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Medicaid Expansion Effort Heads to Court

State of Oklahoma-File photo


A group seeking a public vote on whether to expand Medicaid to tens of thousands of low-income Oklahomans first must clear a legal challenge spearheaded by a conservative think-tank that has long opposed the expansion idea.

A hearing is scheduled Tuesday before the Oklahoma Supreme Court on whether the group can proceed with gathering the nearly 178,000 signatures they will need to get the question on the ballot. The Oklahoma Council of Public Affairs think-tank is challenging the proposal, arguing the proposed ballot language doesn’t accurately describe what the measure does. The court will hear oral arguments on Tuesday and then issue a written opinion later.

Here are some things to know about Medicaid expansion in Oklahoma:



Supporters of Medicaid expansion include doctors, hospitals, business and faith leaders and most Democrats in the Legislature, who say the expansion will infuse close to $1 billion in federal funding into the state’s health care system each year, helping provide medical coverage to low-income Oklahomans who don’t receive health insurance through work or who can’t afford it. Opponents, including Gov. Kevin Stitt and most Republicans, say the cost to the state, even with a 9-to-1 federal match, is a significant investment and raised concerns about what will happen if the state’s share must increase in future years. Republicans politicians in Oklahoma also have spent nearly a decade on the campaign stump demonizing the Affordable Care Act, former President Barack Obama’s signature policy victory.



More than 16% of Oklahoma’s population was uninsured in 2017, giving the state the second-highest rate in the nation, behind only to Texas, according to the most recent figures from Kaiser Family Foundation, a nonpartisan health policy research organization. Nationally, the uninsured rate is about 10%, about 7.6% in expansion states and 14.3% in non-expansion states.



About 786,000 Oklahomans, or 20 percent, currently are enrolled Medicaid, and more than two-thirds of those enrolled in the program are children. Children in Oklahoma can qualify for Medicaid if the annual household income is about $35,500 per year for a family of two. Pregnant women also can qualify if their household income doesn’t exceed about $22,500 for a family of two. Able-bodied adults without children do not qualify for Medicaid in Oklahoma, regardless of income.



So far 36 states and the District of Columbia have approved an expansion of Medicaid, while Oklahoma and 13 others have not. Under Medicaid expansion, health care would be available to those individuals making less than 133% of the federal poverty level, or about $16,000 annually for an individual or about $28,000 for a family of three. Estimates vary as to how many Oklahomans would qualify under Medicaid expansion, but a 2016 study commissioned by the Oklahoma Hospital Association projected about 272,000 Oklahomans would qualify in the first year.