Medicaid expansion’s rippling impact on Oklahoma

As of April 25, 2022, more than 280,000 Oklahomans across the state have been able to lead healthier lives because of Medicaid expansion. When voting to approve expanding Medicaid to include low-income, working-age adults, Oklahoma voters knew the benefits: expansion would lead to lower uninsured rates, lower out-of-pocket costs, better access to preventive care, and reduced mortality for enrollees. It would also have rippling benefits for financial stability, labor force participation, and the state’s economy. One year after the implementation of Medicaid expansion, Oklahoma is reaping the benefits. 

In our new report “Medicaid Expansion in Oklahoma: Year One,” the Oklahoma Policy Institute evaluates the success of the first year of Medicaid expansion. Since implementation on July 1, 2021, Medicaid expansion has decreased Oklahoma’s uninsured rate from 14.4 percent to below 10 percent, and Oklahomans of all races, genders, ages, and in all counties have benefitted. Expansion has strengthened our hospitals and will continue to fortify our communities as more Oklahomans are able to access basic needs like seeing their doctor and filling a prescription. 

Medicaid expansion has decreased the uninsured rate in Oklahoma

As more Oklahomans can access both preventive health care and treatment, they will live healthier, happier lives, and see expanded economic opportunity as it becomes easier to look for a job and keep it. With 280,000 Oklahomans feeling these impacts, the state’s uninsured rate has decreased from 14.4 percent to about 9.6 percent.¹

Some groups of Oklahomans have seen disproportionate benefits. For example, communities of color have historically experienced disproportionately high uninsured rates due to systemic marginalization, such as overrepresentation in industries that don’t offer health insurance and lower-income brackets. Among other factors, unequal access to coverage leads to disparate health outcomes, such as Black and Latinx individuals being more likely to experience conditions like diabetes and hypertension, report symptoms of anxiety and depression, and carry medical debt. 

In a welcome turn-around, Medicaid expansion has reduced some of the inequity in uninsured rates. Since implementation, the uninsured rate for Black Oklahomans has decreased by nearly half, from 15 percent to just 8 percent.² While this is the largest reduction, other racial groups have seen significant declines in uninsured rates as well. Similarly, uninsured rates have decreased across genders and ages, and Oklahomans in every county in the state have enrolled in expansion coverage.³

More people with insurance means healthier children, stronger hospitals, and thriving communities 

Medicaid expansion has had rippling effects throughout Oklahoma communities. For example, Medicaid expansion improves childhood insurance rates; as parents become eligible for coverage, their children are more likely to enroll, as well. This coverage in turn leads to a higher uptake of well-child visits and more preventive care. Since expansion began, nearly 46,000 more children are enrolled in Medicaid.⁴ (At least part of this increase in enrollment is due to the public health emergency, but it’s impossible to separate out the causes with available data). 

Another community impact of Medicaid expansion is stronger hospitals. Since 2010, seven Oklahoma hospitals have closed, at least in part due to the state’s refusal to expand Medicaid when it became available.⁵ However, hospitals in expansion states are 84 percent less likely to close than hospitals in non-expansion states, due to factors like less uncompensated care and improved financial margins. While expansion’s impact on hospitals is difficult to identify in the midst of the pandemic, Roger Knak, CEO of the Fairview Regional Medical Center located in rural Major County, identified two areas of improvement: increased revenue and an expansion of the hospital’s physical and occupational therapy department. Stronger hospitals will fortify communities for years to come. 

There’s more work to be done 

While Medicaid expansion is a critical first step towards better health outcomes, Oklahomans need and deserve a robust and well-rounded approach to achieve healthier communities. “Medicaid Expansion in Oklahoma: Year One” outlines several options for further expanding and strengthening health care access in Oklahoma. Gaps remain in Medicaid coverage for pregnant and postpartum Oklahomans, and the state’s maternal death rate (23.5 deaths for 100,000 live births) is significantly higher than the nationwide rate. Nearly all other states have made full Medicaid coverage available to pregnant individuals at higher income levels than Oklahoma. Following their lead to expand pregnancy coverage would help improve outcomes for new parents and their babies.  

Similarly, implementing continuous eligibility would limit coverage gaps for all enrollees and could create administrative savings for the state. Continuous eligibility helps ensure that enrollees don’t lose coverage for small income fluctuations or for failing to meet an administrative requirement. At the very least, continuously enrolling kids would bring Oklahoma in line with most other states. 

Moving forward, Oklahoma can build on Medicaid expansion’s progress to ensure more of our friends and neighbors have access to high-quality, affordable health care.

Footnotes: 

In the interest of transparency and other interpretations of data, we share our calculations and data sources in a companion document.

1. See Data Documentation Tab 3. Analysis only accounts for new Medicaid enrollees, not those who were transferred from programs like Insure Oklahoma.  
2.  See Data Documentation Tab 5. 
3.  See Data Documentation Tabs 6, 7, 8.
4.  See Data Documentation Tab 10.
5.  Five of those hospitals were converted into other health care facilities; two were closed completely.