Oklahoma voters to decide Medicaid expansion via citizen initiative
Fifty-two statewide ballot measures have been certified for 2020 in 24 states so far, with seven certified in the past month. State legislatures referred two of those measures and the other five are citizen initiatives. By this date in 2018, 37 measures had been certified, while states had certified 52 measures at this point in 2016.
One measure we’re watching is whether Oklahoma voters will decide to expand Medicaid under the Affordable Care Act (ACA). State Question 802 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.
Medicaid is a government program that provides medical insurance to groups of people with income below a certain level and individuals with disabilities. The ACA—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 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.
The federal government financed 94% of the costs of state Medicaid expansion in 2018. For 2020 and subsequent years, the federal government is set to cover 90% of the costs.
Oklahoma is the sixth state to certify a ballot measure concerning Medicaid expansion. Voters in Maine approved the first citizen initiative to implement expanded Medicaid in 2017. The measure expanded Medicaid to persons under the age of 65 and with incomes equal to or below 138 percent of the federal poverty line.
Voters in Oregon, Idaho, Montana, Nebraska, and Utah decided Medicaid expansion initiatives in 2018 (Oregon’s vote concerned funding; the state’s legislature had previously approved Medicaid expansion). Voters in all states passed the initiatives except Montana.
A total of 36 states and Washington, D.C., have expanded or voted to expand Medicaid, while 14 states have not. The map below provides information on Medicaid expansions by state.
 Oklahoma Gov. Kevin Stitt (R) will determine whether the measure will appear on the June 30 primary ballot or the Nov. 3 general election ballot.
From 1996 to 2018, 80 measures have appeared on Oklahoma's statewide ballot. Voters approved 62 (or 78%) of them. Between 1996 and 2018, an average of seven measures appeared on the ballot each even-numbered year in Oklahoma.
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