Oklahoma State Question 802, Medicaid Expansion Initiative (June 2020)

Elections in Oklahoma, 2020

• Primary date: June 30
• Primary type: Closed (Republican and Libertarian parties); semi-closed (Democratic)
• Registration deadline(s): June 5
• Online registration: Yes
• Same-day registration: No

• Early voting starts: June 25
• Absentee/mail voting deadline(s): June 30 (received)
• Voter ID: Non-photo ID
• Poll times: 7 a.m. to 7 p.m.

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Date of Oklahoma presidential primary: March 3

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On the ballot: U.S. Senate • U.S. House • State executive offices • State Senate • State House • Special state legislative • Supreme court • Appellate courts • Local judges • State ballot measures • Local ballot measures • School boards • Municipal • 

Oklahoma State Question 802
Election date June 30, 2020
Topic Healthcare
Status a Approved
Type Constitutional amendment	Origin Citizens
List of Oklahoma measuresState Question 802State Question 805State Question 814Submit

State Question 802, the Oklahoma Medicaid Expansion Initiative, was on the ballot in Oklahoma as an initiated constitutional amendment on June 30, 2020. It was approved.

A "yes" vote supported expanding Medicaid eligibility to adults between 18 and 65 whose income is 133% of the federal poverty level or below, which effectively expanded Medicaid to those with incomes at or below 138% of the federal poverty level under the Affordable Care Act.

A "no" vote opposed this constitutional amendment to expand Medicaid eligibility in Oklahoma under the Affordable Care Act.

Election results

Oklahoma State Question 802
Result		Votes	Percentage
Yes		340,572	50.49%
No		334,019	49.51%

Results are officially certified.

Source

Overview

What did State Question 802 do?

See also: Full text and ballot language

This measure expanded Medicaid in Oklahoma under the Affordable Care Act (ACA), also known as Obamacare. It was designed to provide Medicaid coverage for certain low-income adults between 18 and 65 with incomes at or below 133% of the federal poverty level (FPL). For 2020, the FPL was $12,490 for individuals and $25,750 for a family of four. Because the ACA includes a 5% income disregard, this measure effectively expanded Medicaid to those with incomes at or below 138% of the federal poverty level.

The following table displays the federal poverty level income numbers as of 2020.

Family size	Federal Poverty Level (2020)	138% of Federal Poverty Level (2020)
Individual	$12,490	$17,236
Family of 2	$16,910	$23,335
Family of 3	$21,330	$29,435
Family of 4	$25,750	$35,535

What is Medicaid expansion?

See also: Background information on Medicaid

Medicaid is a government program that provides medical insurance to groups of low-income people and individuals with disabilities. The Affordable Care Act (ACA), also known as Obamacare, 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, 14 states, had chosen not to expand Medicaid.

What did the campaigns say about State Question 802?

See also: Support and Opposition

Oklahomans Decide Healthcare led the campaign in support of the initiative. Oklahomans Decide Healthcare said, "Expanding Medicaid will [make] our families healthier and our economy stronger. It will deliver healthcare to those who need it, including many parents, seniors, and hardworking folks who earn less than $17,000 a year. It will also bring more than a billion of our tax dollars home from Washington, D.C. every year to create jobs, boost our economy, and keep our rural hospitals open. That’s money that 36 other states that have expanded Medicaid get, but Oklahoma has lost out on for years." State Question 802 was supported by the Oklahoma Hospital Association, State Medical Association, Osteopathic Association, and Nurses Association.

The Vote No on 802 Association opposed the initiative. The committee was chaired by John Tidwell, state director of Americans for Prosperity. Tidwell said, "State Question 802, which will force Medicaid expansion, will overwhelm our already struggling state budget and hurt those that the program was intended to help. There is no question that overburdening an already fragile system will lead to cuts of core services we all rely on and trigger tax increases at a time when Oklahomans can least afford additional financial burdens. Oklahoma must vote no on State Question 802." Oklahoma Governor Kevin Stitt (R) also opposed the initiative. A spokeswoman for Stitt said, "If SQ 802 passes, our state agencies will experience deep cuts, because the ballot measure offers no mechanism to pay for it. The governor does not support this unfunded mandate."

Text of measure

Ballot title

The ballot title for the measure was as follows:

“

This measure adds a new Article to the Oklahoma Constitution. The new Article would expand Oklahoma's Medicaid program to include certain low-income adults between the ages of 18 and 65 whose income does not exceed 133% of the federal poverty level, as permitted under the federal Medicaid laws. Shall the proposal be approved? For the proposal - YES Against the proposal - NO A "YES" vote is a vote in favor of this measure. A "NO" vote is a vote against this measure.

”

Constitutional changes

See also: Oklahoma Constitution

The measure added a new article (XXV-A) to the Oklahoma Constitution. The following underlined text was added: Note: Hover over the text and scroll to see the full text.

CONSTITUTION OF OKLAHOMA, ARTICLE XXV-A -MEDICAID EXPANSION

SECTION 1. Definitions

As used in this Article:

A. "Centers for Medicare and Medicaid Services" or "CMS" refers to the agency responsible for administering the Medicaid program at the federal level, including review and approval of State Plan Amendments.

B. "Low Income Adults" refers to those individuals over age 18 and under age 65 whose income does not exceed one-hundred thirty-three percent (133%) of the federal poverty level, as described by and using the income methodology provided in the federal Medicaid statute at 42 U.S.C. § 1396(a)(10)(A)(i)(VIII), and who meet applicable non-financial eligibility conditions for Medicaid under 42 CFR Part 435, Subpart E.

C. "Medical assistance" means payment of part or all of the cost of the care and services, or the care and services themselves, or both, as provided in the federal Medicaid statute, 42 U.S.C. § 1396 et seq.

D. "Oklahoma Health Care Authority" refers to the single State agency responsible for administering the Oklahoma Medicaid program pursuant to 42 U.S.C. S 1396a(a)(5).

E. "State Plan Amendment" refers to the document(s) the State submits to the Centers for Medicare and Medicaid Services for review and approval before making a change to its program policies, including setting forth the groups of individuals to be eligible for medical assistance.

SECTION 2. Medicaid Expansion

A. In addition to those otherwise eligible for medical assistance under Oklahoma's Medicaid program, the State shall provide medical assistance under Oklahoma's Medicaid program to Low Income Adults.

B. No greater or additional burdens or restrictions on eligibility or enrollment shall be imposed on persons eligible for medical assistance pursuant to this Article than on any other population eligible for medical assistance under Oklahoma's Medicaid program.

SECTION 3. Implementation

A. Within 90 days of approval of this Article, the Oklahoma Health Care Authority shall submit a State Plan Amendment and all other necessary documents to seek required approvals from the Centers for Medicare and Medicaid Services to include Low Income Adults as a coverage group in Oklahoma' s Medicaid program beginning no later than July 1, 2021.

B. The Oklahoma Health Care Authority shall take all actions necessary to maximize federal financial participation in funding medical assistance pursuant to this Article.

SECTION 4. Severability

The provisions of this Article are severable, and if any part or provision hereof shall be void, invalid, or unconstitutional, the decision of the court so holding shall not affect or impair any of the remaining parts or provisions hereof, and the remaining provisions hereof shalI continue in force and effect.

Readability score

See also: Ballot measure readability scores, 2020

Using the Flesch-Kincaid Grade Level (FKGL and Flesch Reading Ease (FRE) formulas, Ballotpedia scored the readability of the ballot title and summary for this measure. Readability scores are designed to indicate the reading difficulty of text. The Flesch-Kincaid formulas account for the number of words, syllables, and sentences in a text; they do not account for the difficulty of the ideas in the text. The initiative petitioners wrote the ballot language for this measure. The FKGL for the ballot title is grade level 15, and the FRE is 29. The word count for the ballot title is 46, and the estimated reading time is 12 seconds.

Support

Oklahomans Decide Healthcare- Yes on 802 led the campaign in support of the initiative.

Supporters

• Oklahoma Hospital Association
• Oklahoma State Medical Association
• Oklahoma Osteopathic Association
• Oklahoma Nurses Association
• Saint Francis Health System
• Oklahoma Policy Institute

Arguments

• Oklahoma Hospital Association, the Oklahoma State Medical Association, the Oklahoma Osteopathic Association, the Oklahoma Nurses Association, and the Saint Francis Health System: [The measure would] "allow the citizens of Oklahoma to demand that the state accept the federal dollars that 36 other states and the District of Columbia have already accepted in order to bring Medicaid coverage to many of their fellow Oklahomans who remain uninsured." They further argued that "accepting $9 in federal funds for every investment of $1 by our state is a much better match than many federal programs offer and like other federal partnerships would boost our economy and increase employment."
• Oklahomans Decide Healthcare: "Too many Oklahomans work at jobs that don’t offer health insurance, forcing hundreds of thousands of our neighbors and family members to choose between life-saving care and putting food on the table. Expanding Medicaid will change that for nearly 200,000 Oklahomans, making our families healthier and our economy stronger. It will deliver healthcare to those who need it, including many parents, seniors, and hardworking folks who earn less than $17,000 a year. It will also bring more than a billion of our tax dollars home from Washington, D.C. every year to create jobs, boost our economy, and keep our rural hospitals open. That’s money that 36 other states that have expanded Medicaid get, but Oklahoma has lost out on for years."

Opposition

Vote No on 802 Association was registered with the Oklahoma Ethics Commission to oppose State Question 802. The committee was chaired by John Tidwell, state director of Americans for Prosperity.

Opponents

• John Tidwell, director of Americans for Prosperty-Oklahoma (AFP-OK) said, "State Question 802, which will force Medicaid expansion, will overwhelm our already struggling state budget and hurt those that the program was intended to help. There is no question that overburdening an already fragile system will lead to cuts of core services we all rely on and trigger tax increases at a time when Oklahomans can least afford additional financial burdens. Oklahoma must vote no on State Question 802."

• Oklahoma Council of Public Affairs, which filed a petition challenging the legality of the measure
• Oklahoma Governor Kevin Stitt (R)
• State Rep. Mark Lepak (R)
• Former Oklahoma Governor Frank Keating (R)
• State Rep. Dean Davis

Arguments

• Oklahoma Council of Public Affairs: "Oklahoma would be obligated to provide medical assistance to adults at or below 138% of the federal poverty level regardless whether Congress continues to pay a large portion of the costs. Congress would dictate how much money actually leaves Oklahoma’s treasury. Moreover, federal bureaucrats set the federal poverty level, which would determine Medicaid eligibility. The Oklahoma Legislature would merely be a conduit to finance the federal government’s policy decisions. This is unconstitutional."
• A spokeswoman for Oklahoma Governor Kevin Stitt (R): "If SQ 802 passes, our state agencies will experience deep cuts, because the ballot measure offers no mechanism to pay for it. The governor does not support this unfunded mandate."
• Steve Fair, the District 4 Oklahoma Republican Party chair: "Vote no on SQ 802 for the following reasons: Health care funding should not be a part of the state Constitution; it is an unfunded mandate in that it doesn’t increase taxes to pay for the expansion, it just mandates it; and taxpayers simply can’t afford it."
• Oklahoma State Representative Mark Lepak (R): "Expansion proponents rarely address the enormous costs Oklahomans will shoulder, or how we will pay for it. ... The budget for fiscal year 2021, which begins the day after the SQ 802 vote, had a $1.3 billion hole in it. Prudence suggests a similar budget picture next session. The governor even vetoed his own funding request for SoonerCare 2.0, his less expensive version of Medicaid expansion, because staggering unemployment is swelling the non-expanded Medicaid population at an unaffordable rate."
• Oklahoma State Representative Dean Davis (R): "This is going in our State Constitution, not statute. The State Question ties us to federal law in regards to how Medicaid is handled with the expansion population. This will put the underlying structure of the program in the hands of D.C. instead of Oklahoma."
• Former Oklahoma Governor Frank Keating (R): "What about all that “free” federal money? Here’s the truth: State taxpayers must also come up with hundreds of millions in extra funding for Medicaid expansion—up to $374 million based on the estimated 628,000 able-bodied who will be made eligible. Not only that, but those able-bodied adults would take priority over the truly needy—such as the elderly and disabled—forcing them onto long waiting lists to get the care they need."

Media editorials

See also: 2020 ballot measure media endorsements

Support

• The Muskogee Phoenix: "The reason why Oklahoma has passed up billions in federal health care dollars and allowed an estimated 200,000 of the state's low-income adults go without adequate access to care is because of their disdain for the Affordable Care Act. The [ACA] was a popular target for years by Republicans who vowed to oppose anything the two-term president supported. Those in states that accepted the additional Medicaid funds reaped even more benefits, while states where expansion was rejected saw rural hospitals close and health outcomes stagnate. ... At the very least SQ 802 should be placed on the ballot and presented for a vote. Because voters know what they would get with SQ 802, which is more than what they can get from those who say they plan to offer some alternative, SQ 802 also deserves voters' support."

• Tulsa World: "Oklahoma’s health care outcomes are among the worst in the nation. Diabetes, addictions, cancer and heart disease kill a disproportionate share of the state’s population. It’s a solvable problem, and a big part of that solution is taking advantage of available federal funding to make sure Oklahomans have access to health care. The petition goes around lawmakers. Medicaid expansion would come to the state as described in the Affordable Care Act. The federal government would pay for 90% of the coverage costs of citizens who earn up to 133% of the federal poverty level. No work requirement. No private carriers."

Opposition

• Tulsa Beacon: "Health care is not a right, regardless of what Joe Biden mumbles. You can’t find that in the U.S. Constitution. If it were a right, that would mean that those who work were somehow obligated to pay the medical bills for the able-bodied who chose to not work. Americans are compassionate. If you are sick and can’t pay, you can go to an emergency room and they are compelled by law to treat you and perhaps save your life. ... Oklahoma is facing a critical revenue shortage due to the coronavirus and the slumping energy industry. This is especially not the time to saddle the state budget with federally controlled socialism."

Campaign finance

See also: Campaign finance requirements for Oklahoma ballot measures

	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Support	$5,531,327.45	$303,153.49	$5,834,480.94	$5,531,327.45	$5,834,480.94
Oppose	$211,100.00	$100,083.79	$311,183.79	$173,412.35	$273,496.14
Total	$5,742,427.45	$403,237.28	$6,145,664.73	$5,704,739.80	$6,107,977.08

Yes on State Question 802—Oklahomans Decide Healthcare was registered with the Oklahoma Ethics Commission to support State Question 802. Vote No on 802 Association was registered to oppose State Question 802. The following campaign finance data shows information through December 31, 2020.

Support

Committees in support of State Question 802
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Yes on 802- Oklahomans Decide Healthcare	$5,531,327.45	$303,153.49	$5,834,480.94	$5,531,327.45	$5,834,480.94
Total	$5,531,327.45	$303,153.49	$5,834,480.94	$5,531,327.45	$5,834,480.94

Top donors

The top eight donors gave 94.54% of the contributions to the support campaign.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
Oklahoma Hospital Association	$2,474,750.00	$600.00	$2,475,350.00
St Francis Hospital	$940,000.00	$0.00	$940,000.00
Tulsa Community Foundation	$923,000.00	$0.00	$923,000.00
Stacy Schusterman, chair of Samson Engery Company	$500,000.00	$0.00	$500,000.00
The Fairness Project	$0.00	$250,641.61	$250,641.61

Opposition

Committees in opposition to State Question 802
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Vote No on 802 Association	$211,100.00	$100,083.79	$311,183.79	$173,412.35	$273,496.14
Total	$211,100.00	$100,083.79	$311,183.79	$173,412.35	$273,496.14

Top donors

The top four donors gave 100% of the contributions to the opposition campaign.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
Americans for Prosperity	$200,000.00	$99,849.60	$299,849.60
Jim Antosh	$10,000.00	$0.00	$10,000.00
Nobel Systems, Inc	$500.00	$0.00	$500.00
John Tidwell	$100.00	$234.19	$334.19

Methodology

To read Ballotpedia's methodology for covering ballot measure campaign finance information, click here.

Background

Governor Stitt's Medicaid expansion and SoonerCare 2.0 alternative Medicaid program proposals

Going into the election, Medicaid in Oklahoma (SoonerCare) covered children, pregnant women, disabled adults, and elderly adults. Oklahoma Governor Kevin Stitt (R) had announced a Medicaid expansion plan and an alternative Medicaid program referred to as SoonerCare 2.0. On May 28, 2020, the state withdrew the expansion plan for certain low-income adults that was set to take effect on July 1, 2020. The expansion was withdrawn after Stitt vetoed a bill designed to fund the programs, citing funding concerns amid the coronavirus pandemic. The SoonerCare 2.0 program under the HAO was posted for public comment through June 27, 2020. The following is a timeline of events relating to Governor Stitt's Medicaid expansion and SoonerCare 2.0 alternative Medicaid program proposals.

• January 30, 2020: The Trump Administration announced the Healthy Adult Opportunity (HAO) program, an optional program within Medicare and Medicaid that was designed to give states "new levels of flexibility in the administration and design of their Medicaid programs while providing federal taxpayers with greater budget certainty." On the same day, Oklahoma Governor Kevin Stitt (R) announced his plan to implement an alternative version of Medicaid (SoonerCare 2.0) under the HAO program.

• March 6, 2020: The Oklahoma Health Care Authority submitted a state plan amendment (which would have required approval from the federal Centers for Medicare and Medicaid Services) to expand Medicaid for individuals between the ages of 19 and 64 with incomes at or below 133% of the federal poverty level ($34,846 for a family of four and $16,970 for an individual). The expansion was designed to become effective on July 1, 2020. The state requested an effective date of July 1, 2020.

• April 20, 2020: The Oklahoma Healthcare Authority (OKHCA) submitted a Healthy Adult Opportunity (HAO) demonstration waiver for a program referred to as SoonerCare 2.0, which was designed to become effective on July 1, 2021.

• May 21, 2020: Governor Kevin Stitt (R) vetoed Senate Bill 1046, which would have increased the Supplemental Hospital Offset Payment Program (SHOPP) fee (paid by certain hospitals) in order to fund Stitt's SoonerCare 2.0 plan. Stitt said, "I appreciate the willingness of the Legislature to craft a proposal to fund SoonerCare 2.0. When I announced SoonerCare 2.0, unemployment rates were at 3.2 percent. Due to the current COVID-19 pandemic and uncertainty within energy markets and commodity prices, unemployment rates are predicted to be as high as 14 percent. This will not only increase the number of individuals currently enrolled in Medicaid, but will also increase the number of potential enrollees in the expanded population."

• May 28, 2020: The Oklahoma Health Care Authority submitted a letter to the Centers for Medicare and Medicaid Service (CMS) withdrawing expansion the plan for certain low-income adults that was set to take effect on July 1, 2020. The SoonerCare 2.0 program under the HAO was posted for public comment through June 27, 2020.

State Question 802 vs SoonerCare 2.0

The following chart is a comparison of the medicaid expansion programs as proposed under State Question 802 and SoonerCare 2.0. Click [show] to expand the chart.

State Question 802 vs. SoonerCare 2.0
Provision/issue	State Question 802	SoonerCare 2.0
Statutory/constitutional	Constitutional	Statutory
Effective date	July 1, 2021	July 1, 2021
Program funding mechanisms	Directs the Oklahoma Health Care Authority to "take all actions necessary to maximize federal financial participation in funding medical assistance"; does not establish new or increased taxes; does not charge co-payments or premiums	Paid for 90% by the federal government; charges co-payments and premiums; does not establish new or increased taxes; allows the state to end expansion if the federal government's financial commitments change
Per-person expenditure cap	No	Yes
Co-payments	No (See amendment language: "No greater or additional burdens or restrictions on eligibility or enrollment shall be imposed on persons eligible for medical assistance pursuant to this Article than on any other population eligible for medical assistance under Oklahoma's Medicaid program")	Yes (Up to the 5% out-of-pocket cost-sharing limit)
Monthly premiums	No (See amendment language: "No greater or additional burdens or restrictions on eligibility or enrollment shall be imposed on persons eligible for medical assistance pursuant to this Article than on any other population eligible for medical assistance under Oklahoma's Medicaid program")	Yes ($0, $5, or $10 for individuals or $0, $7.50, or $15 for families)
Work/education requirements	No (See amendment language: "No greater or additional burdens or restrictions on eligibility or enrollment shall be imposed on persons eligible for medical assistance pursuant to this Article than on any other population eligible for medical assistance under Oklahoma's Medicaid program")	Yes (Participants in the expansion population may be required to be employed, enrolled in a continuing education or technical training program, or to participate in community engagement activities)

SoonerCare 2.0 reactions and commentary

Governor Kevin Stitt (R) said, "With SoonerCare 2.0, we will pursue comprehensive reform of Medicaid delivery, made possible due to the unprecedented flexibility and innovation being granted by the Trump administration’s Healthy Adult Opportunity initiative. SoonerCare 2.0 will deliver strong personal-responsibility mechanisms for new enrollees, will target dollars on rural healthcare delivery and substance abuse programs, and transform services to be focused on outcomes and health advancements instead of excessive billing practices." Yes On 802 Campaign Manager Amber England said, "[Governor Stitt] is trying to cap the care that Oklahomans can receive under Medicaid expansion and he’d cost our state billions of dollars when we have a better approach available to us with State Question 802. In fact, the nonpartisan Commonwealth Fund found that Oklahoma would receive 17.2% less federal funding under the governor’s approach than under State Question 802. Without the protections built into State Question 802, we’re betting the health of Oklahomans on the whims of politicians who can restrict the care Oklahomans receive in years to come." When discussing the work requirements under SoonerCare 2.0, the Oklahoma Healthcare Authority wrote, "A large body of research has shown that employed individuals are healthier than those who are not employed. Enhancing employment opportunities for working-age people can improve health status and decrease the overall cost of providing health care. Employment can improve health by increasing social capital, enhancing psychological well-being, providing income and reducing the negative health impacts of economic hardship. Incentivizing employment, pursuit of educational and/or vocational activities and volunteerism promotes all of these objectives." Oklahoma House Speaker Charles McCall (R) said, "Our caucus appreciates Gov. Stitt’s strong leadership working with the Trump administration to bring federal dollars back to Oklahoma. At first glance, the governor’s plan swiftly brings our federal dollars home to help Oklahomans in a far more responsible fashion than the state question. The state question forces the Obamacare federal model upon states, and the Trump-Stitt plan puts states in charge of their own health care and health outcomes." Democratic state representatives Emily Virgin and Forrest Bennett said in a joint statement, "A serious health care plan provides access to health care to all Oklahomans, does so in a way that is equitable to all citizens and is proven to improve health care outcomes. It seems the governor’s plan fails on all three of these points. Under block grants, lawmakers will determine care, not doctors, and unnecessary red tape will limit services amongst the lowest-paid workers in Oklahoma, who also have the highest tax burden."

Medicaid expansion under the ACA

See also: Medicaid and Obamacare

The Affordable Care Act (ACA), also known as Obamacare, was signed into law on March 23, 2010. The ACA provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level, which amounted to $17,236 for individuals in 2019. The law was designed to provide 100 percent of funding to cover the new recipients for the first three years and to cut off federal Medicaid funding to states that chose not to expand coverage. However, the United States Supreme Court ruled in National Federation of Independent Business v. Sebelius (2012) that the federal government could not withhold Medicaid funds from states that chose not to expand eligibility. According to the Kaiser Family Foundation, this ruling had the practical effect of making Medicaid expansion optional for states.

From 2014 to 2016, the federal government covered 100 percent of the costs of state expansion of Medicaid. In 2017, the total cost of expanded coverage that the federal government financed decreased to 95 percent. The ACA was designed to decrease the amount the federal government covers to 94 percent in 2018, 93 percent in 2019, and 90 percent in 2020 and subsequent years.

The Affordable Care Act had not provided tax credits to adults with household incomes less than the federal poverty line because the law had aimed to cover these people under Medicaid. In states that did not expand Medicaid, many of these adults fell into a coverage gap in which they neither qualified for Medicaid nor for federal tax credits to purchase health insurance. As of 2018, around 2.5 million people fell into this coverage gap across the states that did not expand Medicaid.

Adoption of Medicaid expansion under the ACA

As of January 2022, a total of 38 states and Washington, D.C., had expanded or voted to expand Medicaid, while 12 states had not. The map below provides information on Medicaid expansions by state; for states that expanded, hover over the state to view the political affiliation of the governor at the time of expansion.

Medicaid expansion in 2018

In November 2018, voters in Idaho, Montana, Nebraska, and Utah decided ballot initiatives concerning Medicaid expansion and the funding of expanded Medicaid coverage. In January, 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.

The Affordable Care Act, also known as Obamacare, was enacted in March 2010. Between 2013 and 2016, no statewide ballots featured measures related to Obamacare. In 2017, voters in Maine approved a ballot measure to expand 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 an optional provision of Obamacare.

2018 measures:

Measure	Description	Status
Idaho Proposition 2	Expand coverage to 138 percent of the federal poverty line
Montana I-185	Extend expanded coverage and increase tobacco taxes	d
Nebraska Initiative 427	Expand coverage to 138 percent of the federal poverty line	a
Utah Proposition 3	Expand to 138 percent of the federal poverty line and increase sales tax
Oregon Measure 101	Upheld health insurance tax to fund expanded coverage	a

Path to the ballot

See also: Laws governing the initiative process in Oklahoma

The state process

In Oklahoma, the number of signatures required to qualify an initiated constitutional amendment for the ballot is equal to 15 percent of the votes cast for governor in the previous gubernatorial election. Signatures must be submitted 90 days after the initiative is cleared for circulation by the secretary of state. Measures are generally placed on the next general election ballot following signature verification, but the governor may call a special election or place the measure on the primary ballot. If petitioners are targeting a specific election, the secretary of state recommends that signatures be submitted eight months prior to the election; however, they must be submitted a minimum of 60 days before the election to make the ballot.

The requirements to get an initiated constitutional amendment certified for the 2020 ballot:

• Signatures: 177,958 valid signatures were required
• Deadline: Each initiative has its own deadline that is 90 days after it was approved to circulate.

The secretary of state verifies signatures and submits the totals and the vote totals that determine the requirement to the Oklahoma Supreme Court, which makes the final determination of sufficiency. The signature circulation period was set by the secretary of state to begin July 31, 2019, with signatures due by 5:00 p.m. local time on October 28, 2019.

Details about this initiative

• Challenge to the ballot summary: On May 9, 2019, the Oklahoma Council of Public Affairs filed a protest against the ballot summary (gist) of the measure. The council argued that it was legally flawed because it states that Medicaid would be expanded to include adults at or below 133 percent of the federal poverty level "as permitted under the federal Medicaid laws." The OCPA argued, "Because federal law only permits Medicaid expansion for those adults at or below 138 percent of the federal poverty level, this statement is legally inaccurate." The Oklahoma attorney general's office said, “The substance of the petition at issue is legally valid and challenges to its constitutionality must be rejected, but the gist is inaccurate and therefore should be struck. This will allow petitioners to correct the legal flaws in the gist, file a new petition, and circulate it with ample time before the 2020 general election, while also rejecting or avoiding new restrictions proposed by protestants that will permanently burden the right to initiative and referendum." After hearing oral arguments on June 18, 2019, the Oklahoma Supreme Court ruled 6-3 that the gist is clear and accurately informs petition signers of what the amendment intends to do, thereby clearing proponents to move forward with signature gathering.

• Signature submission: Proponents reported submitting 313,000 signatures on October 24, 2019. The Secretary of State's office began a physical signature count on October 30, 2019, which concluded on November 15, 2019.

• Ballot qualification: On April 17, 2020, Oklahoma Governor Kevin Stitt ordered the measure to appear on the June 30 primary ballot rather than the November 3 general election ballot. In 2018, Oklahoma Governor Mary Fallin 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.

Cost of signature collection:
Sponsors of the measure hired FieldWorks LLC to collect signatures for the petition to qualify this measure for the ballot. A total of $1,836,261.73 was spent to collect the 177,958 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $10.32.

How to cast a vote

See also: Voting in Oklahoma

Click "Show" to learn more about voter registration, identification requirements, and poll times in Oklahoma.

How to cast a vote in Oklahoma

The information below covers regular voting policies in the state. Information may have not applied to the election on November 3, 2020, because of temporary changes in response to coronavirus. Click here to read about changes made for the 2020 elections. Poll times In Oklahoma, all polls are open from 7 a.m. to 7 p.m. Central Time. An individual who is in line at the time polls close must be allowed to vote. Registration requirements Check your voter registration status here. To vote in Oklahoma, one must be at least 18 years old, a United States citizen, and a resident of Oklahoma. The deadline for registration is 25 days prior to the election. “ You can fill out a Voter Registration Application using the OK Voter Portal "wizard." (Be sure to print, sign, and mail or hand-deliver the application to your County Election Board to complete the process.) Voter registration applications are also available at your County Election Board, most tag agencies, post offices, and libraries and can be downloaded from the State Election Board website.. ” —Oklahoma State Election Board Once an applicant has been successfully registered, the county election board will mail him or her a voter identification card. Automatic registration Oklahoma does not practice automatic voter registration. Online registration See also: Online voter registration Oklahoma has implemented an online voter registration system. Residents can register to vote by visiting this website. Same-day registration Oklahoma does not allow same-day voter registration. Residency requirements To register to vote in Oklahoma, you must be a resident of the state. Verification of citizenship See also: Laws permitting noncitizens to vote in the United States Oklahoma does not require proof of citizenship for voter registration. An individual must attest that they are a U.S. citizen when registering to vote. According to the state's voter registration application, a voter who submits false information commits a "felony punishable by not more than five years in prison, by a fine of not more than $50,000, or both." All 49 states with voter registration systems require applicants to declare that they are U.S. citizens in order to register to vote in state and federal elections, under penalty of perjury or other punishment. Seven states — Alabama, Arizona, Georgia, Kansas, Louisiana, New Hampshire, and Wyoming — have laws requiring verification of citizenship at the time of voter registration, whether in effect or not. In three states — California, Maryland, and Vermont — at least one local jurisdiction allows noncitizens to vote in some local elections. Noncitizens registering to vote in those elections must complete a voter registration application provided by the local jurisdiction and are not eligible to register as state or federal voters. Verifying your registration The Oklahoma State Election Board allows residents to check their voter registration status online by visiting this website. Voter ID requirements Oklahoma requires voters to present identification while voting. Generally, voters are required to present a photo ID, but there is an exception to this requirement. Valid forms of identification include government-issued photo IDs and county election board voter identification cards (which do not include photographs). Voters can present a document issued by the United States government, the State of Oklahoma, or a federally recognized tribal government. The document must include the following information: Name Photograph Expiration date that is after the date of the election

See also

2020 measures

• 2020 ballot measures
• Healthcare on the ballot

Oklahoma

• Oklahoma ballot measures
• Oklahoma ballot measure laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls

External links

• State Question 802 full text

Support

• Oklahomans Decide Healthcare- Yes on 802 campaign website
• Oklahomans Decide Healthcare- Yes on 802 Facebook page
• Oklahomans Decide Healthcare- Yes on 802 Twitter page

Opposition

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