When voters approved State Question 802 in June 2020, they knew the benefits that Medicaid expansion would bring to Oklahoma. They understood that it would bring a $1.3 billion dollar federal investment, generate $15.6 billion in economic activity and $489 million in tax revenue, and create more than 27,000 new jobs. They recognized that healthier Oklahomans are better parents, workers, and community members.
However, more than 178,000 Oklahomans have been approved for Medicaid expansion as of September 20th, 2021. The data used in this analysis were provided by the Oklahoma Health Care Authority on August 30, 2021. Of the 173,357 Oklahomans who had been approved for expansion benefits on that day, 105,780 were new applicants who had previously been uninsured. (The remaining 67,757 were reprocessed and enrolled from other coverage programs, such as Insure Oklahoma.) Our analysis suggests that the state’s uninsurance rate now sits at about 11.5 percent, representing a significant decline in the number of uninsured Oklahomans.
Medicaid expansion means healthier Oklahomans.
With so many Oklahomans living without regular health care because they lacked insurance, the state has historically had high rates of chronic disease and death. Living without health insurance often means leaving chronic conditions untreated, avoiding necessary care, and risking financial ruin as a result of a medical emergency.
However, years of research have shown that Medicaid expansion leads to improvements in coverage rates, access, and health outcomes. As Oklahomans gain access to health insurance, they will be better able to see a doctor and take charge of their health. This will have rippling economic and health impacts: more children will gain insurance, more people will be able to access mental health treatment, individuals will be better able to work and more financially secure, and the state budget and economy will be stronger for all.
Medicaid expansion levels the playing field across the state.
In Oklahoma, we are seeing these impacts begin in real-time. The coverage gains as a result of expansion have disproportionately benefited several populations with historically high rates of uninsurance.
In 2018, the uninsured rate was slightly higher in rural Oklahoma than in urban areas, and Medicaid expansion has lowered that rate across the board. The overall rural and urban rates have both decreased by about 20 percent. Moreover, there was a greater impact in rural Oklahoma. Although nearly 37 percent of the state’s population is considered rural, about 40 percent of new Medicaid enrollees are from rural areas.
Medicaid expansion has also reduced rates of uninsurance among all racial groups for which we have data. Communities of color have historically had disproportionately high rates of uninsurance, due to systemic policies that have made it more likely for people of color to work in jobs that don’t provide insurance. And though rates remain disproportionately high in many communities of color — particularly for American Indians — Medicaid expansion is a good first step towards health equity. Notably, the Black uninsured rate decreased by 30 percent as a result of expansion.
Uninsurance rates have declined for Oklahomans of all expansion-eligible ages. Those aged 25-34 saw the largest benefit, with a 26 percent decline in the rates of uninsurance. However, Oklahomans under age 35 remain the most likely to be uninsured, with about 19 percent of the population living without health insurance.
Finally, women have seen a disproportionate decline in uninsurance rates, at about 23 percent (compared to a 15 percent decline among men). Men continue to have higher rates of uninsurance and have been thus far underrepresented in the expansion population.
These gains are staggering, and they aren’t just numbers on a page. They represent our friends and neighbors getting regular access to health care so they can live healthier lives. Medicaid expansion has made affordable, quality health care a reality for thousands of Oklahomans . While rates of uninsurance remain high across the state (about 11.5 percent and even higher for some specific populations), Medicaid expansion has already gone a long way towards ensuring all Oklahomans can access health care and live healthier, happier lives.
Some Oklahomans still don’t know they’re eligible for coverage.
Unfortunately, some Oklahomans are unaware of this new pathway to coverage. An estimated 200,000 Oklahomans are eligible for Medicaid expansion, which means some 20,000 are likely eligible but unenrolled. While these individuals likely span the state and all demographics, we can estimate that certain groups may be more likely to be eligible and unenrolled.
For example, about 58 percent of Medicaid expansion enrollees are women, and only about 42 percent are men. This means men are likely overrepresented in the group that hasn’t yet applied. Similarly, fewer older individuals have enrolled, and many are likely unaware of the new coverage option. Targeted outreach to these populations will help the Oklahoma Health Care Authority and community partners reach more eligible individuals, thus increasing the benefits of Medicaid expansion at the personal, community, and statewide levels.
Help protect Medicaid and access to health care in Oklahoma.
Medicaid expansion is a good first step, but we have a long path ahead to get as many Oklahomans covered as possible. Moving forward, it is important that lawmakers understand the importance — and value — of Medicaid, and they should work to protect and expand access to care for all. Additionally, with some 20,000 residents eligible but unenrolled, every single Oklahoman can help spread the word about Medicaid expansion. When all Oklahomans can easily access high-quality, affordable health care, our state will be healthier, happier, and more productive.