Medicaid expansion has helped Oklahomans weather the pandemic

On March 6, 2020, Oklahoma reported its first confirmed case of COVID-19 and declared a statewide emergency 10 days later. As the pandemic now enters its third year, Oklahomans continue grappling with the impact of lives lost and the immense disruptions it has created. OK Policy will be reflecting on the COVID-19 pandemic’s impacts and challenges. Our hope is that this will highlight opportunities for collaborative decision-making, future improvements, and prosperity for all Oklahomans.

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Since the start of the global pandemic, more than 14,500 Oklahomans have died of COVID-19. The enormity of this loss is unimaginable and unnecessary. While the state’s top leadership and policymakers did little to slow the virus’ spread in Oklahoma, voters recognized the difference they could make from the beginning. Voters decided on June 30, 2020 to expand Medicaid to low-income adults, indicating their understanding that access to health care is vital, particularly during a deadly pandemic. This decision undoubtedly kept the death toll from being even larger. 

Throughout this pandemic — and particularly since the implementation of Medicaid expansion in 2021 — Medicaid has fulfilled its purpose: facilitating access to affordable and comprehensive health coverage for those who might otherwise go without health care. State and federal actions have helped maximize the impact of Medicaid, and moving forward we should continue to prioritize accessible coverage for all eligible Oklahomans. 

Medicaid kept people insured during the pandemic. 

Since July 2021, more than 260,000 Oklahomans have gained access to comprehensive and affordable health care coverage through Medicaid expansion. In March 2020, nearly 808,000 Oklahomans were insured by Medicaid. By December 2021, Medicaid enrollment had grown to nearly 1.2 million. This growth can be primarily explained by two factors: Medicaid expansion and the federal declaration of a public health emergency

Though close to 70,000 of the new Medicaid expansion enrollees were reprocessed from other public health insurance programs, the remaining 190,000 were previously uninsured and now have health care coverage through Medicaid. This new coverage has reduced disparities of uninsurance rates for Oklahomans of color and younger Oklahomans, and it has substantially reduced our overall uninsured rate. In 2020, before the implementation of Medicaid expansion, Oklahoma’s uninsured rate sat at 14.3 percent. Now, as shown by the graph below, OK Policy estimates that the state’s uninsurance rate is less than 10 percent. 

While these coverage gains will bring economic, fiscal, and individual benefits to Oklahoma for years to come, the coverage expansion has been particularly important during the pandemic. The 260,000 Oklahomans who enrolled in Medicaid expansion have had continuous access to vital health care services like primary care providers, mental health treatment, and prescription drugs. Further, early research suggests that expansion had an impact on COVID-19 death rates, with expansion states seeing 10.1 percent fewer deaths than non-expansion states among expansion-aged adults. In conjunction with the fact that uninsurance has been linked to COVID-related deaths, it is clear that Medicaid expansion has been life-saving. 

Federal protections reduced Medicaid coverage gaps. 

The national COVID-19 public health emergency strengthened Medicaid access in Oklahoma and across the nation. Declared on January 31, 2020, and continuously extended over the last two years, the national public health emergency has ensured that very few Medicaid enrollees have lost coverage during the pandemic, while an enhanced federal funding match has offset the costs. The national public health emergency was most recently extended until April 16, 2022, and is expected to end in 2022. When the federal emergency declaration ends, the Oklahoma Health Care Authority has estimated that about 150,000 enrollees could lose coverage at that time. It will be vital that states thoughtfully approach the end of the public health emergency by taking steps to ensure that all eligible individuals stay enrolled in Medicaid. A successful public health strategy would ensure that ineligible individuals are connected with options to mitigate coverage gaps.

Taken together, Medicaid expansion and the continuous coverage provision of the federal public health emergency ensured that Oklahomans have been able to maintain their health during a time of hardship and job loss, with disproportionately high impacts for people of color and households with children. In general, Medicaid ensured that folks could see their doctors and fill their prescriptions during this difficult time. Medicaid expansion offered that assurance to many more Oklahomans, and the federal public health emergency declarations strengthened this effort by limiting coverage gaps.  

Oklahoma can take steps to continue making coverage more stable and accessible. 

Leading up to Medicaid expansion’s implementation on July 1, 2021, the Oklahoma legislature and the OHCA are to be commended for demonstrating their strong commitment to a well-implemented expansion process. The legislature honored the will of the voters by fully funding Medicaid expansion for the long-term. Further, ahead of implementation, the OHCA opened a 30-day early enrollment period and automatically enrolled tens of thousands of qualifying members who were enrolled in other programs, representing their prioritization of ensuring all eligible Oklahomans are able to access this coverage. 

Moving forward, it is vital that the state maintain this commitment to excellence, particularly as the end of the national public health emergency approaches. With thoughtful consideration, the state can ensure that all eligible Oklahomans can access Medicaid coverage and that now-ineligible enrollees are smoothly transitioned to other forms of coverage at the end of the PHE. The OHCA has begun preparing SoonerCare members for the end of the public health emergency, but more individual outreach that prioritizes continuous coverage without any gaps must be done.   

Oklahoma voters knew the benefits when they voted to expand Medicaid.  

On June 30, 2020, Oklahoma voters chose to take care of those around them by voting to expand Medicaid. Since expansion began on July 1, 2021, Medicaid expansion has improved the lives of more than 260,000 Oklahomans. Medicaid expansion, along with the continuous coverage provision of the public health emergency, have increased access to coverage throughout the pandemic. Maintaining our shared commitment towards the health and well-being of all Oklahomans will improve our state’s quality of life and economic outlook.

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On March 6, 2020, Oklahoma reported its first confirmed case of COVID-19 and declared a statewide emergency 10 days later. As the pandemic now enters its third year, Oklahomans continue grappling with the impact of lives lost and the immense disruptions it has created. OK Policy will be reflecting on the COVID-19 pandemic’s impacts and challenges. Our hope is that this will highlight opportunities for collaborative decision-making, future improvements, and prosperity for all Oklahomans.

ABOUT THE AUTHOR

Emma Morris joined Oklahoma Policy Institute as the Health Care and Revenue Policy Analyst in April 2021, and she previously worked as an OK Policy intern and as the Health Care Policy Fellow. She has worked as a case manager with justice-involved individuals and volunteered 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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