Supporters and opponents of a controversial Medicaid expansion question say Oklahomans could face dire consequences depending on the outcome at the ballot box Tuesday.

Supporters say State Question 802 would bring Oklahoma billions of federal dollars to pay for health care needs, shore up struggling hospitals and insure as many as 200,000 more Oklahomans.

But, opponents say it it’s unnecessary, comes amid a worsening state budget situation and doesn’t give lawmakers any guidance on how to pay Oklahoma’s estimated $164 million price tag next budget year.

The citizen-led measure, which appears on the June 30 ballot, proposes expanding Medicaid coverage to the state’s working poor — some of whom fall into an insurance coverage gap. They make too much to qualify for Oklahoma’s existing Medicaid program, but too little to qualify for tax credits on the federal health exchange.

Oklahoma lawmakers did not figure out how to increase insurance coverage during the past decade, so voters have taken matters into their own hands, said Amber England, the campaign manager for Yes on 802.

“I think it’s time for us to expand Medicaid in Oklahoma,” she said. “I’m just excited for Oklahomans to have the opportunity to finally decide this issue for themselves.”

England said there’s grassroots enthusiasm for the measure, and everybody she’s met has a personal story about why the state should expand Medicaid. One woman she met works six days a week at two different jobs. Neither offers health insurance.

“When we’ve been out in these communities, we’re not seeing a ton of opposition,” she said. “If you’re living in a rural community, you care about this issue because we can potentially save your rural hospital.”

Six rural Oklahoma hospitals already have closed and eight have declared bankruptcy, said Patti Davis, president of the Oklahoma Hospital Association, which backs 802.

The state now has the second highest rate of uninsured, and its hospitals are providing more than $500 million a year in uncompensated care for those who can’t afford insurance.

“Clearly, we have supported bringing back these federal dollars for a very long time because if we reduce the amount of uncompensated care that hospitals have to provide that helps with hospital stability,” Davis said.

Rural hospitals have higher rates of uncompensated care and more economically disadvantaged residents, Davis said. Those also are the communities that can least afford to absorb the costs generated by the uninsured.

She said SQ802 is the last plan left to expand Medicaid after Republican Gov. Kevin Stitt vetoed a key portion of his own controversial expansion proposal.

Davis said those who crafted the ballot measure intentionally left it up to the Legislature to decide how to fund the state’s required 10 percent match. The federal government is responsible for paying the remaining 90 percent of expansion.

She said hospitals expect they’ll be asked to bare the brunt of the expansion cost.

However, Republican Gov. Kevin Stitt said Tuesday that $200 million to fund the expansion could be funded by raising taxes or cutting services to education, roads or bridges or first responders.

He said the Oklahoma already spends about $6 billion a year to provide coverage to about 800,000 pregnant women, children, the aged, blind and disabled.

In an interview with a group that opposes the state question, Stitt said he’ll be voting no because he doesn’t think 802 is “good for Oklahoma.”

If voters approve the expansion, “the Legislature then is on the hook for paying for this service,” Stitt said. “So really, it’s bad for education. It’s bad for roads and bridges. It’s bad for any other state service because where’s the $200 million going to come from?”

Stitt said the ballot measure comes as the state grapples with increased unemployment due to the cratering oil and gas industry and COVID-19.

“I think that State Question 802 is just the wrong path forward for Oklahoma,” said Kaitlyn Finley, a policy research fellow with the Oklahoma Council of Public Affairs, a conservative-leaning think tank.

She said governor and the Republican-controlled Legislature were unable to agree on how to fund Stitt’s proposed Medicaid expansion plan. This plan, which enshrines expansion into the state Constitution, doesn’t have a designated funding source, either.

About two dozen rural hospitals in expansion states have closed after expansion, she said.

“For those hospitals, it wasn’t the cure for their financial woes,” she said. “Those expansion states spent tens of billions, if not hundreds of billions, but those hospitals did not receive enough of those funds to stay open.”

State Rep. Mark Lepak, R-Claremore, who also opposes the measure, said the federal government has a habit of shifting costs to states. While the state may only need to pay 10 percent now, he worries that burden could increase to 20 or 30 percent over time.

Nobody is talking about how to pay for the state question, Lepak said.

“Oklahomans, if they vote for it, are basically saying I’m going to cover the bill, whatever it is,” he said.

Lepak said state officials just don’t know what expansion is going to do to the state budget.

“If educating Oklahoma kids is your top priority, you ought to be scared to death that 802 will pass,” he said. “The money has to come from some place because you either have to raise taxes or cut something.”

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

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