Oklahoma voters will decide whether or not to expand Medicaid in November. State Question 802, which qualified for the ballot on January 9, would expand Medicaid in Oklahoma under the Affordable Care Act (ACA), also known as Obamacare. It would provide Medicaid coverage for certain low-income adults between 18 and 65 with incomes below 133% of the federal poverty level. Because the ACA includes a 5% income disregard, this measure would effectively expand Medicaid to those with incomes below 138% of the federal poverty level.

Proponents reported submitting 313,000 signatures on October 24, 2019. To qualify for the ballot, 177,958 valid signatures were required. Governor Kevin Stitt (R) will determine whether the measure will appear on the June 30 primary ballot or the November 3 general election ballot. In 2018, Oklahoma Governor Mary Fallin (R) placed State Question 788, the medical marijuana initiative, on the June primary ballot. Prior to 2018, a governor had not selected a date different from the general election for an initiative since 2005.

Medicaid is a government program that provides medical insurance to groups of people with income below a certain level and individuals with disabilities. The Affordable Care Act (ACA), also known as Obamacare, which was enacted in 2010, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138% of the federal poverty level. In 2012, the U.S. Supreme Court ruled in NFIB v. Sebelius that the federal government could not withhold funds from states that refused to expand Medicaid. The ruling had the practical effect of making Medicaid expansion optional for states. In 2018, the federal government financed 94% of the costs of state Medicaid expansion. For 2020 and subsequent years, the federal government was set to cover 90% of the costs. As of 2020, a total of 36 states and Washington, D.C., had expanded or voted to expand Medicaid, while 14 states had not.

In 2017, voters in Maine approved a ballot measure to expanded Medicaid to persons under the age of 65 and with incomes equal to or below 138 percent of the federal poverty line. The measure was the first citizen initiative to implement expanded Medicaid.

In January 2018, voters in Oregon approved Measure 101, thereby upholding 2017 legislation to provide funding for the state’s portion of costs for expanded Medicaid coverage through a tax on healthcare insurance and the revenue of certain hospitals. In November 2018, voters in Idaho, Montana, Nebraska, and Utah voted on ballot initiatives concerning Medicaid expansion and the funding of expanded Medicaid coverage. The Utah and Idaho measures were approved and later altered by the state legislatures. The Nebraska initiative was approved, and Montana’s initiative, which included a tobacco tax increase, was defeated.

Four other initiatives have been filed with the Oklahoma Secretary of State targeting the 2020 ballot. One of the measures was approved for circulation: State Question 805. That measure would prohibit a convicted person’s former felony convictions from being used to “enhance the statutorily allowable base range of punishment, including but not limited to minimum and maximum terms” and would provide for sentence modifications for eligible persons. Signatures for the measure are due by March 26, 2020. The other potential initiatives concern marijuana legalization and an independent redistricting commission.

A total of 80 measures appeared on the statewide ballot in Oklahoma from 1996 to 2018, 77.5% (62 of 80) of the measures were approved, and 22.5% (18 of 80) were defeated. Between 1996 and 2018, an average of seven measures appeared on the ballot each even-numbered year in Oklahoma.

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Additional Reading:
Oklahoma State Question 802, Medicaid Expansion Initiative (2020)