Lawmakers scramble to come up with Plan B on health care expansion (Capitol Update)

Sen. Greg McCortney, R-Ada, and Rep. Marcus McEntire, R-Duncan, chaired the first meeting of their joint healthcare working group last week. The pair introduced a bill last year to create a form of Medicaid expansion, but Governor Stitt wanted to wait a year to give himself time to develop an alternative. The governor announced at the time that he opposed the initiative petition to pass full Medicaid expansion in Oklahoma but realized he would need an alternative, or “plan B” as he called it. He said he was working with one hundred stakeholders to develop a healthcare proposal for Oklahoma. His administration is now part of the working group.

It appears the initiative petition, now known as SQ 802 is off and running, having defeated a court challenge. Proponents have until October 28 to gather 178,000 signatures. Voters would be given the opportunity to include Medicaid expansion, as provided in the Affordable Care Act (ACA), as part of the Oklahoma Constitution. Oklahoma is now one of only 14 states that has failed to extend Medicaid coverage to adults earning less than 133 percent of the federal poverty level.

The working group is in an interesting situation. It seems the ground on healthcare continues to shift beneath them. When the two legislators proposed an amended form of Medicaid expansion last year, it looked like a politically risky effort. Gov. Stitt had just been elected by a wide margin on a platform that opposed expansion while his opponent, Drew Edmondson, gave it full-throated support. Some Republican states that expanded Medicaid were using a private insurance option and calling it the “[You Name the State] Plan” to avoid association with the ACA. But as often happens, on a given issue the people may be out ahead of the politicians they elect. Now it appears there is a lot of support for full expansion as proposed in SQ 802.

And even if the goal were to legislatively pass an “Oklahoma Plan” to blunt the SQ 802 effort, the path forward is unclear. The Trump administration just denied a plan for partial Medicaid expansion submitted by Utah and indicated it will only approve full Medicaid expansion proposals. This is a real head-scratcher. The best explanation seems to be that the administration is anticipating a court victory in which the Affordable Care Act would be held unconstitutional, including the portion that pays for expanding Medicaid coverage. Apparently, they are hoping if that happens, the 37 states with expanded Medicaid coverage will repeal their coverage.

Sen. McCortney and Rep. McEntire were careful to say the task force’s work is broader than simply Medicaid expansion. They want a healthcare system in Oklahoma that saves lives and improves life expectancy. Given the poor state of Oklahomans’ health there is plenty of work to do. But that requires a broader agenda that includes improved assistance for those in poverty, less trauma, higher incomes for the working poor, better educational opportunities, and availability of mental health treatment. In the working group meeting, a Health Department presenter said, “There are certainly policy levers that have either been employed in other states or perhaps have even come across the chambers of this building previously that we at the State Department of Health feel would contribute significantly to being able to help individuals in Oklahoma make a healthy choice.” Let’s hope the ground continues to shift on those issues as well.


Steve Lewis served as Speaker of the Oklahoma House of Representatives from 1989-1990. He currently practices law in Tulsa and represents clients at the Capitol.

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