To help rural Oklahoma families, expand Medicaid

Millions of Americans gained access to health coverage in 2014 when big parts of the Affordable Care Act kicked in – but the health law’s effects were always muted in Oklahoma. When Oklahoma policymakers declined to accept federal funds to expand Medicaid to low-income Oklahomans, they stranded thousands of Oklahomans without access to health coverage. The effects of this decision disproportionately harm rural Oklahomans, their families and communities. Fortunately, it’s not too late to reverse course and expand Medicaid, bringing health coverage to the Oklahomans who need it.

Oklahoma’s uninsured rate is among the highest in the US – and in rural Oklahoma, it’s even higher.

In 2017, Oklahoma had the second-highest nonelderly uninsured rate, behind only Texas. However, drilling down into the data paints a stark picture of what Oklahoma has left behind by refusing expansion. The uninsured rate for adults who would qualify for Medicaid if Oklahoma were to expand is 35 percent statewide. Now, a new report shows that it’s substantially higher for rural areas than for metros. In the state’s urban centers, the uninsured rate for these adults is 32 percent. But in rural Oklahoma, it’s 38 percent. That’s nearly 4 in 10 low-income rural Oklahoma adults going without needed medical care.

This has ripple effects for rural areas, as Medicaid expansion can help these crucial care providers keep their doors open. Oklahoma has seen two rural hospitals close just this fall: Pauls Valley Regional Medical Center and Latimer County General Hospital in Wilburton (previous closures included hospitals in Eufala, Frederick, and Sayre). When rural hospitals close, the next closest source of emergency care can be miles away, putting patients at risk. And the consequences extend beyond patient care. According to one study, when a community loses its only hospital, per capita income falls by 4 percent and unemployment increases by 1.6 percentage points. By contrast, a recent study in the journal Health Affairs found that “Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion.” 

The benefits of Medicaid expansion go far beyond health care

According to projections, some 233,000 Oklahomans would enroll if the state were to expand Medicaid, 153,000 of whom would have been previously uninsured. Creating access to quality health care for low-income Oklahomans would save nearly 500 lives every year. The expansion population includes both childless adults, who don’t qualify for Medicaid at all, and working parents, who are locked out due to the state’s low eligibility threshold but who rarely have access to other forms of coverage. Oklahoma’s child uninsured rate is currently among the highest in the US, and the well-documented link between access to care for parents and children means that expanding coverage for parents will result in more children getting coverage, too. In short, the benefits of Medicaid expansion go far beyond just those who would become eligible for coverage as a result of expanding. 

Medicaid expansion’s benefits extend beyond simply being able to see a doctor or fill a prescription – it would also remove some of the barriers to financial security for Oklahoma families. Getting more people enrolled in Medicaid would reduce medical debt in Oklahoma by more than $200 million and by increasing access to credit as a result, save Oklahoma families more than $66 million per year. Finally, by increasing access to needed mental health and substance use disorder treatment, expanding Medicaid would result in fewer public safety offenses, generating more than $250 million in savings for Oklahoma communities as a result.

Medicaid expansion is popular in red and blue states

Even in the early days of the Affordable Care Act, Medicaid expansion decision never fell cleanly along ideological lines. For instance, two politically conservative states, Arkansas and Kentucky, began enrolling eligible people in expanded coverage in 2014, the first year that it became available. Since then, more red states, including Arizona, North Dakota, West Virginia, and Virginia have signed on. 

Now, a handful of ballot initiatives suggest that even more conservative states could expand coverage. Maine voted overwhelmingly to expand coverage last year. In today’s midterms, Medicaid expansion will be on the ballot in three notably red states as voters in Idaho, Nebraska, and Utah vote on whether to expand coverage. Meanwhile, Montanans will vote on whether to retain their expansion, which took effect in 2016. The outcomes of these measures will send a strong signal to advocates in other red states about whether they could bypass their legislatures and put the issue directly to voters instead.

The bottom line

In 2013, shortly before primary provisions of the Affordable Care Act took effect, then-Kentucky Governor Steve Beshear wrote an op-ed in the New York Times entitled “My State Needs Obamacare. Now.” In the piece, Gov. Beshear described how lack of coverage put Kentuckian’s health and financial security at risk and why he’d embraced the Affordable Care Act:

They roll the dice and pray they don’t get sick. They choose between food and medicine. …They put off doctor’s appointments, hoping a condition turns out to be nothing. And they live knowing that bankruptcy is just one bad diagnosis away.

But since the health law took effect, that largely rural, infamously unhealthy state has turned a corner. Just a few years later, researchers reviewing data from Arkansas and Kentucky found a 30 percent drop in the share of people skipping medications due to cost, a 64 percent drop in the share relying on the emergency room for their health care, and a 40 percent increase in the share of people reporting excellent health.  

Oklahoma could have seen those gains, too, if state leadership hadn’t chosen to leave Oklahoma families behind. Instead, the 4 in 10 low-income rural Oklahomans who would have been covered are in the same position as Kentucky’s in 2013, rolling the dice and praying they don’t get sick. But it doesn’t have to be this way. By expanding access to care, Oklahoma can bring needed health coverage to the people who need it.