Expand or not?
Candidates don’t see eye-to-eye on Medicaid
If elected governor, Drew Edmondson wants to expand Medicaid in Oklahoma, embracing a part of the Affordable Care Act that would open health coverage to an additional 200,000 low-income Oklahomans.
But Edmondson likely would find a Republican-controlled Legislature that would require some major convincing.
“(Medicaid) expansion would be a very hard sell,” said Sen. Greg Treat, R-Oklahoma City, who will lead the state Senate next year.
Republican gubernatorial candidate Kevin Stitt opposes Medicaid expansion, the same position as Gov. Mary Fallin.
Expanding Medicaid would mean about $100 million per year in additional state costs; the federal government would pick up the rest of the $1 billion expansion cost.
As one of the biggest policy achievements of former President Barack Obama, who was unpopular in deep red Oklahoma, Medicaid expansion
has not been welcomed in many conservativeleaning states.
But Edmondson believes if he wins the Nov. 6 election against Stitt and Libertarian candidate Chris Powell, who also opposes Medicaid expansion, he would have a mandate from voters.
“We’re sending hundreds of millions of our tax dollars to other states to take care of the medical needs of people in Michigan and California and Pennsylvania,” Edmondson said. “Let’s bring that home.”
House Floor Leader Jon Echols said he would be willing to talk about it.
“Am I willing to have that conversation? Of course,” said Echols, R-Oklahoma City, when asked about a future governor who may want to expand Medicaid.
“Medicaid expansion can mean lots of different things and there are scenarios where I wouldn’t be in favor of it. But I’ll tell you this, Republicans need to have an answer on health care.”
Rural hospitals have struggled to remain open in parts of the state, Oklahomans continue to rank low in a variety of health metrics and Oklahoma has the second highest uninsured rate in the nation.
If Edmondson wins in November, “I think that would definitely be a sign that Oklahomans are interested in these kinds of ideas, like Medicaid expansion, which Edmondson has not been shy of talking about,” said Gene Perry, the strategy and communications director for the Oklahoma Policy Institute, a Tulsabased think tank.
Perry pointed to movements to expand Medicaid in other conservative states as an example of a shifting political landscape on the issue and said expansion in Oklahoma would help residents whose incomes are too high to qualify for traditional Medicaid but not high enough to afford private health insurance coverage.
Virginia offers Edmondson a possible example, as the state’s Democratic governor reached an agreement this year with the Republican General Assembly to expand Medicaid coverage. The bipartisan pact included work requirements that pleased many conservative lawmakers.
Thirty-four states and the District of Columbia have expanded Medicaid, including Arkansas, Kentucky and West Virginia.
Voters in Idaho, Utah and Nebraska will decide on local expansion plans in November.
Edmondson has said he would support a statewide vote on expansion if he were unable to get support from the state Legislature.
Stitt said he’s opposed to expansion because it creates more dependency on a government system that often doesn’t work.
“We cannot create ... more dependency on our state because that is going to be a tremendous detriment to our state,” Stitt said last month at a debate hosted by The Oklahoman.
The governor can sign a waiver letter to the Centers for Medicare and Medicaid Services to start the process of expanding Medicaid. Necessary changes to Oklahoma’s rules would be sent to the state Legislature for approval, according to Jo Stainsby, a spokeswoman for the Oklahoma Health Care Authority, which oversees the state Medicaid program.
The state’s additional contributions to Medicaid would also have to be approved by the Legislature in the agency’s budget request.
“I think the Republicans will still be in charge of both houses of the Legislature (next year), the odds are very high of that happening,” Edmondson said. “We would need them to at least be cooperative (in expanding Medicaid) or get out of the way and let me go forward at the executive level."