Following Maine's lead in 2017, and red states Idaho, Nebraska, and Utah in 2018, Oklahoma's voters have gone over the heads of their governor and legislature to vote for Medicaid expansion. It narrowly passed, by less than one percentage point, but it passed. It’s more than just expanding Medicaid—they amended their constitution to do so, which will prevent the Republican-controlled legislature from rolling back coverage or imposing restrictions on it. The measure expands Medicaid eligibility in the state to 138% of the federal poverty level, about $17,200 for an individual or $35,500 for a family of four.
This is a blow to the Trump administration and to Gov. Kevin Stitt, who have been trying to make the state a guinea pig for the administration's plan to turn the program into a block grant. The Oklahoma Health Care Authority estimates that about 215,000 residents would qualify for expanded Medicaid at a cost of about $1.3 billion annually, shared with the federal government. The state's share would be about $164 million. That, however, was pre-coronavirus; the number of people who will qualify for the program will undoubtedly grow.
The coronavirus pandemic certainly played into this win. Before the election, Amber England, the campaign manager behind the ballot measure, told Politico: "[N]ow more than ever people understand that when you need health care, you need it now." Support for the measure came from the major health industry associations in the state. Opposition came from the Kochs in the form of the Oklahoma chapter of Americans for Prosperity. Now that Oklahoma has taken the plunge, look for Missouri next, which will be deciding on its expansion measure on Aug. 4.
This vote is a blow to Trump in a number of ways. It sets back his block grant experiment, which, incidentally has been shown to be particularly foolhardy with the pandemic raging. It shows one reason why block granting the program would be so destructive—it’s designed to respond nimbly and effectively to major disasters like pandemics and massive economic downturns, to be there to respond as needed. A block grant is a just that: a block of money that can run out and when it's gone, it's gone.
But this also firmly establishes 2020 as another healthcare election, just like 2018. If Trump has his way with the Supreme Court, Medicaid expansion goes away along with the rest of the Affordable Care Act’s protections.