Fifty-six years of Medicaid: Fiscally responsible and morally mandated

The Medicaid program, since it was signed into law in 1965, has provided access to affordable health care for millions, strengthened private insurance and Medicare, and positively impacted state budgets. Passage of the Affordable Care Act (ACA) in 2010 improved the program and the entire United States health system by prohibiting discrimination on the basis of preexisting conditions, covering preventive services, and eliminating lifetime limits on coverage. Additionally, the ACA’s option for states to expand Medicaid extended the program to cover more low-income adults, which has helped narrow racial disparities in health outcomes. And Medicaid has been particularly important during the COVID-19 pandemic, as more people have relied on this coverage to get vital care. 

In addition, Medicaid is affordable for enrollees and cost-effective for state budgets. Individuals who are insured by Medicaid often have limited or low incomes, and the program’s low copays and limited out-of-pocket costs help ensure it remains affordable for most enrollees. Per capita Medicaid costs have also grown at slower rates than both Medicare and private insurance, and the program has become more efficient as the cost per enrollee has declined in recent years. This investment pays off, as healthier Oklahomans are better able to work, parent, and pay taxes.


The benefits of Oklahoma’s Medicaid expansion will be felt statewide 

Since expansion became an option for states in 2012, most Oklahoma lawmakers have been reluctant to take advantage of this life-saving opportunity, despite its health, economic, and fiscal benefits. In June 2020, however, voters took matters into their own hands and passed State Question 802, enshrining Medicaid expansion in the state Constitution. After nearly a decade of opportunity, expansion became reality in Oklahoma on July 1, 2021. 

More than 141,000 Oklahomans have already been approved for expansion coverage, and some 60,000 more likely qualify. With thousands of newly eligible residents able to see their doctors without financial stress, Oklahomans will be healthier, better contribute to our state economy, and become more financially secure. Expansion will also bring financial benefits statewide, with an estimated 27,000 new jobs, $15.6 billion in economic activity, and nearly $500 million in new tax revenue in the first five years. 

Advocates, legislators, and agency officials worked together to ensure success 

Implementation of Oklahoma’s expansion has been successful, thanks to legislators, the Oklahoma Health Care Authority (OHCA), and a broad coalition of advocates and community members. While the state’s seen a few growing pains, thousands of Oklahomans newly have access to health insurance, financial stability, and peace of mind. 

When the 2021 legislative session began, lawmakers discussed Medicaid expansion funding as a matter of “how,” not “if.” Despite a decade of legislative resistance and continued opposition from the governor, lawmakers — to their credit — honored the will of voters. Legislators fully funded expansion without raising taxes, through a combination of federal American Rescue Plan Act funds and a phased increase in fees charged to hospitals. As federal pandemic assistance phases out, expansion will likely pay for itself and generate increased revenue

The OHCA was instrumental in enrolling tens of thousands of Oklahomans into expansion coverage before the program even began. In preparation for the start date, advocates raised concerns that a sudden influx of 200,000 applications could overwhelm the system and that intentional action on the agency’s part would help mitigate the issue. The OHCA announced plans to open a 30-day early enrollment period and to reprocess several thousand applications that would likely become eligible. Because of these efforts, more than 100,000 Oklahomans were approved for expansion benefits within the first 10 days of enrollment and were able to access their care beginning on July 1. 

With tens of thousands of eligible Oklahomans still unenrolled, advocates and community partners have helped raise awareness. Advocates statewide have joined together to provide resources and support in any way possible, including developing and distributing an informational flyer, an enrollment guide, and a training video. Several organizations have already individually enrolled hundreds of people, and they continue to stand on the front lines and spread the word. Oklahoma’s enrollment navigator program provides individual help for anyone who needs it. These efforts have already made a difference and will continue connecting Oklahomans to care.

We can do more to make enrolling easier 

As with any undertaking this immense, there have been some snags along the way; the past few weeks have brought anecdotal reports of certain administrative barriers. Individuals have been unable to access parts of their applications and accounts during prime enrollment hours due to scheduled maintenance of the system. Some individuals with disabilities have reported hitting brick walls in the application process because of confusion between state agencies about the new eligibility guidelines. Some providers are unable to continue treating patients with certain health needs, and others have seen misleading information on the OHCA website, causing them to deny referrals for necessary care. These barriers must be addressed so the state can move forward in the most accessible way.  

Oklahomans support each other 

In 2020, Oklahoma voters chose to build on Medicaid’s success and expand the program to cover some 200,000 more of our friends and neighbors. Since then, the state has fully funded the program and enrolled thousands of people into life-saving, affordable coverage. We can build on this momentum to further expand access and make it easier to enroll. 

In the meantime, we should celebrate that parents can now take care of their children without worrying about their own health care; that college students can access their medications even when parents’ jobs change; that rural residents don’t have to leave their communities to find a job with health care; that individuals leaving incarceration have a better chance at success; and that providers across the state will be strengthened and better able to serve us all. And we should celebrate the fact that we did it together. 


Emma Morris worked as Oklahoma Policy Institute's Health Care and Fiscal Policy Analyst from April 2021 to January 2024. She had previously worked as an OK Policy intern and as the Health Care Policy Fellow. Previous experience included working as a case manager with justice-involved individuals and volunteering as a mentor for youth in her community. Emma holds dual bachelor’s degrees in Women’s and Gender Studies and Public and Nonprofit Administration from the University of Oklahoma, and is currently working on a Master of Public Administration degree from OU-Tulsa. She is an alumna of OK Policy’s 2019 Summer Policy Institute and The Mine, a social entrepreneurship fellowship.

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