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Red states try everything but straightforward Medicaid expansion — and the latest is Oklahoma

"Oklahoma Plan" would use Medicaid dollars to pay for a premium-assistance plan offered on the state's Obamacare marketplace.

State Capitol of Oklahoma in Oklahoma City.
State Capitol of Oklahoma in Oklahoma City.

Red states that opposed the Affordable Care Act (ACA) during Barack Obama’s presidency are more likely to implement the 2010 law now, under Donald Trump, albeit with limitations — and Oklahoma is a fine example of this phenomenon.

To the surprise of Obamacare wonks, Oklahoma lawmakers in a key committee passed a Medicaid expansion bill this week — sort of. The bill directs the Oklahoma Health Care Authority to create a “Oklahoma Plan” within the state’s ACA marketplace. Residents making up to 138 percent of poverty (an eligibility standard set by Obamacare’s Medicaid expansion) would be able to purchase these subsidized, private plans. If passed, Oklahoma will ask the federal government if the state can use Medicaid expansion dollars for the plan.

“We have an administration in [Washington] D.C. that has indicated it is willing to sign off on something like this instead of a Medicaid expansion program,” state Sen. Greg McCortney (R), the bill’s sponsor, told the News & Observer.

“The Oklahoma Plan, what it is, is being able to use private insurance to take care of and manage the healthcare costs for our population so, instead of asking the state agency to do that, and state agencies traditionally don’t do that, well, we’re going to go out to the private market and let private companies do that,” McCortney told News 4.

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Actually, dozens of states have implemented the ACA’s Medicaid expansion the traditional way. The success of the program is manifold, from lowering the uninsured rate, to increasing financial security by reducing medical debt. There’s even growing research that suggests residents who live in Medicaid expansion states are more likely to vote in the next election.

Oklahoma’s plan is actually similar to Arkansas’ approach to Medicaid expansion, approved under the Obama administration. Arkansas’ Medicaid expansion hybrid, locally referred to as the Private Option, lets residents making up to 138 percent of poverty purchase private plans and the state uses Medicaid dollars to pay the premium. A study conducted by The Commonwealth Fund called Arkansas’ approach to Medicaid expansion successful, as compared to states (namely, Texas) that haven’t expanded. However, critics of the private option maintain it is less cost-effective and more complicated for enrollees than traditional Medicaid expansion.

What distinguishes Oklahoma’s approach to Medicaid expansion is it also includes work requirements. The Obama administration wouldn’t approve work requirements, but Arkansas officials eventually asked the Trump administration to condition Medicaid eligibility on reported work in 2018. So far, more than 18,000 enrollees have lost coverage for failing to report work activities — a requirement enrollees could only fulfill online until mid-December.

Oklahoma is not the only state trying to get Medicaid expansion dollars without implementing the policy straightforward. Utah Gov. Gary Herbert (R) signed a bill last week that would cap enrollment and add work requirements to Medicaid expansion, pending federal approval, despite the fact that residents voted in favor of a straightforward expansion in November. Arkansas and Massachusetts are also asking the federal government if they can change its way of expanding Medicaid through partial expansion of eligibility and still receive the full ACA funds.