Expanding Medicaid can be life-changing for older Oklahomans

This year, Oklahomans will vote on State Question 802, which would expand Medicaid coverage for adults with incomes up to 138 percent of the federal poverty level. For a childless couple, this threshold would be $23,336. Adults currently are covered only if they are over 65, have certain disabilities, or have children and a household income less than half the poverty level, which is about $8,000 per year for a single parent with one child. Medicaid expansion in other states has led to healthier mothers and stronger, better insurance options for young adults just starting out on their own, all while saving states money

While many think expansion will mainly benefit younger Oklahomans, like new parents and others just starting their careers, it’s important to remember that older Oklahomans between the ages of 45 and 65 stand to benefit as well. Recent research suggests expansion also will improve insurance coverage, care, and save lives of those who aren’t yet old enough to qualify for Medicare. Because rural areas have a disproportionately higher population of residents over age 45, Medicaid expansion will make more health care dollars available in rural communities where they are in urgent need.

Expanded Medicaid improves statewide health

A recent study of southern states found that adults in expansion states have better access to insurance and are more likely to sustain their health. They also are less likely to experience a decline in their health as they age. Even those who previously had access to free or reduced-price health care experienced better health after they had full Medicaid coverage. 

The study authors found that health declines slowed in Southern expansion states and concluded that expansion helps slow health declines. These impacts were so significant that one study author estimated the worst-ranked Southern state would rise “about halfway up the rankings in state population health if it expanded Medicaid.” This study demonstrates that Medicaid expansion is the solution. America’s Health Rankings ranked Oklahoma’s overall population health as 47th nationally. The Oklahoma Legislature has identified this low ranking as a cause for concern, as evidenced by its creation last year of the Health Care Working Group to address the matter. However, the working group met without offering solutions. 

Expansion also reduces opioid deaths

Drug overdose deaths more than tripled in the U.S. between 1999 and 2017, and those aged 55 to 64 had the highest fatal overdose rate of any age group. Opioids played a large role in this increase. A new study shows that Medicaid expansion is part of the solution to the alarming growth rate. This study was the first to look at county-level data, and it found that counties in Medicaid expansion states had six percent fewer total opioid deaths, an 11 percent reduction in heroin deaths, and a 10 percent reduction in deaths from synthetic opioids other than methadone. The study’s authors found a strong association between expansion and a decreasing mortality rate due to opioid overdose at the county level. The authors concluded that “the findings suggest that expanding eligibility for Medicaid may help to mitigate the opioid overdose epidemic.” 

Medicaid expansion saves lives

Medicaid expansion provides residents with better access to insurance and health care, better health, and fewer overdoses. When taken in combination, this adds up to lives being saved by Medicaid expansion. In one study, researchers estimated that access to Medicaid reduced mortality rates by 39 to 64 percent for those aged 55 to 64.  In expansion states, Medicaid access saved about 4,800 lives per year. Conversely, another 3,900 lives could have been saved — including about 500 Oklahomans — annually had all states expanded Medicaid. 

Rural areas see most difference when covering middle-aged Oklahomans 

Serving more older Oklahomans will have an outsized impact in our rural areas, which have older populations than urban places. Thirty-eight percent of low-income rural adult Oklahomans are uninsured, compared to 32 percent of urban dwellers, according to a Georgetown University study. In expansion states, Medicaid has narrowed or eliminated the uninsured gap between rural and urban residents.

In the last decade, the nation has seen an alarming trend in rural hospital closures. These closures trace their roots to a shortage of privately insured patients, the growing costs of caring for chronically ill patients, and the difficulty in attracting and retaining medical professionals. Nearly all the rural hospitals that have closed across the country are in non-expansion states like Oklahoma, which has seen nine hospitals closed since 2007.  Five of these Oklahoma hospitals closures occured in just the last two years. Full Medicaid expansion provides Oklahomans a clear opportunity to stem the tide of hospital closures.

Full Medicaid expansion is the only proven way to help middle-aged Oklahomans get insured, get treatment, and live longer

The legislative Working Group and Governor Kevin Stitt have both extensively examined Oklahoma’s poor health outcomes.They have promised alternatives to improve those outcomes without the straightforward Medicaid expansion required by SQ 802. Gov. Stitt  recently offered an alternative, taking advantage of new federal guidance to expand Medicaid through a capped block grant and implementing work requirements and other barriers to care. While the Governor has been insistent on examining alternatives, these alternatives are risky, create unnecessary bureaucracy, invite lengthy legal challenges, and will keep Oklahomans from the care they need. Research consistently has shown that straightforward Medicaid expansion is the best way to expand coverage, improve treatment, and extend lives for middle-aged Oklahomans and low-income adults of all ages. Oklahomans should demand Medicaid expansion as if the lives of their family and neighbors depended on it — because they do.


Paul Shinn

Paul Shinn served as Budget and Tax Senior Policy Analyst with OK Policy from May 2019 until December 2021. Before joining OK Policy, Shinn held budget and finance positions for the Oklahoma House of Representatives, the Department of Human Services, the cities of Oklahoma City and Del City and several local governments in his native Oregon. He also taught political science and public administration at the University of Oklahoma, University of Central Oklahoma, and California State University Stanislaus. While with the Government Finance Officers Association, Paul worked on consulting and research projects for the U.S. Environmental Protection Agency, the U.S. Department of Transportation, and several state agencies and local governments. He also served as policy analyst for CAP Tulsa. He holds a Ph.D. in Political Science from University of Oklahoma and degrees from the University of Oregon and the University of Maryland College Park. He lives in Oklahoma City with his wife Carmelita.

One thought on “Expanding Medicaid can be life-changing for older Oklahomans

  1. Thank you Paul. Your important service to our state goes back decades and you have absolutely nailed the medicaid expansion issue. For the life of me I cannot fathom why Governor Stitt is just another in a long line of Republican elected leaders who have continued to put their political and personal interests ahead of 200,000 uninsured, at risk Oklahomans. Actually I do get it. The right wing, anti-Obama segment of their party, as embodied in former U.S. Senator/ Dr. Tom Coburn, dominates the primaries. Just ask two term Governor Mary Fallin who abandoned medicaid expansion when Coburn told her he would run against her if she accepted the billions available to our state’s health deprived citizens. Meanwhile, Dr. Coburn himself enjoys world class, taxpayer paid health insurance as he battles his own expensive and challenging health problems. How in the world does this guy look himself in the mirror every morning surely knowing of the unnecessary and premature deaths he causes among our most vulnerable residents, especially out here in rural Oklahoma? When he goes for his next checkup I recommend he has his eyes examined and heart monitored to see if all are operating properly. If they are that leaves only one solution for Dr. No’s deficiency and a brain transplant hasn’t been perfected yet.

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