By Emma Murphy, Oklahoma Voice
OKLAHOMA CITY — Oklahomans could vote in November on a state question seeking to make major changes to the Medicaid expansion program if a new proposal unveiled this week gains traction.
The latest legislative effort, House Joint Resolution 1067, would ask general election voters to approve a single ballot measure to both remove Medicaid expansion from the state Constitution and allow the Legislature to decline to cover the cost of the program if the federal match drops below its current rate of 90%.
Republican lawmakers previously proposed splitting the issues into two different state questions, which would have appeared on two different election dates, but the Senate was unable to garner enough support to qualify Medicaid changes for the August ballot.
“We were sitting here with two similar proposals to the voters of Oklahoma to be on the November ballot,” said Rep. Ryan Eaves, R-Atoka, the House bill author. “I don’t think anybody wants that, that doesn’t make sense.”
Potential state questions on Medicaid expansion have been stuck in limbo over what election date they should appear, but Eaves said the latest plan combines the original concepts behind HJR1067 and House Bill 4440 into one measure.
The Legislature cannot alter Medicaid expansion without first obtaining voter approval because it’s enshrined in the Oklahoma Constitution.
Against the wishes of many legislators, voters in 2020 approved expanding the state’s Medicaid program to provide healthcare access to over 200,000 working, lower-income Oklahomans.
Lawmakers have repeatedly said the state cannot afford the rising cost of Medicaid expansion unless changes are made to the program. They want permission to make adjustments to it.
Under HJR1067’s new language, the state would be required to provide healthcare services to low-income Oklahomans and “for medical services at healthcare facilities for which the State receives a match of 100% pursuant to federal law.”
Eaves said this new language would cover Indigenous populations and was the result of negotiations with Oklahoma tribes.
Cherokee Nation Principal Chief Chuck Hoskin Jr. and the Inter-Tribal Council of the Five Civilized Tribes have spoken out in support of preserving Medicaid expansion.
While Eaves said he’s personally not a fan of having “two different sets of rules,” he said he is not concerned about challenges to the constitutionality of the measure, including whether it violates the state’s prohibition against measures that contain more than one subject or because it carves out a special population, such as tribal members.
The Oklahoma Constitution contains a single-subject rule. It forbids lawmakers from combining unrelated topics into legislation or ballot measures.
The state Constitution also bars the creation of “special laws” that give special or preferential treatment to people based on race, ethnicity or origin.
This is a “strictly financial” issue and the Oklahoma Legislature’s hands are tied because Medicaid expansion is enshrined in the state Constitution, Eaves said.
“I’m from Oklahoma, I know how important Medicaid is, both to the people and our rural hospitals,” Eaves said. “However, we’re five or six years into Medicaid expansion, being told it was going to do all these great things for us, and it hasn’t. We have not seen health outcomes increase.”
Republican leaders were pushing to place one Medicaid state question on the Aug. 25 primary runoff ballot, but failed to garner the two-thirds support needed due to a rare moment of unity between Senate Democrats and far-right Republicans in the Freedom Caucus.
House Speaker Kyle Hilbert, R-Bristow, said the plan is to move forward with a single Medicaid state question and he hopes the new language will go before the House.
Senate President Pro Tem Lonnie Paxton, R-Tuttle, said he assumes the chambers will come to an agreement in order to place the question on the November ballot, and the Senate is looking at the proposed language.
The Senate adjourned Wednesday morning without taking up any legislation and plans to return next week before the wrapping up session on May 14, about two weeks earlier than constitutionally required.
