OKLAHOMA CITY — Facing a winner-take-all showdown, Gov. Kevin Stitt will pit his untested Medicaid expansion plans against a citizen-led state question swiftly gaining support across large swaths of Oklahoma.

In the end, observers note there will be a sole survivor. The onus will be on Oklahoma voters to determine whether they want to embrace a traditional Medicaid expansion plan or reject the citizen-led ballot measure in favor of Stitt’s new proposal.

“It would be disastrous to our state if it (the state question) passed,” Stitt said Thursday. “If it passed we would not be able to take advantage of any of these waivers. I’m afraid there’s going to be huge cuts in state agencies if that thing passes because the ballot initiative doesn’t talk about how to pay for it or anything.”

Stitt unveiled his long-awaited Medicaid expansion plans — SoonerCare 2.0 — during a press conference Thursday morning with members of President Donald Trump’s administration in Washington D.C. He was the lone governor who announced plans to participate. Stitt said the administration’s Healthy Adult Opportunity initiative would give the Oklahoma unprecedented flexibility to innovate and develop Medicaid plans for adults.

Stitt’s proposal involves charging Medicaid participants “modest premiums” and establishing work requirements by using a controversial block grant plan.

Under both Stitt’s plan and the ballot measure, the state would be eligible for more than $1 billion in federal Medicaid expansion funds. The state would be responsible for paying roughly $150 million.

Stitt proposes paying for his program by using cost savings from the Department of Corrections and the Department of Mental Health and Substance Abuse; leveraging a hospital payment program fee; and asking voters to reform that state’s constitutionally protected Tobacco Settlement Endowment Trust.

“We’ve been studying the best practices in all 50 states; and we’ve learned a lot about what is working and what isn’t,” Stitt said. “And one thing we know without a doubt is that there is not a one-size-fits-all approach to delivering better health care and better outcomes. Every state has their unique challenges, their unique climates and their own cultures.”

Back home, though, critics questioned why Stitt would embrace such a controversial plan that’s likely to face years of legal challenges, ultimately delaying health care for hundreds of thousands of Oklahomans.

“It’s irresponsible to put something in place that’s bound to be tied up in litigation for several years and will just further delay health care,” said House Minority Leader Emily Virgin, D-Norman.

Virgin said there are a lot of negatives under block grants for people who need treatment, particularly in rural parts of Oklahoma.

“Block grants just serve to cut off people from the services that they need because it’s a capped spending amount,” she said. “We, of course, should be looking at how much we spend each year and try to keep that under control, but ultimately we want people to get the care that they need so that they can be healthier in the long run and our costs can go down in the long run.”

Virgin said Stitt’s plan is “too little, too late.”

More than 300,000 Oklahomans have already inked their name on State Question 802, a citizen-led constitutional question that asks voters to expand Medicaid coverage to nearly 200,000 more low-income Oklahomans who can’t afford health insurance, yet make too much to qualify for Medicaid.

Stitt said Thursday he still hadn’t decided when he’d put that measure before voters. It’ll have to be on a statewide ballot in 2020.

“What we are hearing from the governor right now sounds like a tactic to distract voters — not a serious attempt to deliver care,” said Amber England, campaign manager for Yes on 802. “As the conservative think tank, the American Enterprise Institute pointed out, any Medicaid expansion plan that includes block grants isn’t legal and wouldn’t survive a court challenge. Oklahomans can’t risk putting their trust into any plan that will be tied up in a lengthy court battle and could be dismantled on a whim by politicians.”

In a statement, the state’s Hospital Association said it did not participate in discussions regarding Stitt’s proposed reforms and couldn’t comment until it had time to study the details.

“We remain focused on the passage of SQ 802, full Medicaid expansion, which will provide needed health care to more than 200,000 working Oklahomans, bring back more than a billion of our tax dollars to the sate, and have a $2 billion impact on our economy each year,” said Patti Davis, the association’s president.

Stitt’s plan has generated some initial support from Republican lawmakers Thursday morning, but most admitted they were still trying to sort through the details.

“I’m excited that we’re trying to take our destiny into our own hands,” said Greg Treat, president pro tem of the state Senate. “And not just allowing the Medicaid expansion carte blanche to be in the Constitution. We’re trying to come up with an Oklahoma plan that’s customized.”

Still, Treat, R-Oklahoma City, said he had concerns about how long it would take to get a state plan adopted and implemented. He said he needed time to “digest” the plan.

State Rep. Marcus McEntire, R-Duncan, said he’d just heard the plan 45 minutes earlier.

At first blush, the plan would increase access to health care and capture federal tax dollars without increasing taxes, he said.

“Of course, everybody knows the devil’s in the details on all of these things, and we don’t have all the details yet,” McEntire said. “From what I can tell, it looks very promising, and it could actually revolutionize health care in the state of Oklahoma.”

Stecklein covers the Oklahoma Statehouse for CNHI's newspapers and websites. Reach her at jstecklein@cnhi.com.

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