Voters narrowly approved an amendment to the state constitution on Tuesday that expands Medicaid to include many people who previously were ineligible due to income limits on the program.
With all of the precincts counted, the yes votes for State Question 802 held a more than 6,000-vote lead over the no votes, in a contest that came down to rural voters versus urban voters, with the latter winning.
In all, 50.48% of the more than 673,110 votes cast were in support of expanding the Medicaid program in the state to help low-income working adults.
An estimated 200,000 low-income Oklahomans now will be eligible for the health insurance program when it becomes effective by July 1, 2021.
Amber England, campaign chair of the pro-802 effort, thanked supporters on Facebook Live about 10:40 p.m. as the last of the results were counted.
“We knew from Day 1 that this would be a tough battle,” England said. “They threw everything they had at us at the last minute.”
Passage of the state question means low-income individuals age 19 to 64 who earn no more than 133% of the federal poverty level will be eligible for government-subsidized Medicaid coverage, with the state picking up 10% of the cost and the federal government paying the rest.
Under 2019 poverty guidelines, expanded Medicaid coverage would provide health insurance to a single adult making less than $17,236 annually or adults in a family of four with a household income of less than $35,535 annually.
The measure prohibits officials from creating additional restrictions to qualify for the program beyond the regular Medicaid program requirements.
Prior to the vote, 36 states and Washington, D.C., had expanded their Medicaid coverage.
In October, proponents of expanding Medicaid turned in 313,000 signatures — well in excess of the 178,000 needed — to land the question on a 2020 ballot.
The state question drew support from a wide range of businesses and organizations, from local and state chambers of commerce and the Oklahoma Education Association to hospitals and medical associations.
Gov. Kevin Stitt led the opposition to the state question. He was joined by the Oklahoma Council of Public Affairs, Americans for Prosperity and the 1889 Institute.
During a COVID-19 news conference Tuesday afternoon, Stitt continued to voice concerns about the measure being carved into the state constitution and how the state would come up with the required 10% in matching funds.
“The question is how are we going to pay for it,” Stitt said. “We don’t have an extra $200 million sitting around,” referring to one estimate of the annual cost.
Stitt said that since he opposes a tax increase to pay for the state’s share of the program, the only other option will be agency budget cuts.
He vetoed a funding bill this year for his own SoonerCare2.0 Medicaid expansion program. In his written veto message, Stitt explained that in the time since he proposed the measure, the unemployment rate in the state had increased from 3.2% to more than 14% due to the COVID-19 pandemic.
Stitt has favored a President Donald Trump-backed expansion program that included block grants, “modest premiums” and a work requirement.
John Tidwell, state director of Americans for Prosperity and chairman of the Vote No On 802 Association, issued the following statement when 99% of the precincts were counted:
“Results are clear: a plan that claims to save ‘rural health care’ was overwhelmingly rejected by rural communities across Oklahoma.”
Proponents say Medicaid expansion will bring an estimated $1 billion in federal Medicaid funding to the state and will help financially strapped rural hospitals.
Oklahoma currently ranks No. 2 nationally in the percentage of the population without health insurance.
An estimated 14.2% of Oklahomans, or 548,316 individuals, didn’t have health insurance when surveyed for the 2018 U.S. Census Bureau American Community Survey of households.
An estimated 31% of the state’s 2.1 million registered voters cast a ballot on the state question.
Tulsa County was one of seven counties in the state that supported the state question. About 60% of the more than 104,590 ballots cast in Tulsa County were for the measure.
Other counties supporting it were Cherokee, Cleveland, Comanche, Oklahoma, Payne and Pontotoc.
Gallery: Voters cast ballots on Election Day