Managed care isn’t a silver bullet: Improving Oklahoma’s health outcomes requires multi-faceted investments

Oklahoma’s health rankings have long been in the bottom half when compared to other states, and we’ve stagnated in the bottom 10 for at least the last two decades. High rates of uninsurance, cancer and cardiovascular deaths, infant mortality, and physical and mental distress —caused in large part by outdated and ineffective health policy — have all contributed to Oklahoma’s abysmal health rankings. 

Fortunately, Oklahoma has the tools at its disposal right now to begin prioritizing the health of our friends and neighbors. The answer, despite recent claims, is not outsourcing the administration of our Medicaid program, also known as SoonerCare. Rather, we must look at the factors that actually impact health and increase our investment in the mental, physical, and economic well-being of all Oklahomans. 

The state government has not prioritized health

In recent years, Oklahoma has remained solidly among the bottom 10 states when looking at health rankings. The overall ranking is determined by five categories, all shown in the graph below. In looking at the ranking trends between 2015 and 2019*, the state ranks slightly lower now in the categories of health outcomes and behaviors, and we have stayed at 49th in health policy since 2017 (though notably we do rank 25th for public health funding). This dismal policy ranking is due in large part to the state’s high uninsured rate and low immunization rate, both of which could have been improved long ago through public policy choices. 

Oklahoma has improved slightly in other areas. In the community and environment category, we rose from 47th to 44th, though we still face high rates of things like infectious disease and childhood poverty. Most notably, Oklahoma has risen from 43rd to 32nd in clinical care. This is evidence that we don’t have to be content with mediocrity; targeted investments on the part of the state can improve the health of Oklahomans and begin to mitigate health disparities.  


Medicaid administration isn’t the problem

These results communicate clear measures that Oklahoma can target to address these poor health rankings, which would improve Oklahomans’ health and benefit the economy. Oklahoma must address its high rates of uninsured individuals, premature deaths, mental and physical distress, infant mortality, and children in poverty, low rates of immunizations, and low availability of dental and primary care providers in order to have any hope of improving health outcomes. 

Notably, none of those tactics have anything to do with how the state’s Medicaid program is administered. In fact, these health rankings are reflective of the entire population, not just the 1 in 4 Oklahomans who are covered by Medicaid. It’s misleading to generalize the rankings to support the position that Medicaid administration will significantly improve health outcomes in Oklahoma. Indeed, if our state leadership truly cared about improving health outcomes, we would have begun addressing the state’s high uninsured rate and expanded Medicaid more than a decade ago when it became an option. Instead, improving health outcomes has become a false flag for state executive leadership to unilaterally outsource the care of more than 770,000 Oklahomans who use Medicaid to see a doctor or even fill a prescription. 

Furthermore, peer-reviewed evidence finds no definitive correlation between privatized managed care and improved health outcomes, despite Gov. Stitt’s claims otherwise. State health rankings also show no correlation between privatized managed care and outcomes. That is, states ranked among the healthiest 10 use privatized managed care at about the same rate as states ranked least healthy, suggesting that managed care will likely not have a meaningful impact on our health rankings. There-is-no-correlation-between-health-rankings-and-managed-care-via-Oklahoma-Policy-Institute

In fact, when Oklahomans approved Medicaid expansion in 2020, they likely made more of a difference in health outcomes than managed care ever can. Five of the 10 lowest-ranked states are currently non-expansion states (South Carolina, Tennessee, Oklahoma, Alabama, and Mississippi), and all of the highest-ranked states expanded Medicaid in 2014 (with the exception of Utah, which expanded in 2020). Of the 18 states that improved their health ranking between 2010 and 2019, all but two expanded Medicaid during that time. When Oklahoma expands Medicaid to working-age adults in July 2021, the state will have taken a significant and evidence-based step towards improving our health outcomes.

It doesn’t have to be this way

As noted earlier, Oklahoma’s spending on public health ranks 25th nationally. So, how do we square the fact that Oklahoma spends more on public health than many other states, yet our residents have among the nation’s lowest health outcomes? Much of this disparity comes from all the other factors that influence health. 

Only about 20 percent of health outcomes are a direct result of medical care, with the rest influenced by social determinants of health like socioeconomic and environmental factors. A true commitment to improving health would mean increased investment in education, economic security, food security and nutrition, developing a paid family medical leave program, increasing the Earned Income Tax Credit to go along with the recent move to restore its refundability, and so much more.

Beyond expanding Medicaid, Oklahoma can meaningfully address these abysmal health outcomes by making smarter investments in all of the environmental factors that can ensure healthy, thriving Oklahomans. We have the tools to address this problem that has plagued Oklahoma for too long. Lawmakers and public leaders should take steps now to begin investing in the state’s future.


Actions for Advocates: 

  • Contact your legislators to ask for increased investment in Oklahoma communities.   
  • Share your story about how you or your family can benefit from expanded Medicaid coverage, or have struggled with gaps in health care coverage.  
  • For more information, tools, actions, and resources for advocates, visit



* America’s Health Care Rankings updated its reporting metrics in 2020,  which limits the trend comparison over time. Its 2020 report showed that Oklahoma remained in the bottom 10 states using its new reporting model.


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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