Health advocates have long known how critical Medicaid is to the lives of countless Americans. Medicaid’s value has now become more apparent to legislators as the COVID-19 pandemic has exacerbated issues of access to critical health services. Thanks to the tireless efforts of health advocates in Oklahoma, a waiver application that would have weakened Oklahoma’s Medicaid program has now been withdrawn. This comes two months after Oklahomans voted to approve a ballot measure to expand their Medicaid program. These triumphs in advocacy will allow Oklahomans to benefit from expanded health care access with no strings attached.
How was Governor Stitt attempting to weaken Oklahoma’s Medicaid program?
Earlier this year, Republican Governor Kevin Stitt proposed SoonerCare 2.0, a Medicaid 1115 demonstration waiver, in response to the Trump administration’s Healthy Adult Opportunity (HAO) initiative. The HAO initiative is an attempt by the Trump administration to impose federal Medicaid funding caps (sometimes referred to as block grants or per capita caps) in exchange for flexible state oversight of their respective Medicaid programs. Governor Stitt’s SoonerCare 2.0 would have allowed him to “impose premiums and work requirements on Medicaid expansion enrollees while accepting a limit on how many federal dollars the state would receive.” With alarming unemployment levels and Oklahoma’s 14 percent uninsured rate, the second highest in the nation, this proposal would have been detrimental to Oklahomans who are especially vulnerable amidst the current public health crisis.
SoonerCare 2.0 could have been particularly harmful to communities of color in Oklahoma, who have been disproportionately affected by COVID-19 and are more likely to live in poverty. For example, the Tulsa Health Department shows that as of July 7, 2020, Latinx people accounted for 24.14 percent of total COVID-19 reported cases in Tulsa County, but only make up 13.3 percent of the general population. This is due to the fact that communities of color face multiple inequities that impact their health and access to health care, such as disproportionate levels of financial stress. “According to the U.S. Census Bureau, in 2017 approximately 95,550 Hispanic Oklahomans, 76,622 Black Oklahomans, and 61,820 Indigenous Oklahomans were living in poverty.” These individuals are more likely to be in the Medicaid coverage gap, and expanding Medicaid with waiver barriers could have created significant challenges for them to access care (including work requirements, potential cuts to benefits, and potential cuts to eligibility) if SoonerCare 2.0 had been implemented. As a result of the successful ballot measure to expand Medicaid and withdrawal of the SoonerCare 2.0 proposal, those newly eligible for expanded Medicaid will have more equitable access to health care.
How did advocates’ efforts contribute to the Medicaid victories in Oklahoma?
Advocates across Oklahoma recognized the dangers posed by SoonerCare 2.0 and rallied together to ensure that Governor Stitt would not jeopardize Oklahomans’ access to needed services in the midst of the COVID-19 pandemic.
The Cover Oklahoma Coalition and the Oklahoma Policy Institute activated a strong grassroots base of health care advocates to speak out against the Governor’s HAO waiver. During Governor Stitt’s 30-day state comment period for his SoonerCare2.0 waiver, the Cover Oklahoma coalition collected more than 2,700 comments from Oklahomans concerned about the proposal and its restrictions. That was nearly double the comments collected during a similar Medicaid public comment campaign in 2018. OK Policy Institute also brought attention to the fact that Oklahoma Health Care Authority’s virtual public hearings for the HAO Waiver were flawed and lacked transparency.
Beyond advocates’ public comment campaign, OK Policy Institute and partners continued to educate the public about the need for full Medicaid expansion with no barriers – and push back against political attacks on the Medicaid program. For example, just days before the ballot measure vote to expand Medicaid in Oklahoma, Governor Stitt held a press conference about a Medicaid audit he ordered nearly sixteenth months prior. With no clear purpose for the press conference, OK Policy Institute made clear that the Governor’s press conference was simply a political ploy to confuse the public.
Congratulations to our partners in Oklahoma who dedicated their time and energy to ensuring greater health care access for Oklahomans!
OK Policy Institute and other Oklahoma advocates have proven that despite challenges to coordinating in-person outreach opportunities amidst a pandemic, it is still possible to effect change. These victories are a testament to the passion of our advocacy partners and the outrage felt by Oklahomans in response to Governor Stitt’s restrictive health care proposal. In the world of Medicaid defense, there is no sweeter victory than the defeat of a block grant proposal that could stand to erode the funding mechanisms and core purpose of the Medicaid program. Seeing a state like Oklahoma do an about-face on block grants is some very good news we all can celebrate!