When Oklahomans voted to expand Medicaid on June 30, they showed that our state values increased access to health care, less reliance on emergency rooms, and higher quality of care. The election was close with just 6,000 votes out of 674,951 cast determining the outcome. Commentators were quick to assign a narrative of a rural-urban divide to the outcome. Indeed, only seven counties had more yes votes than no. However, a look at the results with attention to more than surface-level detail reveals a more accurate picture of the election: close vote counts in most precincts, a correlation between votes and income, and a strong impact from American Indian communities. The data show that quite literally every type of Oklahoma voter made a difference in passing State Question 802.
The majority of precinct outcomes were decided by less than 100 votes
It’s true that “no” votes exceeded “yes” votes in a majority of Oklahoma counties. However, the narrative of a supposed rural-urban divide was much less of an issue than originally suggested. With a more nuanced look at the data, it becomes clear that Oklahomans from precincts across the entire state voted in favor of State Question 802. The margins of results from many precincts were very close. In fact, in 75 percent of precincts (or 1,459 out of 1,950), the margin was less than 100 votes. In 12 percent of all voting places, the vote came down to fewer than 10 votes.
Some rural counties were remarkably close to passing the ballot measure. For example, in Jefferson County, the measure failed by only 31 votes. With 397 voting against expansion and 366 voting in favor, every single vote had an impact. Fourteen counties saw the vote decided by less than 200 votes, indicating that while many rural counties did vote against SQ 802 in total, many rural Oklahomans in all of those counties voted for it.
Counties with higher levels of poverty had more votes for expansion
Medicaid expansion means access to health coverage for low-income Oklahomans who otherwise can’t access health care. This appears to have had an impact on many voters’ decisions at the polls. With a few exceptions, counties with a higher percentage of people living in poverty also had a higher percentage of votes in favor of expansion.
Conversely, many counties with a higher median income were more likely to have a lower percentage of yes votes on average. It does seem that income and wealth, or the lack thereof, played a role in the decision to vote for or against SQ 802. The popular narrative that low-income individuals ‘vote against their best interests’ is not supported by the data from Oklahoma’s vote to expand Medicaid.
Across the state, American Indians played a large role in passing SQ 802
Tribal communities were instrumental in passing SQ 802. Counties with a higher share of residents identifying as American Indian or Alaska Native were more likely to have a larger percentage of votes in favor of expansion. In Cherokee County, home of the Cherokee Nation, the vote passed by more than 1,000 votes, something that occurred in only five other counties. Medicaid expansion will bring in more funding, improve access to quality care, and provide coverage for almost 35,000 American Indians in Oklahoma. Multiple Oklahoma tribes endorsed the measure, including the Cherokee Nation, Choctaw Nation, Chickasaw Nation, Citizen Potawatomi Nation, and Muscogee (Creek) Nation. Considering the closeness of the vote, these endorsements were likely critical to the final outcome.
Every single vote mattered in the Medicaid expansion election
Following the election, there was a general interpretation that rural Oklahomans ‘voted against their best interests’ by voting against expansion. The data show that this simply isn’t the case. The data show that this election wasn’t a matter of geographical location, but rather a reflection of ideological differences across the entire state.
Oklahomans made their voices heard when they voted to expand Medicaid, and it is important to rely on data rather than anecdotes to avoid making harmful generalizations about voters. Without the votes of low-income, rural, and indigenous Oklahomans, Medicaid expansion would not have passed. Oklahomans did indeed vote for their best interests.