OKLAHOMA CITY -- Oklahoma Gov. Kevin Stitt is not too keen on expanding Medicaid under the provisions of the Affordable Care Act, also known as "Obamacare." Or at least he would rather the voters not force it on lawmakers.
The Oklahoman recently reported that Stitt would "actively discourage" state voters from approving a Medicaid expansion by getting a state question on the November 2020 ballot.
"I'm going to tell Oklahomans that's the wrong approach, but I understand I've got to give them a Plan B," Stitt told the Oklahoman.
Expansion supporters have filed to gather signatures for an initiative petition to let voters decide on the funding. The petition will need 178,000 signatures to trigger a state question.
The petition was sought because it's unlikely state legislators will vote for the expansion. With Republicans controlling the House and Senate, Democrats do not hold enough seats in either chamber to derail the 75 percent approval needed for new revenue measures.
Oklahoma is among 14 states that do not accept the ACA Medicaid expansion. The arguments against expansion include the state not being able to afford it, or the possibility of the federal government offloading some funding burden to the states. Match rates vary, but the federal government currently picks up more than 90 percent of the bill for most states.
Supporters have argued that Oklahoma taxpayers are helping foot the federal expense of Medicaid expansion and reaping none of the benefit.
CN officials have taken no official stance on whether it believes Oklahoma should accept the Medicaid expansion -- uninsured Cherokees can receive health care through tribal services -- but the tribe encourages its citizens to purchase health insurance if possible. CN Health Services can bill insurers for reimbursement, thereby stretching the Nation's health care resources. The CN has estimated that about half its citizens do not carry health insurance.
The option to take or leave Medicaid expansion was established when the U.S. Supreme Court -- while ruling the ACA constitutional -- decided the Medicaid provisions were unreasonable. The ruling said the federal government could not withhold matching funds for state Medicaid programs if they didn't increase eligibility to 133 percent of the federal poverty level.
Medicaid expansion was expected to offset some reductions to Medicare reimbursements. In states that refuse expansion, hospitals and health care providers may try to recover lost revenue from other insured patients.
Some states have attached work requirements to Medicaid eligibility. While decried by some, such requirements are believed to have little effect on benefits or costs.
Stitt told the Oklahoman he would any Medicaid expansion ballot question that doesn't include a work requirement.
While stumping for the office, Stitt said: "Obamacare is a disastrous law that Congress should repeal and replace with a solution that encourages a competitive business climate to drive down cost for all Oklahomans and increase health care options."
But after taking office in January, his hostility toward expansion seemed to soften, though he expressed little enthusiasm for locking in on federal terms. In January, Stitt and GOP lawmakers suggested they might be more receptive to expansion with an opt-out or waiver.
"I'm going to be very careful where I don't put Oklahoma in a tough situation ... where we're stuck providing more government services and a billion dollar price tag," Stitt said in January. "We've got to be very careful, but absolutely."
Stitt claimed he would not "say never" to expansion, but said he also had to look at the "big picture" of what is best for all Oklahomans.
"While Medicaid expansion currently stops at a 90 percent federal match, we cannot assume that it will remain this high forever," he said. "The estimated $150 million price tag today for Oklahoma to expand Medicaid could leave us down the road fronting more than $1 billion when the federal government pulls back on its commitment."