There’s been much debate nationwide about Medicaid expansion.  To date, 36 states and the District of Columbia have expanded Medicaid according to the Kaiser Foundation. 

            I’ve noticed most media coverage is slanted one way or another so I wanted to try to get both sides in the same article.  This could possibly be a state question in the future so it’s important that we’re all educated on the subject.

            The Affordable Care Act (ACA) required the states to expand Medicaid eligibility to more low-income citizens specifically those with incomes up to 138 percent of the federal poverty level (FPL).  This is about $17,000/year for an individual; about $23,000 /year for a family of two; and around $35,000/year for a family of four. However, in June 2012, the Supreme Court ruled that unconstitutional and left it up to the states to decide whether to participate or not.

            Remember, Medicare covers those over the age of 65; CHIP covers children through age 18 up to roughly 210 percent FPL; and people with disabilities can be covered through Medicare, SSDI and Medicaid if they meet the income guidelines.

            By 2017 between ten and eleven million citizens had gained coverage through Medicaid expansion in their states.  This number changes as people’s circumstances do. In states that expanded Medicaid, enrollment increased by nearly 14 million people or nearly 36 percent between 2013 and July 2018. 

            In the 14 states, like Oklahoma, that haven’t expanded, there’s a “coverage gap” that has left nearly two million citizens ineligible for any kind of affordable coverage.

            Oklahomans ages 19-64 without children and/or disabilities don’t qualify for Medicaid, regardless of their income.  Oklahomans have to meet one of the population categories as well as the income guidelines. These able-bodied adults without dependents (ABAWD) are considered Oklahoma’s “expansion population”.

            From 2014 to 2016 the federal government paid the full amount of the Medicaid expansion and then slowly states have begun absorbing some of the cost, which will increase to a total of 10 percent by 2020. The federal government is supposed to continue paying 90 percent of the expansion as long as the ACA stays active.

However, many opponents look at other programs through history that became unfunded mandates and fear that states will eventually be responsible for a majority of the costs.  Again, once a population receives any kind of government benefit, it’s hard to take it away from them.

            The cost of expanding Medicaid in Oklahoma will depend on how it is expanded.  This decision can be made by the state legislature or through a state question. Most lawmakers aren’t opposed to Medicaid expansion, conservative ones and Gov. Stitt just believe there should be certain conditions met to receive government assistance. This is no different than Oklahoma state employees and educators, for instance, being required to work so many hours a month in order to receive their health insurance benefits.  Some suggestions have included work requirements or participants paying a small portion of their premiums.

In past years, Oklahoma tried to require drug testing for those receiving state government assistance as it was found that many struggled with some kind of addiction, which was why they couldn’t stay employed and had such low incomes. However, that requirement was ruled unconstitutional.

            State leaders are studying the issue this interim to provide an alternative health care plan to improve health outcomes and get the state additional federal health care funding. 

            It’s been pointed out that Oklahoma has lost around $1 billion in annual federal healthcare funds since 2014. To get that money, Oklahoma would have had to provide $100 million annually as well. From 2009 to 2017, Oklahoma had faced historic revenue failures and shortfalls as high as $1.3 billion. There was no way for the state to provide $100 million annually for the health care funding match without raising fees or taxes, which most Oklahomans are opposed to.

            It also must be noted that this isn’t a program Oklahoma can provide and then stop if our state economy falls again. Once these benefits are provided, the state will have to figure out a way to pay its 10 percent from now on. 

            To contact me at the Capitol, please write to Senator Ron Sharp, State Capitol, 2300 N. Lincoln Blvd. Room 412, Oklahoma City, OK, 73105, email me at, or call (405) 521-5539.