improve health outcomes and unlock additional federal health care dollars. He has not offered details of what he wants to see in his "Oklahoma plan."

Oklahoma, which has the second highest rate of uninsured behind Texas, is one of 14 states that has not expanded Medicaid under the Affordable Care Act. Since Medicaid expansion went into effect in 2014, the state has forfeited an estimated $1 billion a year in available federal funds.

Like many conservative lawmakers, Stitt opposes straight Medicaid expansion, which does not include conditions like work requirements or requiring Medicaid participants to pay a small portion of their premiums.

Many Republican lawmakers are taking their cues from Stitt, who has said he will introduce his plan this fall.

If the court's decision to green-light the initiative petition made Stitt nervous, he largely didn't show it.

Stitt spokesman Baylee Lakey said the governor doesn't see a need to change his timeline or call the Legislature into a special session this year to tackle health care. Lawmakers can tackle the issue next year, she said.

"Gov. Stitt is committed to working with stakeholders to develop an Oklahoma plan to improve health outcomes by increasing access to affordable coverage and modernizing health services delivered by the state," Lakey said in a statement. "The governor's timeline hasn't changed, and while it is quick, we will also take the necessary time to ensure it is thorough and has been built with robust feedback from Oklahomans."

Mere days after the high court's ruling, Stitt announced he has hired someone with more than a decade of experience in health care policy to help develop his health care plan.

Carter Kimble, health policy director for the Oklahoma State University/A&M Board of Regents, will serve as Stitt's Deputy Secretary of Health and Mental Health. His hiring is the first public step the governor has taken toward crafting a health care plan for the state.

Sen. Greg McCortney, R-Ada, praised Kimble as the most knowledgeable person in the state on Medicaid expansion and said his hiring indicates forward progress on the issue.

McCortney introduced a health care expansion proposal during the legislative session but it didn't advance.

But as the initiative petition moves forward, McCortney feels pressure for the Legislature to act on the issue sooner rather than later.

"I definitely feel a sense of urgency," he said. "I feel like the more momentum this ballot initiative picks up, the more we're going to paint ourselves into a corner."

McCortney anticipates that lawmakers and the governor's office will form a joint working group to start laying the groundwork for an "Oklahoma plan" that could receive approval from the federal Centers for Medicare and Medicaid Services.

Outside observers also are hopeful the ballot initiative will force Oklahoma's elected officials to act.

Fred Morgan, president and CEO of the State Chamber of Commerce, said the chamber's members are closely watching the initiative petition and hopes the state's elected officials are doing the same. The chamber supports expanding health coverage and pursuing all available funds for health care, Morgan said.

"We believe now is the time state leaders should consider how Oklahoma can responsibly expand coverage to uninsured Oklahomans; this initiative petition is forcing a long overdue conversation about Oklahoma's health care system," he said.

The Greater Oklahoma City Chamber of Commerce also supports expanding health insurance coverage but has no preference on whether it gets done through a ballot question or through the state's elected leaders, said Mark VanLandingham, vice president of government relations and policy at the Greater Oklahoma City Chamber.

"I think it's fair to say that it has their attention," he said. "It will be up to them to decide whether they want to let this move forward under the language in the ballot initiative or whether they want to take action perhaps in a special session to do it in a form that is more suitable to them."

GOP pollster Pat McFerron said Republicans don't want Medicaid expansion on the 2020 general election ballot because polling shows Oklahomans broadly support the measure. If the question is on the general election ballot, it also will become a major talking point through the 2020 election cycle, he said.

Republicans' best chance to defeat proposed State Question 802, which would mandate Medicaid expansion under the Affordable Care Act, is to devise an alternative plan that is tailored to Oklahoma, McFerron said.

"If it becomes an option between full Medicaid expansion and doing nothing, there's a preference for the Medicaid expansion," he said. "If it comes down to the choice between full Medicaid expansion and an Oklahoma plan, voters do prefer an Oklahoma plan."

Rep. Emily Virgin, D-Norman, isn't holding her breath waiting for the Legislature to act.

Oklahoma has a history of voters taking matters into their own hands when the Legislature has punted on issues, the House Minority Leader said, citing state questions for criminal justice reform and to legalize medical marijuana -- both passed.

"This is sort of a trend, I think, that we see the voters are getting tired of waiting on issues like this," she said. "On Medicaid expansion, it's been almost a decade now since we started refusing to accept federal funding and I think, frankly, people are tired of waiting."

The proposed state question would amend Oklahoma's constitution to expand Medicaid to certain low-income adults between the ages of 18 and 65 whose income does not exceed 133 percent of the federal poverty level.

Supporters of Medicaid expansion will have 90 days to collect about 178,000 valid signatures, an effort that will likely start this summer.

Chris Casteel contributed to this story.

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