Oklahoma voters narrowly approved an expansion of Medicaid on Tuesday after years of local political opposition and the governor’s own claim that it would result in budget cuts to core services next year. 

Passage of State Question 802, which received just under 51 percent of the vote, will allow more than 200,000 Oklahomans to qualify for the federal/state plan that provides health coverage for low-income Americans. 

The expansion means a person in a family of four making between $25,750 and $35,535 may qualify for Medicaid.

Oklahoma has the nation’s second highest rate of uninsured residents – 14.2 percent, according to the U.S. Census – and has likely seen thousands more lose employer-provided health coverage in recent months though coronavirus-related layoffs. 

States already with expanded Medicaid have seen significant growth in users since unemployment rates spiked. 

Oklahoma’s unemployment rate hit 12.6 percent in May and many remain out of work as businesses, restaurants and hotels are still closed or operating at reduced capacity. 

However, the passage of SQ802 won’t have an immediate impact as the deadline for expanded coverage is not until July 1, 2021.

Supporters of SQ802 pointed to the closure of several rural hospitals in recent years and the fact that Oklahoma lags behind most states in key health metrics, such as diabetes, heart disease and life expectancy.

Passage of Medicaid expansion comes after years of political opposition as Oklahoma’s Republican leaders regularly rejected a key element of the program dubbed “Obamacare.”

But the majority of states, including conservative strongholds, have passed their own expansion initiatives. Oklahoma is the 37th state to accept Medicaid expansion. 

Gov. Kevin Stitt speaks during a media conference at the state Capitol on June 30, 2020. BEN FELDER/The Frontier

Gov. Kevin Stitt opposed SQ 802 and earlier this year floated his own expansion plan, Soonercare 2.0, that would have utilized block grants and new work requirements. 

But Stitt later vetoed the funding for his plan citing the declining economy.

On Tuesday, Stitt said he wanted to explore value-based Medicaid reimbursements that “hold hospitals accountable” for health outcomes, instead of just reimbursing for delivery of service.

He also warned that paying the state’s share of expansion would result in budget cuts.

Ninety percent of the more than $1 billion in expansion funds will be paid by the federal government and because SQ802 adds Medicaid expansion to the state Constitution, the state Legislature will be required to fund its share, estimated at around $164 million. 

“Where is that money going to come from?” Stitt asked about the state’s contribution. “It’s going to either be raising taxes, which I’m not going to be for, or cutting from other state agencies.”

An Oklahoma Watch article this week cited studies that showed little evidence that states with Medicaid expansion had to cut services.

SQ802 supporters have said Oklahomans have already been on the hook with their tax dollars funding expansion in other states.

The state question was supported by many health organizations, including the Oklahoma Hospital Association and the Oklahoma State Medical Association.

The State Chamber also backed SQ802.

Opposition intensified in the weeks leading up to the election with nearly half a million dollars spent in ads urging Oklahomans to reject the state question. The Oklahoma Council of Public Affairs spent more than $420,000 in the last two weeks of the campaign, according to finance statements. 

A pro expansion “social welfare organization” called Yes On State Question 802/Oklahomans Decide Healthcare has funded numerous ads on television and online. Often called a “dark money” group, it is not required to reveal funders