The initiative to extend health coverage for some 200,000 Oklahomans kicks off July 31st. That’s when Oklahomans Decide Healthcare will begin collecting signatures for State Question 802, which would put Medicaid expansion to a vote of the people. If the group is successful, Oklahomans will get to vote in 2020 on whether the state will expand Medicaid.
What happens next?
Oklahomans Decide Healthcare has 90 days from July 31st to collect at least 178,000 signatures – 15 percent of the votes cast in the most recent gubernatorial election – and signatories must be registered voters in the state of Oklahoma. Organizers have said they intend to collect more than 200,000 signatures, giving themselves a cushion in case some signatures are thrown out.
Ballot initiatives in Oklahoma can change statute or amend the state Constitution, with the latter requiring more signatures to make it onto the ballot. Oklahomans Decide Healthcare wants to put Medicaid expansion in the state Constitution rather than simply changing statute. If enough signatures are collected and voters approve the measure, Medicaid expansion will be added to the Oklahoma Constitution, which will make it difficult for the legislature to tamper with it. In the four states where Medicaid expansion passed via ballot initiative, the change was only statutory, and those states’ legislatures and Governors were able to limit or roll back the expansion passed by voters.
Once the signatures are collected, the Secretary of State, state Attorney General, and state Supreme Court will count the signatures to ensure they meet the state’s requirements and write the ballot title. There’s also a period for legal challenges. After that, Governor Kevin Stitt will determine which ballot State Question 802 will appear on, or call a special election.
How did we get here?
Oklahoma is one of just 14 states that hasn’t expanded their Medicaid programs to include low-income working-age adults, who otherwise have virtually no health insurance options. Thirty-six states and Washington, DC have expanded Medicaid. The Oklahoma state legislature seriously considered expansion for the first time in 2019, when SB 605 became the first Medicaid expansion bill heard in a legislative committee. Although the bill passed out of committee unanimously, it died when it was not heard before the next legislative deadline.
The ballot initiative process in Oklahoma formally began in April 2019, when two Oklahoma women, Kelly Smalley and Erin Taylor, filed a petition with the Oklahoma Secretary of State, which designated the petition State Question 802. Although the Oklahoma Council for Public Affairs filed a legal challenge shortly thereafter, alleging that SQ 802 was unconstitutional and the gist was inadequate, the state Supreme Court disagreed. On June 19, the state Supreme Court cleared the way for a Medicaid expansion ballot initiative to move forward.
What about Governor Stitt’s plan?
The ballot initiative may not be the only expansion effort under consideration in the fall of 2019 or in 2020. Governor Kevin Stitt has said he expects to be able to unveil a customized Medicaid expansion plan in late summer or early fall 2019. The Legislature will then take up the plan in the 2020 Legislative session.
There is a possibility that both the initiative expansion and legislative expansion could pass. If the Legislature passes an expansion bill, the expansion initiative will still be put on the ballot if it gathers enough signatures and meets other legal requirements. In this situation, if the initiative passes, it should supersede the legislative expansion because the initiative is a constitutional amendment and the legislative expansion would be statutory.
Carly Putnam is Policy Director at Oklahoma Policy Institute.