Oklahoma is one of the reddest states in the country, yet it just voted for Medicaid expansion, a key element of Obamacare. Government may be broken, but democracy is making itself heard.
In just under 90 days, 313,000 Oklahomans, twice the number needed, signed petitions to gain a place on the ballot to approve extending health care through Medicaid to more than 200,000 low-income Oklahomans. It passed by a whisker—with 50.5 percent support.
Next up is Missouri, another red state, where voters head to the polls on Aug. 4 to decide for themselves whether they want health care for 230,000 uninsured people in their state despite the opposition of the state’s Republican politicians.
“The level of enthusiasm is historic,” says Jonathan Schleifer, executive director of the Fairness Project, the activist group behind the ballot access strategy. Oklahoma is their fifth win on Medicaid expansion, joining Maine, Utah, Idaho and Nebraska, all but Maine dark-red states where governors and legislatures were forced by the voters to expand Medicaid.
“Our work is not the cynical politics of Twitter, but the politics of what’s possible when you ask people what they want for themselves and their families,” Schleifer told The Daily Beast. “We expect the same momentum will carry us through Missouri,” where the state’s attorney general is part of the lawsuit before the Supreme Court challenging the constitutionality of the Affordable Care Act. Missouri Governor Michael Parson, a Republican, opposes the ballot initiative, saying it would be too costly for his state to expand Medicaid.
The state would have to pick up 10 percent of the tab while the federal government pays 90 percent, a pretty good deal in most people’s estimation, especially in the middle of a pandemic.
Jack Cardetti, spokesman for the ballot initiative campaign in Missouri, told The Daily Beast that they started collecting signatures early last fall. “We got 350,000 from every corner of the state,” way more than the required 170,000 to place a constitutional amendment on the ballot. Missouri has seen 15 hospitals close since 2014, 10 of them in the rural parts of the state. The hospital closures were a big draw. “What the pandemic has shown us is the ability to get care in your own community is vital,” he says. “If you’re having a heart attack, you don’t want to be driving an extra 50 to 75 miles.”
Groups like the Chamber of Commerce and the AFL-CIO that normally are on opposite sides joined forces. In rural areas, the hospital is typically the biggest employer, so Medicaid expansion is an economic lifeline that saves jobs as well as a health necessity.
Activists have been on the ground fighting for health care for a long time, and for Medicaid expansion since the Supreme Court ruled in 2012 it was optional for states. Amber Englund, who ran the ballot access campaign in Oklahoma, recalled her marathon T-shirt in 2008 that said, “Thousands of Oklahomans go without health care. We run to be their voice.” The ballot access campaign set a record in the state with those 313,000 signatures. “We knew then the campaign was special,” she told the Daily Beast. “Thousands of Oklahomans had the courage to stand up and do something politicians didn’t have the courage to do.”
The Fairness Project went about this work in a very practical way, says Shleifer, targeting red-leaning states that allowed ballot access, and where they would have the time and resources to do the grassroots organizing. Florida, Mississippi, South Dakota, and Wyoming are on their To-Do list for 2022, while understanding that a potential change in power in Washington could have an impact.
In Washington, the Democratic-controlled House last week passed a bill designed to incentivize states to accept Medicaid expansion by cutting federal funding for their regular Medicaid program if they blocked expansion. The Republican Senate won’t take it up, but that could change if Democrats win the Senate and the White House, as some polls suggest is at least an even bet. Currently 38 states and the District of Columbia have adopted the expansion; 13 have not.
“There is a massive disconnect between Trump and other Republicans who are completely out of synch with their voters,” says Maura Calsyn, managing director of health policy at the Center for American Progress. “Even after voters vote to expand Medicaid, state officials are still reluctant to do so.”
Like everyone active in the health-care policy world, Calsyn worries about what might happen when the Supreme Court considers the challenge brought by Republican attorneys general in red states to overturn the entire Affordable Care Act because the individual mandate to require health insurance has been thrown out. “I am hopeful that (Chief Justice) John Roberts recognizes this latest case as really one without a whole lot of legal merit,” she told the Daily Beast.
A number of conservative law professors and commentators have criticized the challenge that originated in a Texas lawsuit as “implausible,” “hard to justify,” “surprisingly weak” and even “ridiculous,” but it’s hard to predict what a conservative leaning Court will do in the midst of what could be a dramatically changed political climate.
Oral arguments could be scheduled before the November election, but a ruling is unlikely before next year. “You have to be worried about it, it’s a real threat,” says Leslie Dach, who chairs the advocacy group Protect Our Care. “It’s in John Roberts’ hands.” If anything, the uncertainty surrounding Obamacare makes anything health care-related the most important issue going into the November election. In polling done by Democratic pollster Geoff Garin, concern about the coronavirus and health care dwarf concerns about the economy 2-to-1. When people are asked if it’s worth opening the economy soon if it means that 200,000 people might die, 65 percent say no.
While Americans in red states want health care, the Trump administration doubles down on its opposition to Obamacare, siding with the Republican attorneys general seeking to overturn the Affordable Care Act. “They’re doing this at their own peril. They know better. They lost the House over this,” says Dach. “Here they are in this lawsuit that would take health care away from 23 million Americans, on top of 27 million who lost health care because they lost their jobs.”
Add to that the 135 million with preexisting conditions who would no longer be protected. Every American with coronavirus has a preexisting condition. “Why would you do that in the middle of a pandemic? It makes no sense politically or with any sense of decency,” says Dach.
Based on what we’ve seen in Oklahoma and potentially in Missouri, the voters, when given the chance, will have the last word.