SQ 802: Medicaid Expansion – Information and resources

This page is a resource on the Oklahoma Medicaid expansion ballot initiative (SQ 802). It will be updated to reflect the most recent information available.

Click below to jump to a section:

• Where are things now?
• What will the ballot initiative say?
• What happens next?
• What has happened already?
• General information
• News
• Studies
• Op-Ed

Where are things now?

Advocates began collecting signatures to place SQ 802 on the ballot on July 31, 2019. Organizers will have until 5pm on October 28, 2019 to collect some178,000 signatures (15 percent of the total number of votes cast in the last gubernatorial election). Signatories must be registered voters in the state of Oklahoma. 

The ballot initiative is run by the group Yes on SQ 802: Oklahomans Decide Healthcare. Medicaid expansion in Oklahoma would cover approximately 200,000 people.

What will the ballot initiative say?

The measure adds a new article the Oklahoma Constitution to expand the state’s Medicaid program (SoonerCare) to include low-income, non-elderly adults who earn up to 133 percent of the federal poverty level ($21,595 per year for a single person, or $34,248 for a family of four). The state can’t put more eligibility or enrollment restrictions on these enrollees than it has for anyone else on SoonerCare.

In order to expand coverage, the state has to submit an amendment to its current federal Medicaid plan within 90 days of the ballot measure passing. The state must try to access all available federal funding. 

What happens next?

Initiative petitions face a lengthy process to be eligible for the ballot. After signatures are delivered to the Secretary of State’s office, the Secretary of State, Attorney General, and Supreme Court will review the ballot title and count the signatures to determine whether they meet legal requirements.

Assuming the petition meets those requirements and survives any further legal challenges, the Governor will choose when the initiative will be voted on. The Medicaid expansion initiative will likely be voted on in 2020, giving Governor Stitt four possible statewide elections to choose from: the Presidential primary election in March; the general primary election in June, the primary runoff in August, or the general election in November. Alternately, the Governor can call a special election. Whenever it is held, the initiative would have to receive 50 percent or more votes to pass.

The ballot initiative may not be the only expansion effort under consideration in the fall of 2019 or in 2020. Governor Kevin Stitt has said he expects to unveil a customized Medicaid expansion plan in late summer or early fall 2019. While the Governor may have the authority to implement the expansion via executive order, it’s more likely that he’ll call on the Legislature to pass a bill, either in a special legislative session in 2019 or during the 2020 legislative session. In July, legislative leaders announced the formation of a bicameral working group, chaired by Sen. Greg McCortney (R-Ada) and Rep. Marcus McEntire (R-Duncan) to develop a plan to expand access to health care and increase coverage of uninsured Oklahomans. The working group’s first meeting was August 14th and it is expected to hold weekly meetings throughout the fall.

There is a possibility that both the initiative expansion and legislative expansion could pass. If the Legislature passes an expansion bill, SQ 802 will still be put on the ballot if it gathers enough signatures and meets other legal requirements. In this situation, if the initiative passes, it should supersede the legislative expansion because the initiative is a constitutional amendment while the legislative expansion would be statutory. 

What has happened already?

The ballot initiative process in Oklahoma formally began in April 2019, when two Oklahoma women, Kelly Smalley and Erin Taylor, filed a petition with the Oklahoma Secretary of State. It was designated State Question 802 (SQ 802) by the Secretary of State’s office. The Oklahoma Council for Public Affairs  filed a legal challenge shortly thereafter, alleging that SQ 802 was unconstitutional and the gist was inadequate. The state Supreme Court disagreed, and on June 19, the state Supreme Court cleared the way for a Medicaid expansion ballot initiative, or State Question, to move forward.

Oklahoma’s efforts to expand Medicaid via ballot initiative follow successful expansion ballot initiatives in four states: Maine in 2017, and Nebraska, Idaho, and Utah in 2018. In all four states, the Governor and/or Legislature has sought to roll back or limit the full expansions approved by voters. This prompted organizers in Oklahoma to seek a constitutional rather than statutory amendment – putting Medicaid expansion in the state constitution limits the state Legislature’s ability to tamper with it.

To date, Oklahoma is one of just 14 states that have not expanded their Medicaid programs to include low-income working adults. Thirty-six states and Washington, DC have expanded Medicaid. Medicaid expansion was authorized by the Affordable Care Act and became available to states in 2014. The state legislature seriously considered expansion for the first time in 2019, when SB 605 became the first Medicaid expansion bill heard in a legislative committee. Although the bill passed out of committee unanimously, it died when it was not heard before the next legislative deadline.

General information:

• State Question 802 (Oklahoma Secretary of State)
  • Outline of the Oklahoma Initiative and Referendum Petition Process (Oklahoma Secretary of State)
• Oklahoma Medicaid Expansion Initiative (2020) (Ballotpedia)
• Oklahoma Council of Public Affairs v. Smalley (Oklahoma State Courts Network)

Campaign Pages:

• Yes on SQ 802 – Oklahomans Decide Healthcare 
•  [we are currently unaware of any organized efforts in opposition to SQ 802]

News:

• ‘Leaving billions of dollars on the table‘ Rural hospitals foundering in states that declined Obamacare (Gatehouse News)
• ‘Yes on 802’ making way through Oklahoma (Duncan Banner)
• SQ 802: Court moves Medicaid expansion effort forward (NonDoc)
• Proponents rally, urges lawmakers to expand health coverage now (The Oklahoman)
• Oklahoma’s rural hospitals see a lifeline in Medicaid expansion (StateImpact Oklahoma)

Studies:

• Study: the US could have averted about 15,600 deaths if every state expanded Medicaid (Vox)
• What you need to know about coverage expansion (OK Policy)
• The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Kaiser Family Foundation)
• The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid (Kaiser Family Foundation)
• The Implications of Medicaid Expansion in the Remaining States: 2018 Update (Urban Institute/Robert Wood Johnson Foundation)
• Covering the Low Income, Uninsured in Oklahoma: Recommendations for a Medicaid Demonstration Proposal (Leavitt Partners; commissioned by Governor Mary Fallin for the Oklahoma Health Care Authority in 2012)

Op-eds and editorials

• Oklahomans tired of waiting for a state Capitol solution can join the movement for Medicaid expansion (Tulsa World editorial)  
• Medicaid expansion proponents must question working group’s motives (Muskogee Phoenix editorial)
• Point of View: A funding promise we can count on (Carly Putnam, The Oklahoman)
• New Mexico shows the way on battling opioid overdose deaths, and it starts with Medicaid expansion (Dr. Gerard Clancy, Tulsa World)
• Point of View: Expanding Medicaid makes good business sense for Oklahoma (Patti Davis, The Oklahoman)
• I’m a Tulsa doctor, and I must speak out for Medicaid expansion (Dr. Donald E. Loveless Jr, Tulsa World)

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